A perforated septum is a hole in the nasal septum, the thin wall of cartilage and bone separating the nostrils. This partition supports the nose and guides airflow. A perforation disrupts normal nasal function. This article explores factors leading to its development.
Direct Physical Factors
Physical actions and interventions frequently cause septal perforations. Repeated minor trauma, such as nose picking, can damage the delicate nasal lining and underlying cartilage. Direct blunt force injuries to the nose can also result in a septal perforation, especially if a septal hematoma forms, cutting off blood supply to the cartilage. Foreign objects, particularly button batteries, pose a significant risk due to immediate corrosion and damage to the nasal septum.
Nasal surgical procedures, like septoplasty or rhinoplasty, can lead to septal perforation as a complication. This occurs if a tear in the nasal mucosal lining is not identified and repaired during surgery, disrupting blood flow to the cartilage. Recreational drug use, particularly intranasal cocaine and methamphetamine, is a significant cause. Cocaine narrows blood vessels, reducing blood flow and nutrients to the septal cartilage, while impurities can cause direct chemical irritation and damage.
Systemic Health Conditions
Underlying medical conditions contribute to septal perforation by causing inflammation and tissue damage. Autoimmune diseases, where the body’s immune system mistakenly attacks its own tissues, are a notable category. Granulomatosis with Polyangiitis (GPA) is a rare autoimmune disorder characterized by inflammation of small blood vessels, destroying nasal cartilage. Systemic lupus erythematosus (SLE) can also cause septal perforation, often during disease exacerbations and in the context of systemic vasculitis. Relapsing polychondritis, a rare immune-mediated disease affecting cartilage throughout the body, frequently involves the nasal cartilage and leads to septal perforation.
Certain infections can erode the nasal septum. Syphilis and tuberculosis are examples, though less common in developed regions. Fungal infections can also be a cause, especially in individuals with compromised immune systems. Chronic inflammatory processes like sarcoidosis, characterized by the growth of inflammatory cells, can affect nasal tissues and lead to septal perforations. Malignant or benign tumors can also cause erosion of the nasal septum.
Environmental and Occupational Irritants
Chronic exposure to certain environmental or workplace substances can damage the nasal septum. Prolonged inhalation of industrial chemicals, such as chromic acid in chrome plating, can irritate and damage the nasal lining. Other corrosive fumes and dusts, including arsenic, nickel, silicone compounds, cadmium, fluorine, soda, and ammonia, have been linked to septal perforations in occupational settings. These irritants cause a gradual progression from rhinitis to ulceration and ultimately perforation.
Overuse or misuse of certain nasal sprays, particularly those containing vasoconstrictors like phenylephrine or oxymetazoline, can contribute to septal damage. While prescription corticosteroids can cause irritation, some over-the-counter decongestant sprays also pose a risk. These substances reduce blood flow to the delicate nasal septum, increasing the risk of perforation.