Specialist article: Nose
Deviated nasal septum?More than a straight piece of cartilage
Your nose is often blocked, and the findings say you have a deviated nasal septum? Here you will learn why a deviated septum is so common, what the nasal cycle has to do with it, what studies show about septoplasty and why free nasal breathing is a pattern of breathing, swallowing and head balance.
Does this sound familiar?
Your nose is blocked, and the septum is supposed to be to blame?
What applies to you?
Tap whatever applies to you.
If several of these points apply, it is worth taking a closer look at how your nose works. The shape of the septum is only part of it. The mucous membrane, the erectile tissue and the pattern with which you breathe matter at least as much. This pattern can be trained.
Why one side is often blockedWhat studies show about surgeryThe key points at a glance
- A slightly deviated nasal septum is the rule, not the exception, and taken on its own is often not a defect.
- How clear the nose is depends mainly on the mucous membrane and erectile tissue, tissue tension and the breathing pattern. If one side is blocked, that is often simply the nasal cycle.
- According to studies, septoplasty brings the most benefit for severe symptoms. Nasal breathing itself is, in our view, a pattern of breathing, swallowing and head balance, and patterns can be trained.
Video
Deviated nasal septum: what really determines nasal breathing
Das Video lädt erst nach dem Klick. Dann werden Daten an YouTube (Google) übertragen.
Anatomy
Deviated nasal septum: the rule, not the exception
If you go for an examination with a blocked nose, you will often hear the same finding: the nasal septum is deviated. What is rarely added is that this applies to most people.
The dividing wall of the nose, the septum, splits the nose into two halves. At the front it consists of cartilage, at the back of thin bone. It grows along with the face over many years and rarely ends up exactly in the middle. If it deviates to one side, this is called a septal deviation, in plain terms a deviated nasal septum.
of nasal septa were straight, examined in 2,112 skulls from five world regions. The rest were curved or kinked1
of newborns had a straight septum in the same study, examined in 2,380 infants directly after birth1
of the 386 people whose 3D X-ray images were evaluated by two radiology centres in Tehran showed a deviation2
A deviation is therefore the norm. Whether it causes symptoms is another question. A review from the Netherlands evaluated 16 studies comparing the perception of nasal breathing with airflow measurements. Almost every conceivable combination occurred, and the relationship remained uncertain3. How freely you breathe simply does not depend on shape alone.
Physics
The drinking straw experiment: faster, not less
A simple experiment shows why a narrowing does not automatically reduce the amount of air.
Take a drinking straw and squeeze it slightly in the middle, similar to a septum bending to one side. Then breathe through it. You still get air. In the narrow section it flows faster, but what goes in at the front also comes out again at the back.
Try it out: the narrowing in the straw
unchanged
Narrow the straw with the slider. In the narrow section the air particles speed up, but the same amount of air passes through every cross-section per second.
The physics behind this is the continuity of flow and Bernoulli’s principle. If the cross-section becomes smaller, the speed increases and the pressure in the narrow section falls. This does not come entirely free, because a severe narrowing noticeably increases resistance. With a slight curve, in our view, this extra effort hardly matters.
In addition, the nose has two channels. If the septum bends to one side, that side becomes narrower and the other correspondingly wider. In the diagram, 30% of the inhaled air goes through one side and 70% through the other. Overall, the passage is maintained.
The air is simply divided differently. An uneven distribution is therefore not in itself a finding, especially as it shifts over the course of the day anyway.
3D film
The path of the air through the nose
In 32 seconds, the animation shows how air flows through the nose, how it is distributed with a deviated septum and what changes with mouth breathing.
Mucous membrane and erectile tissue
What really makes the nose narrow
The septum stays fixed. What changes in the width of the nose over the course of a day comes from the mucous membrane.
On the side wall of each half of the nose lie three nasal turbinates, ridges of bone covered with mucous membrane. Within this mucous membrane sits erectile tissue, a dense network of blood vessels that can fill and empty again4.
The autonomic nervous system controls this filling continuously. If the mucous membrane swells, the channel becomes narrow; if it shrinks, the channel becomes wide. The septum stays as it is, and yet the width of the nose changes from hour to hour.
