Unilateral Nasal Obstruction in a 36-Year-Old Male with Suspected Deviated Septum

Case at a Glance

A 36-year-old male presents with chronic unilateral nasal obstruction, nocturnal mouth breathing, and concerns about reduced oxygen intake secondary to suspected deviated nasal septum.

Patient's Story

The patient reports a significant difference in nasal airflow between his left and right nostrils. He demonstrates that when occluding his left nostril and exhaling through the right, it takes approximately 12 seconds to empty his lungs, compared to less than 3 seconds when using his left nostril. He has developed a new symptom of waking with severe xerostomia (dry mouth), which differs from his previous experience of dry mouth only after excessive fluid intake before bedtime. The patient also describes chronic fatigue and low energy levels, which he attributes to possible inadequate oxygenation due to nasal obstruction. He has a history of tobacco use.

Initial Assessment

Physical examination revealed marked asymmetry in nasal airflow with significant right-sided nasal obstruction. The patient's self-demonstration of differential airflow times suggested structural nasal pathology, likely septal deviation. Vital signs were stable with normal oxygen saturation.

The Diagnostic Journey

The patient's presentation of unilateral nasal obstruction with compensatory mouth breathing was consistent with structural nasal pathology. The differential diagnosis included deviated nasal septum, nasal polyps, turbinate hypertrophy, or chronic rhinosinusitis. The patient's concern about oxygen deprivation was addressed through patient education.

Final Diagnosis

Suspected deviated nasal septum with unilateral nasal obstruction and compensatory mouth breathing. Rule out additional contributing factors such as allergic rhinitis or turbinate hypertrophy.

Treatment Plan

Initial conservative management with topical nasal corticosteroids (fluticasone propionate) for 4-6 weeks to reduce any inflammatory component. Patient counseled on smoking cessation to optimize nasal function. If symptoms persist despite medical therapy, referral to otolaryngology for comprehensive nasal endoscopy and consideration of septoplasty.

Outcome and Follow-up

Patient educated that septal deviation does not cause systemic hypoxemia, as adequate ventilation occurs through mouth breathing and the patent nostril. Follow-up scheduled in 6 weeks to assess response to topical steroid therapy. ENT consultation planned if conservative management fails to provide symptomatic improvement.