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Suffering from nasal deviated septum. Breathing difficulty, nostril closed leading to depression. What can be done?

Aug 2013
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Answered by

ENT Specialist
Practicing since : 1996
Answered : 1025 Questions
Hi I am 34, female suffering from nasal deviated septum. For the past 3 months I develop sudden sensitivity to almost everything ( mainly odour, cold air, dust) in my right nostril. My left nostril is almost closed due to the deviated septum and i hardly breath through it. It was not so much a problem until lately where my breathing through my right nostril is too sensitive like the air and odour are going in without filter and too much and I have breathing difficulty. My whole body feels weak and leads to depression all the time. It makes me so uncomfortable being outdoor. ENT diagnosed enlarged turbine in right nostril and given antihistamine and nasal spray but doesn't seem like helping. I am also suffering form GERD due to mild hiatal hernia and this developed at the same time but not sure if this related to my nose problem. My sensitivity to odours really putting me into depressions. Please advise the possible cause and if this problem if is permanent
Posted Wed, 9 Oct 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sriram Nathan 35 minutes later
hello XXXXX and welcome to XXXXXXX

I am Dr Sriram Nathan an ENT surgeon who has treated thousands of such nose problems such as the one you are having.

I have understood that you have two chief problems. One is a deviated nasal septum and another is reflux, let us try to go through them one by one

As far as your deviated septum is concerned, since it has reached a point where you have complete block and also since the turbinates have also enlarged which has worsened your symptoms then it is imperative that you go on to a surgical procedure called the septoplasty to correct your septum. This is a failry simple procedure in good hands and I have performed more than thousand of such procedure with very satisfying results.

The procedure is done within the nose with no scar and requires a rest for around a week. It will definitely cure your nose block and all the other symptoms you mentioned of the opposite non blocked nostril also! This is since you have nose block the opposite non blocked nose has to over work and is now showing signs of strain. When the block is corrected by surgery then your symptoms in the nasal area will disappear.

Also note that at this stage no medication will give you much relief since the block is more.

Get a good ENT consultant to perform the same and you may ask me the details if you need to undergo the same

Regarding your reflux, you need to understand that reflux treatment requires both medication and lifestyle modification. Take proper anti reflux medication in consultation with your doctor and follow them properly.
The lifestyle modifications include things like, avoiding spicy and oily food, perform good exercise, take more green leafy vegetable to name a few.

Rest assured both your problems are easily treatable so do not worry. When these two primary problems get treated then am sure your depression and general health will also become much much better.

I will be happy to assist you in any more doubts which you may have


Dr Sriram Nathan
Above answer was peer-reviewed by
Follow-up: Suffering from nasal deviated septum. Breathing difficulty, nostril closed leading to depression. What can be done? 19 minutes later
Thank you for your prompt reply Dr. I have fear of going for surgery knowing that it may not fix the problem sometimes and the side effects. I have seen few ENT and some suggesting for surgery and some saying its not so critical. May I know if the cause of enlarged turbinates on my right nostrils and can it shrink naturally by time or surgery needed to reduce that too together with deviated septum. And please explain the 'strain' that you have mentioned, does that include the odour sensitivity and if this is common? Any alternative way to overcome this problem instead of surgery. And if surgery is the only way, please advise the possible side effects.
Answered by Dr. Sriram Nathan 18 minutes later
Brief Answer:
please do not worry...

Detailed Answer:

I am getting to know you are quite tensed but do not worry. Let me try to explain and help you:

The strain which I mentioned includes the over sensitivity which you mentioned like mainly to odour, cold air, dust. This happened because the non blocked nose started receiving more air flow and hence had to work harder because of the increased load. This makes them more sensitive as I mentioned before.

This overload is also the cause of your enlarged turbinate which are similar to muscles which become big because of exercise.

In the initial stage of this problem medications such as antihistamines and nasal spray do offer some partial relief although the relief is never complete and not permanent. I advised surgery for you since you mentioned that these do not offer you any relief. This means that the turbinates, the septum and the block as such has reached a point where you no longer have any relief with medication. Hence surgery is the only alternative which can give you a permanent and complete relief.

If you had only turbinate swelling then I would have suggested the multitudes of turbinate reduction mini-surgeries available. But in your case coupled with the deviated septum, I would definitely suggest surgery as I can assure you that the relief is good and permanent.