The nose is not a pipe. It is a functional organ.Mucous membrane, erectile tissue, sensors and the nasal valve work together. How clear it is therefore does not depend on its shape alone.
Then there is tissue tension. In our view, the tissue of the airways behaves like muscles and connective tissue everywhere in the body. What is integrated into a function is used and keeps its tension. What is not used becomes slack. A nose that is hardly breathed through loses the stimulus of the airflow, and the mucous membrane is more inclined to swell.
The nose is used little
It often begins with mouth breathing in childhood, during an infection or with an allergy.
The airflow is missing
The mucous membrane and erectile tissue receive less stimulus, and tissue tension decreases.
The mucosa swells
The nose feels narrower, especially at night and when lying down.
The mouth steps in
The air takes the easier route through the mouth, and the nose is used even less.
The pattern becomes ingrained
With every night, mouth breathing becomes more of a habit. In the end there is often the finding of a deviated nasal septum.
Decongestant nasal sprays work quickly but are intended for a few days. With longer use, the mucous membrane itself can swell, technically called rhinitis medicamentosa, and after long use, lost ciliated cells were found in mucosal samples13. In our view, anyone who needs a spray for weeks needs a look at the cause, not the next spray. A nose with hardly any air flowing through it swells shut more easily, and the spray keeps this cycle going. Do not stop a medically prescribed spray on your own.
Nasal cycle
Nose blocked on one side? Often that is the nasal cycle
Even with a perfectly straight nasal septum, you never breathe evenly through both nostrils.
The erectile tissue on both sides works in alternation. When one side swells, the other shrinks, and after a while this reverses. This natural alternation is called the nasal cycle. A research group at the Weizmann Institute in Israel measured it by recording the airflow of each nostril separately over 24 hours.
was the average length of one switch while awake, measured in 33 healthy people4
was its average length during sleep, in the same study4
Body position also plays a part. Those lying on their side breathed more through the upper nostril4. So if the lower side closes up at night, that is not a sign of a diseased nose. A single examination showing one side as narrow may simply have caught one moment of the cycle.
Close one nostril at a time. Which side is clearer right now?
The triad
Nasal breathing is a pattern
A clear nose is one half. The other is whether you actually use it, during the day, during sport and above all in your sleep.
Breathing
The nose warms, humidifies and cleans the air. In the paranasal sinuses, nitric oxide is also produced in very high concentrations, a messenger substance that reaches the airways with nasal breathing5. With mouth breathing, the air bypasses this route.
Swallowing
After each swallow, the tongue settles against the palate and the lips rest lightly together. The base of the tongue seals the oral cavity off from the throat, and the airflow stays in the nose. The starting point is the tongue reference position.
Head balance
When the head balances over the body, the space in the throat stays clear. If it drifts forwards, in our view the tension and width of the upper airways change, and the mouth opens more easily.
So nasal breathing needs more than an open nose. It needs a tight seal of the oral cavity. If the mouth is open, pressure equalises via the mouth, even if the nose is clear. The difference shows particularly clearly during sleep. In twelve healthy people, upper airway resistance during sleep was considerably higher with mouth breathing than with nasal breathing6.
An open nose is a condition. Nasal breathing is a skill.This skill arises from the interplay of breathing, swallowing and head balance. It is a stored sequence, and that is why it can be trained.
If the septum is only slightly deviated and the nose is still often blocked, in our view the cause usually lies in the breathing pattern, not in the cartilage. This triadic functional circuit is at the start of many causal chains that can lead to a blocked nose, to snoring or to a dry mouth in the morning.
Research
Nasal septum surgery: what studies show
Septoplasty, the surgical straightening of the septum, is one of the most common ENT procedures in adults7. For a long time there were hardly any comparative studies on it; there are now two large ones.
In the Netherlands, 203 adults with a blocked nose and a deviated septum were randomly assigned either to surgery or to non-surgical treatment. After twelve months, the surgery group was on average better off, and the advantage lasted up to 24 months7. The British NAIROS study with 378 adults came to a similar result. After six months, septoplasty performed better than a steroid nasal spray and saline solution, most clearly in severe symptoms8.
