What to do for a 60-year-old female with nasal septal deviation to the left seen on MRI (Magnetic Resonance Imaging) of the brain?

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Last updated: June 19, 2025 • View editorial policy

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From the Guidelines

For a 60-year-old female with nasal septal deviation to the left seen on MRI of the brain, referral to an otolaryngologist (ENT specialist) is recommended for proper evaluation and consideration of treatment options such as septoplasty if symptoms significantly impact quality of life. The presence of nasal septal deviation is common, with approximately 80% of the general population having an off-center nasal septum, and about 26% of patients with nasal obstruction having a clinically significant deviated nasal septum 1. If the septal deviation is asymptomatic and was simply an incidental finding on the MRI, no immediate treatment may be necessary. However, if she experiences symptoms like nasal obstruction, recurrent sinusitis, nosebleeds, or sleep disturbances, treatment options should be considered.

Initial Management

Conservative management may include:

  • Saline nasal sprays (0.9% sodium chloride solution, 1-2 sprays per nostril 2-4 times daily) to moisturize nasal passages
  • Nasal steroid sprays like fluticasone propionate (50 mcg, 1-2 sprays per nostril daily) to reduce inflammation, as these can help alleviate symptoms associated with nasal septal deviation and turbinate hypertrophy 1.

Surgical Consideration

For significant symptoms affecting quality of life, surgical correction through septoplasty may be recommended by the ENT specialist. Septoplasty is currently the preferred procedure for correcting a deviated septum, as it reshapes, repositions, or recontours the cartilage, with as many as 77% of patients achieving subjective improvement 1. The decision for surgery depends on symptom severity, not merely the presence of deviation. Endoscopic septoplasty is replacing traditional septoplasty in many clinical settings and may offer a less invasive option for patients requiring surgical intervention 1.

Additional Considerations

Nasal septal deviation often develops from previous trauma or natural growth patterns, and the key consideration is whether the anatomical finding correlates with clinical symptoms that warrant intervention. The surgeon must make a careful preoperative assessment and attempt to differentiate between physiological and pathological septal deviation, considering all factors that may be contributing to nasal obstruction 1. Inferior turbinate reduction surgery may also be considered, especially if turbinate hypertrophy is contributing to the patient's symptoms, although the long-term benefits of this procedure can vary 1.

From the Research

Nasal Septal Deviation Diagnosis and Treatment

  • The diagnosis of nasal septal deviation can be made through clinical assessment, and imaging techniques such as MRI or CT scans may be used to classify and assess the severity of the deviation 2.
  • A 60-year-old female with nasal septal deviation to the left seen on MRI of the brain may be experiencing symptoms such as nasal obstruction, headache, or rhinosinusitis, which are common clinical presentations of nasal septal deviation 2.

Treatment Options

  • Surgical correction, specifically septoplasty, is a common treatment option for nasal septal deviation, with high satisfaction levels and low complication rates 2, 3.
  • Clinical assessment at initial presentation can accurately predict which patients will need septoplasty, with a sensitivity of 86.9% and specificity of 91.8% 3.
  • Early interventional management of nasal septal deviation, even in infancy, can prevent long-term complications and the need for septoplasty surgery later in life 4.

Potential Complications

  • Complications of nasal septal corrective surgery can include septal perforation, adhesions, recurrence of symptoms or deformity, and saddle nose deformity, with an overall incidence of 21% 5.
  • The type of procedure performed can affect the risk of complications, with classical submucosal resection having a higher incidence of complications compared to septoplasty 5.

Recommendations

  • A thorough clinical assessment and evaluation of the patient's symptoms and medical history are necessary to determine the best course of treatment for nasal septal deviation 2, 3.
  • Imaging techniques such as CT scans or MRI may be used to assess the severity of the deviation and guide treatment decisions 2.
  • Septoplasty or other surgical procedures may be recommended for patients with significant symptoms or complications related to nasal septal deviation 2, 3.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Nasal septal deviation: effective intervention and long term follow-up.

International journal of pediatric otorhinolaryngology, 1986

5
Research

Complications of the surgery for deviated nasal septum.

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2003

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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