Any surgery especially done under general anesthesia (such as this one) has risks and side effects which even you will have. These include anesthesia risk, risk of bleeding, risk of swelling and non healing of the wound to name a few. In the hands of a novice you may not get relief from nose block and you may even have worsening of symptoms. Your nose shape may also change and get deformed. But believe me these are only rarest of rare cases and for your information only and these are only from literature.
But you must know this that your surgery is a minor one and in the hands of an expert it is usually not associated with much risk. This I can say with confidence of my more than thousand cases done by me.

Just remember that when someone crosses the road, there is always a risk of accident however small right? But that must not stop you from crossing the road all the same!

Go with my assurance and confidence for surgery and you will be symptom free!

Take care and you can ask any more doubts if you wish and I will be more than happy to answer them.


Dr Sriram Nathan
Above answer was peer-reviewed by
Follow-up: Suffering from nasal deviated septum. Breathing difficulty, nostril closed leading to depression. What can be done? 21 minutes later
Thank you. From my understanding, septoplasty is suggested together with turbine reduction. How if only septoplasty is performed, will it be able to reduce turbinate naturally. How soon should I go for this surgery? will it got worsen by time.
Please explain if the correction of deviated septum could be able to bring back the septum to straight line, meaning that the wider space of opposite non blocked nose can be returned back to normal or it will still stay wide permanently allowing air to flow more and keep the sensitiveness to continue.
Answered by Dr. Sriram Nathan 19 minutes later
Brief Answer:
Septal surgery

Detailed Answer:
Hello XXXXX,

Let me try to clear your doubts one by one again!

Septoplasty in the initial phase could have been done alone without any turbinate reduction. But in your case the turbinates have become so enlarged that you have developed sensitivity and also they do not respond much to medications.

Considering these I will definitely advice both septal correction and also turbinate reduction as it is just a minor extension of the septal surgery and will yield very good results later.

Septum correction will definitely make the septum straight and make the block better. You must however remember that the straightening of the septum may not be so accurate that you can hold a scale to define it!
The operating surgeon will usually assess the bend parts and remove or repair the parts which are causing the block. You must remember that in septal surgery the block is corrected and not only the shape of the septum.

In a properly performed septoplasty and turbinate reduction surgery, both the cavities will get a fairly equal (no one can give an exact equal percentage) amount of air and your sensitivity will definitely reduce. The opposite side will definitely become better and your symptoms will definitely improve.

Go for both the procedure and in fact if you have headache or heaviness of head then you can even ask the surgeon to analyze if sinus surgery is needed or not as it is just another extension. I am mentioning this because since anyway you are under anesthesia, I would usually try to clear out the sinuses also.

Take care and get back to me anytime


Dr Sriram Nathan
Above answer was peer-reviewed by
Follow-up: Suffering from nasal deviated septum. Breathing difficulty, nostril closed leading to depression. What can be done? 22 minutes later
Thank you. Meaning to say, enlarged turbinate can only be reduced with surgery. Please explain, sometime when we have cold/ flu, our turbinate used to get enlarged and give discomforts but it reduces once we recovered. Correct me if I am wrong. In this case, removing a part of turbinate may disturbs it functions as its very important part in nose. Can I just have septoplasty without turbine reduction, hoping the correction will bring down the turbine size. Some side effects of turbine reduction is said to be empty nose syndrome.

From my understanding turbinate is important for blood supply in nose. Please explain how enlargement of turbine could cause sensitiveness escpecially towards odour. Thankyou
Answered by Dr. Sriram Nathan 16 minutes later
Brief Answer:
Not removal but reduction

Detailed Answer:
Hello again XXXXX,

I am happy that you are well informed and you have asked such intelligent questions. Now lets go through the answers one by one...

When the turbinates enlarge during infections, they usually go back to the original size when the infections get controlled. This is a temporary phenomenon. But when this enlargement is caused due to a permanent problem like the deviated septum then it is unlikely to go back to the normal state especially if the block is there for a long time. In your case since the medications do not help, the normalization of the turbinate will not happen.

Even if you just correct the septum, you may still have nose block because of the turbinates and the whole surgery will be a bother for you and your surgeon.

The most important turbinate of the nose is the middle turbinate which is never touched by any surgeon during septoplasty or turbinate surgery. The turbinate enlargement and correction we are mentioning about is of the inferior turbinate which can be removed or corrected without any problems whatsoever!

Empty nose syndrome is caused when we remove all the turbinates on both sides including middle and inferior! This is a very radical surgery and will definitely not apply to you!! I have suggested turbinate reduction of one side of inferior turbinate only. So you have nothing to worry about.

Finally, the inferior turbinate will only be trimmed and not completely removed. Also the mucusal layer over the turbinate will be kept intact and only the bony part which is causing the block will be trimmed or removed. So no worries there also!

