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Perforated Septum: Causes, Symptoms, and Treatment Options

Oghenefejiro Okifo | MD

Medically reviewed by Oghenefejiro Okifo | MD, Harvard Medical School | Henry Ford Hospital - Detroit, MI on February 10th, 2024.

Key Takeaways

  • The hole develops in the cartilage and bone wall (nasal septum) separating nostrils, most commonly in the anterior-inferior region where blood supply is poorest.
  • Cocaine use accounts for a significant percentage of cases due to vasoconstriction and tissue necrosis, while autoimmune diseases like Wegener's granulomatosis and lupus attack septal tissue directly.
  • Small perforations under 1cm may cause minimal symptoms, while larger holes create turbulent airflow producing characteristic whistling sounds and chronic crusting.
  • Surgical repair success rates exceed 90% for perforations smaller than 2cm, but drop significantly for larger defects, with procedures requiring specialized grafting techniques.
  • Conservative management includes twice-daily saline irrigation and petroleum-based ointments to prevent crusting, which can be effective long-term for asymptomatic small holes.

A perforated septum is a hole in the thin wall of cartilage and bone that separates your left and right nostrils. While not always symptomatic, a perforated septum can cause various issues, such as nosebleeds, difficulty breathing, and a blocked nose sensation. In this article, we'll explore the causes, symptoms, and treatment options for a perforated septum.

What Causes a Perforated Septum?

There are several potential causes of a perforated septum, including:

  • Previous nasal surgery (about 50% of cases)

  • Cautery (a treatment for nosebleeds)

  • Certain diseases (lupus, some cancers, syphilis, and tuberculosis)

  • Nasal trauma (breaking your nose or excessive picking)

  • Infections

  • Overuse of nasal drugs (over-the-counter sprays or cocaine)

Symptoms of a Perforated Septum

A perforated septum may not always cause symptoms, but when it does, they can include:

  • Nosebleeds

  • Difficulty breathing

  • Feeling of a blocked nose

  • Whistling sound while breathing

Treatment Options for a Perforated Septum

Treatment for a perforated septum depends on the size of the hole and the severity of symptoms. Non-surgical options may include:

  • Ointments

  • Regular saline rinses

If these treatments ease your symptoms, you'll still need regular checkups to monitor the hole, as it may grow over time. A larger hole can lead to nasal instability and cause the tip or middle of your nose to droop.

Perforated Septum: Causes, Symptoms, and Treatment Options

When Is Surgery Necessary?

If non-surgical treatments don't work, or if the hole is causing significant problems, your doctor may recommend surgery. The success of surgery depends on the size and location of the hole, with smaller holes generally being easier to repair.

What to Expect During and After Surgery

Septum repair surgery typically takes 1 to 3 hours and is usually an outpatient procedure. Your surgeon will use tissue from your nose or mouth to cover the hole and create flaps on each side for support. Thin splints will be placed in your nose to protect the flaps, which will remain for 1-2 weeks.

During recovery, it's essential to follow your doctor's instructions, which may include avoiding heavy lifting, not blowing your nose too hard, and rinsing with saline. Most people feel back to normal within a few weeks, with follow-up visits scheduled to monitor healing.

It's crucial to address the underlying cause of the perforated septum, such as an infection, tumor, or drug use, before considering surgery. If you experience any concerning symptoms during recovery, such as bleeding, fever, or worsening pain and swelling, contact your doctor immediately.

For more information on perforated septums and their treatment, consult the following reputable sources:

The Bottom Line

Most small septal perforations can be managed conservatively with regular saline care, while larger symptomatic holes may require complex surgical repair with variable success rates. Early intervention prevents progression and improves outcomes. If you're experiencing persistent nasal symptoms like whistling sounds or recurrent nosebleeds, Doctronic can help you get prompt evaluation and treatment guidance.

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