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Is surgery the right option to correct my deviated septum?

The question: I find that I'm always breathing through my mouth and have been told I may have a deviated septum. I've heard the surgery is not always effective. Is it worth having to correct the problem?

The answer: On occasion, we may breathe through our mouths because we're running fast or have a stuffed nose from a cold or flu. However, long-term mouth-breathing can have potentially negative consequences on your health.

When you breathe, the air that passes through the nasal passages is warmed and moisturized. Any bacteria or viruses present in the air are filtered and prevented entry by the defence mechanisms of the nasal passages. With mouth-breathing, these protective functions are not present and the air that enters the body is cool and unfiltered.

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Mouth-breathing can occur for a number of reasons, but one of the most common culprits is obstruction of the passages caused by a deviated nasal septum. The septum is the wall that runs down the centre of the nose and divides it into two chambers. It is part cartilage and part bone and helps to support the structure of the nose and airflow through it. It is considered deviated when the bone or cartilage is not straight.

Most of us do not have a perfectly straight nasal septum, but a small deviation won't generally cause symptoms. If, however, the septum is deviated too far to one side or the other, it can obstruct the movement of air through the nasal passages and prevent the draining of mucous from the sinuses and nose.

For some, the alteration in airflow through the nose can interfere with exercising to full capacity. In more severe situations, it can cause obstructive sleep apnea, a condition that can cause significant impairment of sleep quality, daytime sleepiness, low energy and has long-term implications on cardiovascular health.

If you have a deviated septum, it may be because you were simply born with it or as in many cases, it occurred after some form of trauma such as a broken nose.

Treatment depends on the extent of the deviation, but also the severity of symptoms. For mild symptoms such as occasional snoring, it's best to start with conservative measures such as saline nasal rinses or medicated sprays that can help to decongest and clear the passages. For nighttime symptoms, nasal strips can help open the passages.

If the symptoms are more severe such as chronic infections or sleep apnea, as it sounds like it may be in your case, surgery can straighten the deviated septum. The procedure involves cutting away part of the septum that is deviated. Several studies done on the effectiveness of surgery to correct septal deviation have shown significant improvement in nasal airflow and quality of life for the majority of patients. While most seem to have a positive outcome, it is important to note that sometimes symptoms may persist for some.

As with any surgical procedure, there are risks involved that need to be considered. If you're still having symptoms after trying the non-surgical options, discuss surgery with your doctor to see if it is the right choice for you.

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Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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