The nose gets blood supply independent of the turbinate, what you meant is that the turbinate gets a lot of blood supply. This will have no bearing on the state of the nose after surgery. The nose will continue to get good blood supply irrespective of what we do to the turbinates.

Having said all these, though I would definitely recommend turbinate reduction along with septal correction in most of my patients, it is not a cent per cent rule. Every case is different and needs to be addressed differently. The final decision of whether to operate the turbinates will have to be taken by your ENT surgeon who will assess the block caused by the turbinates and decide on the course of surgery. I am just assuring you that both these procedures are safe and commonly done. Of the close to thousand cases I would have performed for nose block, around eighty percentage I have done both septal correction and turbinate reduction and around twenty only septal correction.

Hope your doubts are getting better

Any more you are always welcome


Dr Sriram Nathan
Above answer was peer-reviewed by
Follow-up: Suffering from nasal deviated septum. Breathing difficulty, nostril closed leading to depression. What can be done? 38 minutes later
Getting clearer with what's happening inside my nose now. So, the enlarged turbine in my right nostril is not due to infection but overload function which only can be repaired with surgery. I understand the reduction will avoid nose blockage but just for your info, even with it, i still could breath in a lot of air where its not blocking my nose, do you think reduction is necessary in this case ( where its not blocking the right nostril at all). Or maybe the reduction has other benefits like will reduce the sensitiveness. But as far as I concern the correction of septum is already helping in reducing sensitiveness as the air flow is more balanced in both nostrils. I may sound to fussy about this, just wants to be very clear before going into surgery.
Answered by Dr. Sriram Nathan 10 minutes later
Brief Answer:
Deciding on case to case basis only

Detailed Answer:
Hello again XXXXX,

Your intelligence and inquisitiveness is endearing...

Let me go over some points to explain a little more:

- The flow of air in the body is automatic and is not done voluntarily! Whether you have the block or not, the distribution of air will be decided by your autonomic mechanism of the body even if you breath harder!

- Our body has a mechanism called the nasal cycle which ensures that one nostril gets partially blocked automatically while the other works. This last for some time and the cycle alternates. So both the nostrils get work and rest and if the septum is central and turbinates are not enlarged, this work and rest is made more equal to both!

- Even a perfect septum cannot reverse the turbinate enlargement because the tissues have reached a point of no return as we call it and they have to be addressed by the surgeon.

- I am mentioning this to you again that whether to reduce the turbinate or not will be decided by the surgeon who is operating on a case to case basis only. If the surgeon feels on the table that the block can only be improved by turbinate reduction then it is better to go ahead an do the same. You may get a rough picture in the CT and endoscopy also which can help the surgeon make this plan before surgery and inform you of the same.

Like I mentioned before, almost eighty percent if my nose block patients who were posted for septoplasty needed turbinate surgery also.

Hope it getting a little more clearer now


Dr Sriram Nathan
Above answer was peer-reviewed by
Follow-up: Suffering from nasal deviated septum. Breathing difficulty, nostril closed leading to depression. What can be done? 40 hours later
Hi Dr,

I have been trying to post an attachment of my nose CT scan for you to have clearer picture but failed. Please advise. I have attached one report in my profile and not sure if you could access that.
Answered by Dr. Sriram Nathan 4 minutes later
Brief Answer:
not got the report

Detailed Answer:
Hello and welcome back!

I am not able to view your report

You may try sending the same again and I shall definitely get back to you


Dr Sriram Nathan
Above answer was peer-reviewed by
Follow-up: Suffering from nasal deviated septum. Breathing difficulty, nostril closed leading to depression. What can be done? 1 hour later
Please send this attachement to Dr Sriram XXXXXXX or update in my profile.
Answered by Dr. Sriram Nathan 31 minutes later
Brief Answer:
need more images or report

Detailed Answer:
Hello XXXXX,

I know it is very difficult for you to send the reports like this but you need to send me more images as what you have sent is called the axial sections which are not much useful for FESS surgeons.
Although I can see that you have deviated septum and enlarged turbinates, I cannot get a clearer picture until I see a section of the film called the CORONAL section.

Alternatively, if you have the physical report then you may just type what is mentioned in BOLD letters or in highlighted print and sent them to me.

Nevertheless some things are clear,

You have deviated nasal septum so you need to undergo septoplasty
You have enlarged turbinates but how much enlarged it has to be seen in coronal images and on the table to make a decision on the turbinate reduction surgery
There is no clear image which suggests that you have sinusitis, so I will wait for the coronal images or the report to make a decision on that

take care


Dr Sriram Nathan
Above answer was peer-reviewed by
Follow-up: Suffering from nasal deviated septum. Breathing difficulty, nostril closed leading to depression. What can be done? 1 hour later

I don't have any more pictures, in the report it says sinus is clear because this is actually a brain CT. I have to go for face CT in detail I guess.

