The nasal septum is the wall dividing the nasal cavity into two passages. It consists of cartilage and bone, covered by a soft tissue lining called mucosa. A hole in this septum is known as a septal perforation.
What Causes a Septal Perforation
A septal perforation can arise from various factors that damage nasal tissues and blood supply. Physical injury is a common cause, including trauma from accidents, repeated nose picking, or complications from nasal piercings. Surgical procedures, such as septoplasty to correct a deviated septum or electrocauterization to stop nosebleeds, can also result in a perforation.
Certain medical conditions also contribute to septal perforations. Autoimmune diseases like granulomatosis with polyangiitis, lupus, and rheumatoid arthritis can damage nasal tissues. Infections such as tuberculosis, syphilis, or fungal infections may also lead to a hole. Inhaling recreational drugs like cocaine, which constricts blood vessels, or chronic overuse of certain nasal sprays can also cause this damage.
Signs and Symptoms of a Septal Hole
The presence of a septal hole can manifest through symptoms, varying in intensity based on the perforation’s size and location. A common indication is a whistling sound when breathing through the nose, particularly with smaller perforations, as air passes through the opening. This turbulent airflow can also lead to a feeling of nasal blockage, even when no physical obstruction is present.
Other frequent symptoms include crusting around the perforation edges and recurrent nosebleeds. Disrupted airflow can cause excessive dryness within the nasal passages, contributing to discomfort and scab formation. In some cases, a foul-smelling discharge or pain may also be experienced.
Does a Septal Hole Heal Naturally?
Most septal perforations do not heal naturally due to the lack of blood supply to the cartilage. Damaged and exposed cartilage struggles to regenerate. Constant airflow through the hole also prevents the edges from fusing, creating an environment that hinders natural closure.
Very small, acute perforations might occasionally close spontaneously, but this is not typical. Factors influencing potential natural healing include the size and location; larger or chronic holes are especially unlikely to heal without intervention. Therefore, waiting for the perforation to close is generally not an effective approach.
Medical and Surgical Repair Options
Managing a septal perforation involves non-surgical and surgical approaches, depending on symptoms and hole size. Non-surgical management often focuses on alleviating symptoms and preventing enlargement. This includes using humidifiers to keep the nasal passages moist, regular saline rinses, and applying lubricating gels or antibiotic ointments to reduce crusting and dryness. Some patients add corn syrup to saline rinses for prolonged moisturizing effects.
For a non-surgical barrier, a septal button or prosthesis can be inserted into the perforation. These silicone implants act as a physical plug, reducing turbulent airflow, whistling, and crusting. Septal buttons can be custom-made or standard-sized, serving as a temporary or long-term solution for those who prefer to avoid surgery.
When symptoms are bothersome and non-surgical methods are insufficient, surgical repair is an option. Surgery aims to close the hole and restore normal nasal airflow. Techniques often use mucosal flaps, sections of the patient’s own tissue from inside the nose, to cover the perforation. Cartilage grafts, sometimes taken from the ear or other parts of the nose, are placed between mucosal layers for structural support and healing.
These procedures involve multi-layered repair to enhance success rates. While generally successful, larger perforations can be more challenging to close.
Preventing Septal Perforations
Preventing a septal perforation involves minimizing factors that damage the nasal septum. Avoiding aggressive nose picking is a straightforward preventive measure, as repeated trauma can lead to tissue breakdown. Proper care of nasal piercings also prevents localized irritation or infection that could compromise the septum.
Judicious use of nasal sprays is advised; overuse of decongestant sprays or improper direction of steroid nasal sprays can irritate or thin the septal mucosa. Avoiding intranasal drug use, such as cocaine, is also important due to its ability to restrict blood flow and damage nasal tissues. Maintaining nasal hydration with saline sprays or a humidifier helps keep the nasal lining healthy and resilient.