Most singers are familiar with the nasal septum, and many may even have been told that they have a “septal deviation.” The septum is the partition wall that separates the two nasal passages. Each nasal passage opens to the outside by means of the nostril, and to the back of the throat (behind and above the palate) through a kind of internal nostril, called the choana. The septum forms the inner wall of each nasal passage, or cavity, whereas the outside wall is lined inward-projecting radiator-like humidifiers called turbinates. The size and shape of each nasal cavity is largely defined by the position of the septum. If the septum is straight, and perpendicular to the floor of the nose, each nasal cavity will be more or less the same size, and maximally open to airflow. This allows the nose to do its job, which is heating and humidifying inspired air. If the septum is deflected, curved, or angled, it will project into one of the nasal cavities (or both, if the deflection is S-shaped or otherwise complex), and may compromise your ability to breathe well through your nose.
But the story doesn’t end there. When the septum curves into one nasal cavity, narrowing the passage, one would expect that the other (concave) side should be more open. In fact, the lining turbinates will often overgrow that extra space. This allows the covering mucous membranes to better humidify, but may have the inadvertent effect of blocking BOTH sides of the nose!
A deformity of the septum can develop at any time, from birth on. Certainly, nasal trauma can cause a fracture or dislocation of the septum. The septum can also curve just in the process of growth. This is more common in people with tall noses, thus more often seen in Italians or Armenians than in Asians or Blacks. Nonetheless, any one may have this condition.
Should a septal deviation be fixed? Only if it causes symptoms. These symptoms can include nasal blockage, snoring, postnasal drip, nosebleeds, or sinusitis. Secondary problems include chronic dry mouth (due to mouth breathing), tonsillitis, and blocked ears. Singers with deviated septums may complain of any of these symptoms. Additionally, they may feel that the voice is somewhat nasal (even when NOT singing French opera!), and lacking resonance.
It is important to realize that septal deviation is not a cosmetic problem, but a functional one. There are, I am sure, many “septal deviants” walking around New York, whose noses work just fine, despite the fact that the nasal cavities are not exactly symmetrical in shape.
When treating nasal problems in general, the most important first step is to moisturize the nose, by increasing water intake and the use of saline nasal sprays. This reduces the irritating effect of inhaled allergens or pollution, and allows the mucous membrane to function effectively. Anti-allergy measures, such as pills, nasal sprays or shots can also be effective. At the same time, none of these measures will correct a structural deformity inside the nose.
Septal surgery, if indicated, is a relatively minor procedure. In singers, it should be done under local anesthesia with sedation, to avoid intubating the larynx. This operation is not cosmetic, and should have no effect on the outside appearance of the nose. Although the larynx is not touched by this surgery, I usually recommend that singers do not begin to vocalize for about a week, to avoid raising the pressure in the head, which may cause discomfort in the nose. After the procedure, the tip of the nose is often tender for two weeks, and the upper front two teeth may be numb for several weeks. This is more of an issue for wind instrumentalists, but may also be disconcerting for the singer.
What, then, are the benefits to the voice? In addition to relieving or improving the symptoms listed above, many singers tell me that after septal surgery the voice feels bigger or more open. It is a different place in the mask, and it is less nasal. Keep in mind that, although good technique normally closes off the nasal cavity by lifting the palate, the nasal cavities still resonate as sound vibrates the hard palate and facial bones. By changing the shape of the nasal cavities, the voice (or at least the subjective perception of the voice) may, indeed, be different.
As with all surgeries, if you’re considering having this procedure done, try to get a second opinion. Not every nasal obstruction is caused by a deviated septum, and all septal deviations do not obstruct.
DISCLAIMER: The suggestions given by Dr. Jahn in these columns are for general information only, and not to be construed as specific medical advice, or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