Anyway dr, i have other problem as well and hope could get some answers from you. I have diagnosed with mild to moderate hiatal hernia. The symptoms such as bloating, continuous hunger, chest pressure and difficulty sleeping really depressing me. I am on ayurvedic medicines now which helps me little on acid reflux. All i want to clarify dr, i am worried that i am suffering with serious problem. Couldn't sleep and morning feels so horrible and days passing by with a lot of tears. I cant accept that i am suddenly down with a lot of health problems. More than my nose, i am struggling with my stomach. Please advise, dr if this hiatal hernia will ruin my life as i feel the whole left part of my chest is pushed congested sometimes. will it damage the heart and lungs.
Answered by Dr. Sriram Nathan 18 minutes later
Brief Answer:
No need to worry

Detailed Answer:
Hello XXXXX,

Since the report says the sinuses are clear then you have nothing to worry about the sinuses although I am sure your doctor will take a CT study of the sinuses before he takes you up for surgery.

If you do take the study you may share the report with me though I have explained what we can expect so do not worry.

I have also understood your concern about your reflux problem and how frustrating it can be!

You should understand that reflux treatment involves both medications and more importantly lifestyle modifications. While medications can offer you good temporary relief, the lifestyle modifications give you a permanent relief which takes times to achieve.

Coming to your treatment as such:
1. Continue the anti relux medications in proper dosage as advised by your doctor (you may send me a list if you have any doubt regarding the same)
2. Start a multivitamin tablet like Zincovit twice daily for two weeks after food for two weeks and then once daily after food for one month or so. Your doctor will know about this.
3. Avoid anything which is spicy, Oily and high flavored
4. Take lots of green leafy vegetables in any form like salad, soup, side or main course even if it tastes bland or salty.
5. Take an exercise regimen to achieve and maintain your ideal weight. You should remember that even weight loss can cause or aggravate reflux.

Wait for at least ONE MONTH after you do the above religiously before you panic, as reflux take time to manage.

Reflux has become a way of life because of the stressful living so you have absolutely nothing to worry about. Even hiatus hernia is very common and you can easily manage by diet and medications.

Although reflux can cause many problems, in the ground level if you have a good control with medications and lifestyle modifications you can have a very comfortable life and avoid any complications.

Do not think much about this and further increase your stress which will further aggravate the reflux!

All said and done you must definitely bring your reflux to a control before you embark on any surgery of the nose.

If you have any more doubts you may ask


Dr Sriram Nathan
Above answer was peer-reviewed by
Follow-up: Suffering from nasal deviated septum. Breathing difficulty, nostril closed leading to depression. What can be done? 13 minutes later
please explain about hiatus hernia, the trouble is more than acid reflux. Is it serious , can it be cured. I am concern about my pressure on left chest, where I feel my lungs and heart are pushed, pinching left arms and my back. My dr here saying its mild to moderate, no need for surgery but the symptoms are very depressing. I am on yoga and cycling and my weight has gone down 3 kg in few weeks due to lack of sleep and no appetite for food. 'Hiatal hernia' is it serious as it sounds.. I am kind of traumatized reading a lot about it, as it sounds like very complicated problem.. I feel my stomach is at my chest, not sure how I got it. I wish it can be reversed.
Answered by Dr. Sriram Nathan 23 minutes later
Brief Answer:
Nothing to worry about

Detailed Answer:
Hello XXXXX,

Hiatus hernia refers to the fact that a amount of herniation has occurred of the stomach into diaphragm or chest. This will explain your feeling of heaviness in the chest.

Although when you search on the net you will will terrifying images and definitions, as far as the hernia due to reflux is concerned you have nothing to worry about as it is a small problem. And if you have good control on your reflux problem then it will not invade into your chest so do not worry.

It is usually caused due to increased reflux, or a lax lower sphincter or the food pipe and weight gain. So you can very well understand that it can be controlled and even reversed if you control your reflux and maintain an ideal weight like i mentioned earlier.

Furthermore the mild and moderate variety needs no treatment as such and gets controlled with conservative methods only. Although there are many surgeries for hernia, in your case it is not necessary.

Have a good control of your diet and maintain an ideal weight and the hernia will become better.

Take care and hope your doubts are clear


Dr Sriram Nathan
Above answer was peer-reviewed by
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