This is robust evidence. However, there are two questions these studies do not answer. They compare surgery with medication, not with training of the basic functions. And they extend two years at most. Registry data and long-term surveys from Sweden show what happens after that.
of those operated on with severe nasal obstruction reported an improvement after twelve months in a study of 888 patients who had surgery; with mild obstruction it was 31 %. The authors advise against surgery for mild complaints9
had no or only mild obstruction after the procedure according to the Swedish registry, evaluated across 11,714 operations10
was the fall, among 111 people operated on, in the proportion who were free of their symptoms, between six months and three to six years after the procedure11
of 35 people operated on were satisfied with the surgery after nine years; 26% were free of obstruction12
The figures do not argue against surgery when the finding is severe, but they do argue against seeing it as a simple solution for mild complaints. In addition, in some of those operated on, the effect wears off over the years. Then there are risks. In the Swedish registry analysis of 11,714 patients who had surgery, almost one in four reported a chronic complication after twelve months10. In the NAIROS study, 4 % of those operated on were readmitted to hospital because of postoperative bleeding, and 12 % needed antibiotics because of an infection8.
Among the known risks of surgery on the nasal septum is a permanent hole in the septum. If tissue is also removed from the turbinates at the same time, empty nose syndrome can develop. The nose is then wide open and nevertheless feels blocked or dry, because the airflow is hardly perceived any more14. This is rare but difficult to treat15 and therefore belongs before the decision.
Context
Why the nose can close up again after surgery
Surgery changes the shape; the breathing pattern initially stays as it is. Anyone who has breathed through their mouth for years does not automatically switch over after a procedure, especially not at night. In our view, a familiar situation then arises. The nose is open but feels blocked, and breathing continues through the mouth. Then the cycle described above can begin again.
Like a freshly cleared woodland path
A woodland path that is cleared only stays clear if people walk on it. If it is avoided, it slowly becomes overgrown again. That is roughly how we see the nose. Surgery can open the path; in our view, it is daily use that keeps it open.
If you are considering nasal septum surgery, get medical advice and talk openly about your expectations. Questions like these can help. How severe are my symptoms? Is the same side narrow at several appointments? Do I breathe through my mouth at night? Training of the basic functions can be combined with medical treatment, including before and after surgery.
Training
Improving nasal breathing: training the pattern
Resolving to breathe through your nose often works for a while. With the next exertion, in conversation or in your sleep, the mouth takes over again. A breathing pattern is not a resolution but a stored sequence, and it changes through repetition. Our approach is therefore to train the basic functions of breathing, swallowing and head balance, which creates the preconditions for free nasal breathing.
In FaceFormer training, the FaceFormer sits in the oral vestibule, behind the lips and in front of the teeth. The tip of your tongue rests on the small ridge behind your upper front teeth, you breathe through your nose, and your head is balanced upright.
In the basic exercise you press the lip wedge together with your lips, bite down briefly with your back teeth and swallow once. The negative pressure draws the tongue to the palate, the oral cavity is sealed, and the air takes the route through the nose.
From around week 6, the breathing exercise is added. You breathe in through your nose for about six seconds, briefly hold your breath, bite down and swallow, and then breathe out for six seconds.
You extend the breathing pause afterwards in small steps, only as far as feels comfortable. This way your body gets used to calm nasal breathing.
- From day 1
Basic exercise
A few minutes three times a day with the FaceFormer ZERO; you increase the repetitions week by week.
- From around week 3
Pull exercise and night
The pull exercise is added. At night you wear the FaceFormer ZERO as soon as you have mastered the basic exercise.
- After a few weeks
Switching to the ONE
During the day, you train with the FaceFormer ONE. It is the same size and shape as the ZERO, just made of firmer material.
- From around week 6
Breathing exercise
The breathing exercise combines the training with calm nasal breathing and breathing pauses that become longer over time.
- Over months
The pattern runs by itself
The exercise manual allows six to twelve months until the new sequences run without thinking.
