Deviated Septum & Septoplasty in Singapore

What is a Deviated Septum?

The nasal septum is the wall of cartilage and bone that divides the inside of the nose into a left and right airway. In a perfectly straight septum the two airways would be roughly equal in size. In reality, almost no one has a perfectly straight septum — published anatomical studies estimate that around 80% of people have some degree of deviation. The clinically important question is not whether there is deviation, but whether the deviation is significant enough to obstruct airflow or contribute to sinus disease.

A deviation is considered symptomatic when it produces a persistently blocked nostril, blocks normal sinus drainage, contributes to recurrent infections, or disturbs sleep. These are the patients who benefit from surgical correction; everybody else can be safely left alone.

What Causes a Deviated Septum?

• Congenital — many people are born with a deviated septum, sometimes from in-utero or birth-related forces on the nasal skeleton
• Trauma — sports injuries (football, basketball, contact sports), road accidents, and falls are common causes in adults; even a childhood injury that seemed minor at the time can produce a deviation that becomes obvious later as the face grows
• Previous nasal surgery — a small number of patients develop or retain deviation after earlier rhinoplasty or septoplasty, usually because cartilage memory pulls the septum back towards its original position
• Differential growth — the cartilaginous and bony parts of the septum grow at slightly different rates during adolescence, which can produce buckling

Symptoms of a Deviated Septum

Symptoms are often mistaken for "just allergies" because allergic rhinitis frequently sits on top of a deviated septum and the swelling exaggerates the obstruction. Typical symptoms include:

• One-sided nasal blockage — the most specific symptom; one nostril is consistently more blocked than the other
• Alternating blockage — patients describe one side blocking, then switching to the other side over hours (the "nasal cycle" exaggerated by deviation)
• Mouth breathing, particularly at night, leading to a dry mouth on waking
• Snoring and disrupted sleep — even mild deviation contributes to airflow turbulence and snoring
• Frequent sinus infections — the deviation blocks the natural drainage pathway of one or both sinus systems
• Recurrent nosebleeds from one side — the high-flow side dries out and crusts more easily
• Post-nasal drip and a feeling of constantly clearing the throat
• Reduced sense of smell when severe
• Headaches and facial pressure when the deviation rests against the lateral nasal wall

How is a Deviated Septum Diagnosed?

Diagnosis at CENTAS is straightforward and is usually completed within a single consultation:

• History and decongestant test — Dr Pang asks about the pattern of obstruction, trauma, sleep, and infections. A topical decongestant spray is applied to shrink the lining; if the airway opens dramatically, the obstruction is mostly due to swelling. If it remains blocked, the obstruction is structural.
• Anterior rhinoscopy — examination using a nasal speculum and headlight
• Nasoendoscopy — a thin flexible camera passed gently through the nose. This is the gold standard examination because it shows the entire septum (front, middle, and back), the turbinates, the sinus drainage areas, and the nasopharynx in a single one-minute examination
• CT scan of the sinuses — only required when surgery is being planned, when there is co-existing sinus disease, or when previous surgery has been performed. The CT shows the bony structure of the septum and the relationship to the surrounding sinuses, which is essential for safe surgery

Treatment Options for Deviated Septum

Medical Treatment of Co-Existing Symptoms

While medication cannot straighten the septum, it can reduce the contribution of swelling and allergy:

• Intranasal corticosteroid sprays — fluticasone or mometasone reduce mucosal swelling on the deviated side
• Antihistamines — when allergic rhinitis is present
• Saline irrigation — clears mucus and crusting
• Treatment of co-existing allergic rhinitis — see Allergic Rhinitis

If a 6-week trial of optimised medical therapy still leaves you with significant obstruction, surgery becomes the next step.

Septoplasty — the Definitive Surgical Treatment

Septoplasty is the operation that straightens the nasal septum. Key facts:

• Day surgery — performed under general anaesthesia, you go home the same day
• 30 to 60 minutes operating time for a straightforward case; longer when combined with turbinate or sinus surgery
• Internal incision only — the incision is made on the inside lining of the nose. There is no external cut and no change to the shape of the nose
• Cartilage and bone are reshaped, not simply removed — Dr Pang preserves as much cartilage as possible to maintain long-term structural support
• Soft silastic splints are usually placed inside the nose for about a week and removed painlessly at the first follow-up
• Modern septoplasty rarely uses traditional gauze packing
• Recovery: 1 to 2 weeks off work for office-based jobs; longer for heavy physical work
• Medisave-claimable up to the published limit and covered by most integrated shield plans
• Success rate: approximately 85 to 90% report significant or complete resolution of nasal blockage

Why Septoplasty is Often Combined with Turbinate Reduction

When the septum deviates to one side, the turbinates on the opposite side enlarge over time to fill the wider airway — this is called compensatory turbinate hypertrophy. Straightening the septum without addressing the now-too-large turbinates would leave the patient with a still-narrow airway on the previously open side. For this reason Dr Pang often combines septoplasty with turbinate reduction in the same operation. The combined procedure does not significantly increase recovery time and produces noticeably better long-term breathing.

Cost & Medisave Coverage in Singapore

Septoplasty in a private hospital in Singapore typically costs between $6,000 and $12,000 inclusive of surgeon, anaesthetist, hospital, and operating theatre fees. Costs vary depending on whether turbinate reduction or sinus surgery is combined, the length of the operation, and the room class chosen.

Septoplasty is Medisave-claimable under the Ministry of Health's published surgical procedure code, up to the prevailing Medisave withdrawal limit. Most integrated shield plans (AIA, Great Eastern, Prudential, Income, Singlife) cover septoplasty as an inpatient surgical procedure. Our clinic team verifies your specific coverage and provides a written cost estimate before you commit to surgery.

Recovery After Septoplasty

Week 1

Mild facial congestion, low-grade ache, and a feeling of fullness — usually well controlled with paracetamol. Internal splints are removed at the first follow-up around day 5 to 7. Do not blow your nose during this period.

Week 2

Most patients return to office work. Crusting and intermittent blockage are normal as the lining heals. Saline irrigation is used to keep the nasal cavity clean.

Weeks 3 to 6

Swelling steadily settles and the new airway becomes obvious. Avoid heavy exercise, swimming, and contact sports until cleared at follow-up. Most patients notice the full benefit by week 6.

Why Choose Dr Pang for Septoplasty?

• Former Senior Consultant and Clinical Director at NUH Department of Otolaryngology
• Established the Image Guided Surgery Program at NUH — important for patients requiring combined septoplasty and revision sinus surgery
• Over 20 years of nasal and sinus surgical experience across the United Kingdom, United States, and Singapore
• Combined septoplasty and turbinate reduction routinely performed in a single operation for the best long-term outcome
• Day-surgery service at Mt Elizabeth Medical Centre — short hospital stay, fast return home

Frequently Asked Questions