The nose serves as the primary entrance to the respiratory system, playing an important role in breathing and the sense of smell. Its internal structure, composed of bone and cartilage, provides both support and flexibility. The nasal septum, a wall of cartilage and bone, divides the nasal cavity into two passages. This lining, rich in blood vessels and covered with a mucous membrane and cilia, warms, moistens, and filters inhaled air before it reaches the lungs. These structures are susceptible to various factors that can lead to damage, including the formation of perforations or “holes.”
Intentional Causes
The most direct way holes appear in the nose is through intentional actions, primarily nasal piercings. These procedures involve creating a small puncture through the nostril, septum, or other nasal structures using a needle. The body then forms a healed channel around the jewelry inserted into the new opening.
Common types of nasal piercings include nostril piercings, which pass through the cartilage of the ala, and septum piercings, which go through the soft tissue and cartilage of the nasal septum. During the healing process, which can take several months, the body encapsulates the foreign object, creating a permanent fistula. Minor complications like localized swelling, redness, or tenderness are common during this period.
Trauma and Injury
Physical trauma is a significant cause of perforations within the nasal structure. Direct impacts, often from accidents or sports injuries, can fracture the nasal bones or damage the cartilage, particularly the nasal septum. Such acute force can result in a septal hematoma, where blood collects under the septal lining, potentially leading to cartilage necrosis if not promptly drained.
Surgical procedures, such as septoplasty or rhinoplasty, although intended to improve nasal function or appearance, can sometimes lead to septal perforations. These may occur due to excessive removal of cartilage or injury to the mucosal lining during the operation. Prolonged pressure from medical devices like nasal cannulas, used for oxygen delivery, can cause localized tissue breakdown and ulceration, eventually leading to a hole in the nasal wall.
Infections
Infections can compromise nasal tissues, leading to holes. Bacterial infections, such as Staphylococcus aureus, can lead to localized abscesses and tissue necrosis, where the infected tissue dies and breaks down. More specific bacterial diseases, like leprosy, can cause widespread destruction of nasal cartilage and bone, resulting in a saddle nose deformity and septal perforations over time. Similarly, late-stage syphilis can manifest as gummas, which are soft, non-cancerous growths that can erode nasal structures, including the septum and palate.
Fungal infections, though less common, can be aggressive. Mucormycosis, for instance, is a severe fungal infection that typically affects individuals with weakened immune systems. This infection can rapidly invade blood vessels, causing tissue infarction and necrosis, leading to extensive destruction of the nasal and sinus cavities, often manifesting as black lesions and perforations. Early diagnosis and aggressive antifungal treatment are important to prevent widespread tissue damage in these cases.
Chronic Conditions and Diseases
Chronic conditions and systemic diseases can lead to the development of holes in the nose. Autoimmune diseases, where the body’s immune system mistakenly attacks its own tissues, are significant contributors. Granulomatosis with polyangiitis (GPA), previously known as Wegener’s granulomatosis, is an autoimmune disorder that causes inflammation of blood vessels, leading to granuloma formation and destruction of nasal cartilage and bone. Lupus, another autoimmune disease, can also cause chronic inflammation and ulceration of the nasal lining, potentially leading to septal perforations.
Long-term intranasal substance abuse, particularly cocaine use, is a documented cause of septal perforation. Cocaine acts as a potent vasoconstrictor, restricting blood flow to the nasal septum. This prolonged lack of oxygen and nutrients leads to tissue ischemia and necrosis, resulting in the breakdown and eventual perforation of the septal cartilage. In rare instances, certain cancers originating in the nasal cavity or paranasal sinuses, such as squamous cell carcinoma, can erode the surrounding bone and cartilage as they grow, creating destructive lesions and holes within the nasal structure.