The free FaceFormer app guides you through the basic exercises, and you can find all modules on the exercise pages. If your nose is completely and permanently blocked, have this clarified by a doctor before training. If it is only often blocked or the side alternates, that is part of the starting situation with which the training begins. A separate exercise plan applies to children, more under FaceFormer for children.
Everyday life
Nasal breathing in everyday life
Lips closed, nose open
Your lips rest lightly together, the tip of your tongue at the reference point. This keeps the oral cavity sealed, and the air takes the route through the nose by itself.
One side blocked is normal
If one side closes up at night, that is usually the nasal cycle. If you turn onto the other side, the clear half of the nose often switches too.
Calm rather than forceful
If your nose is narrow, breathe more slowly rather than harder. Think of the straw. The faster the air flows, the more the pressure drops, and soft nostrils give way.
Build up gradually when exercising
Start by breathing through your nose during gentle exertion, such as walking or easy cycling, and build up from there.
Head balance at the screen
Set up your screen and seat so that your head balances over your body and does not drift forwards.
Do not stop prescribed treatment on your own
If you use nasal spray or other remedies on medical advice, discuss any changes with your practice. The training can be combined with them.
Questions
Frequently asked
Is a deviated nasal septum normal?
Yes, in most cases. In a study of more than 2,000 skulls, only around one in five nasal septa was straight. A slight deviation is a common variant and, taken on its own, not a defect. Whether it causes symptoms depends on its extent and on how the mucous membrane, erectile tissue and breathing pattern work.
Why is my nose often blocked on only one side at night?
Usually that is the nasal cycle. The erectile tissue on the two sides swells and shrinks alternately; during sleep, one switch takes about four and a half hours on average. If you lie on your side, you also breathe more through the upper nostril. It is therefore normal for the lower side to close up.
Does a deviated nasal septum need surgery?
Not every one. What matters are the symptoms, not the shape alone. Studies show the greatest benefit of septoplasty in severe nasal obstruction; for mild symptoms, Swedish registry authors advise against surgery. Whether a procedure makes sense for you is something to discuss with your ENT practice.
Can the nose become clearer without surgery?
In our experience, a lasting improvement in nasal breathing is also possible without surgery if it is not a pronounced bony finding but the breathing pattern that has blocked the nose, and if it is trained consistently. Some people notice in the first few weeks that their nose becomes clearer. This is experience from individual cases and not a promise.
How well does nasal septum surgery help?
In two large randomised studies, people who had surgery were on average better off after six to 24 months than comparison participants who did not have surgery. However, long-term data from Sweden also show that freedom from symptoms fades over the years in some of those operated on. In our view, this is also because surgery changes the shape, but not the breathing pattern.
Why is my nose blocked again after septoplasty?
Often it is not the septum but the mucous membrane. It swells during the nasal cycle, with infections or with allergies, and it receives little airflow if you keep breathing through your mouth, especially at night. Have the findings checked by a doctor and take your breathing pattern into account too.
Does nasal spray help in the long term?
Decongestant nasal spray is intended for a few days. With longer use, it can make the mucous membrane itself swell, the nose becomes even narrower without the spray, and you reach for it again. In our view, anyone who needs it for weeks should look for the cause of the blocked nose, for example the breathing pattern.
How can I improve my nasal breathing?
By making it the norm. This includes lightly closed lips, the tongue reference position against the palate and upright head balance, because then the oral cavity stays sealed and the air takes the route through the nose. In FaceFormer training you practise breathing, swallowing and head balance in one sequence until the pattern runs without thinking.
Can I train before or after nasal septum surgery?
Yes, the training can be combined with medical treatment. You can start before an operation as long as the nose is not completely blocked. If it is only often blocked, that is part of the starting situation. After an operation, only resume once the nose is freely passable, and agree the timing with your treating practice.
What is the difference between the nasal septum and the nasal turbinates?
The nasal septum is the dividing wall in the middle, made of cartilage and bone; its shape stays the same. The nasal turbinates are ridges on the side wall with mucous membrane and erectile tissue. They swell and shrink over the course of the day and have a strong influence on how clear the nose feels.
More articles from the knowledge section
Where to go next
Sources
- Gray LP (1978). Deviated nasal septum. Incidence and etiology. Annals of Otology, Rhinology and Laryngology Supplement 87(3 Pt 3 Suppl 50):3-20. PMID 99070. Source
- Moshfeghi M, Abedian B, Ghazizadeh Ahsaie M, Tajdini F (2020). Prevalence of Nasal Septum Deviation Using Cone-Beam Computed Tomography: A Cross-Sectional Study. Contemporary Clinical Dentistry 11(3):223-228. PMID 33776347. Source
- André RF, Vuyk HD, Ahmed A, Graamans K, Nolst Trenité GJ (2009). Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clinical Otolaryngology 34(6):518-525. PMID 20070760. Source
- Kahana-Zweig R, Geva-Sagiv M, Weissbrod A, Secundo L, Soroker N, Sobel N (2016). Measuring and Characterizing the Human Nasal Cycle. PLoS One 11(10):e0162918. PMID 27711189. Source
- Lundberg JO, Farkas-Szallasi T, Weitzberg E et al. (1995). High nitric oxide production in human paranasal sinuses. Nature Medicine 1(4):370-373. PMID 7585069. Source
- Fitzpatrick MF, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS (2003). Effect of nasal or oral breathing route on upper airway resistance during sleep. European Respiratory Journal 22(5):827-832. PMID 14621092. Source
- van Egmond MMHT, Rovers MM, Hannink G, Hendriks CTM, van Heerbeek N (2019). Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial. The Lancet 394(10195):314-321. PMID 31227374. Source
- Carrie S, O’Hara J, Fouweather T et al. (2023). Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial (NAIROS). BMJ 383:e075445. PMID 37852641. Source
- Pedersen L, Schiöler L, Finjan S, Davidsson Å, Sunnergren O, Holmberg K, Ahlström Emanuelsson C, Hellgren J (2019). Prognostic factors for outcome after septoplasty in 888 patients from the Swedish National Septoplasty Register. European Archives of Oto-Rhino-Laryngology 276(8):2223-2228. PMID 31037387. Source
- Sunnergren O, Alexandersson C, Broström A et al. (2025). Clinical Practice and Outcome of Septoplasty: A Retrospective Study of 11,714 Surgeries in Sweden 2014-2023. Laryngoscope Investigative Otolaryngology 10(4):e70199. PMID 40693163. Source
- Sundh C, Sunnergren O (2015). Long-term symptom relief after septoplasty. European Archives of Oto-Rhino-Laryngology 272(10):2871-2875. PMID 25432640. Source
- Jessen M, Ivarsson A, Malm L (1989). Nasal airway resistance and symptoms after functional septoplasty: comparison of findings at 9 months and 9 years. Clinical Otolaryngology and Allied Sciences 14(3):231-234. PMID 2743612. Source
- Ramey JT, Bailen E, Lockey RF (2006). Rhinitis medicamentosa. Journal of Investigational Allergology and Clinical Immunology 16(3):148-155. PMID 16784007. Source
- Gao Z, Jang YJ (2026). Empty Nose Syndrome: An Update on Pathophysiology, Diagnosis, and Treatment. Clinical and Experimental Otorhinolaryngology, online ahead of print. PMID 42219257. Source
- Galaverni G, Adamo D, Raj AC, Genna VG, Pellegrini G (2026). Evidence-based approaches for Empty Nose Syndrome management: a systematic review highlighting current treatments and future directions. Frontiers in Bioengineering and Biotechnology 14:1778266. PMID 42027390. Source
Get started
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The free FaceFormer app guides you through the basic exercises, counts along and reminds you of your sessions. If you wish, a practice from the practitioner directory can support you.
FaceFormer ZERO + ONE
Both material hardnesses for getting started, day and night. The set for adults.
FaceFormer ZERO
The softer FaceFormer for getting started, for children and for the night.
FaceFormer ZERO Children’s Set
ZERO with hygiene box, plush bag and success book with stamp.
FaceFormer training aims to restore the physiological setting of the basic functions of breathing, swallowing and head balance, with lip closure and the tongue reference position, thereby creating the conditions under which symptoms can improve. It does not replace a medical assessment. You can find practitioners near you in the practitioner directory.
