A perforated septum is a hole that develops in the nasal septum, the wall dividing the two sides of the nose. While some individuals experience no issues, this condition can lead to a range of symptoms. Understanding its causes, signs, and management options can help those affected seek appropriate care.
What is a Perforated Septum?
The nasal septum is a structure within the nose, composed of cartilage and bone, covered by mucosa. It acts as a partition, separating the nasal cavity into two distinct nostrils. This arrangement helps regulate airflow, ensuring air is filtered, warmed, and humidified before reaching the lungs.
A perforated septum is a full-thickness defect, or hole, in this dividing wall. This opening creates a direct communication between the two nasal passages. While some perforations may be small and asymptomatic, others can be larger and lead to noticeable symptoms that affect breathing and overall nasal comfort.
Why Perforations Occur
Perforations in the nasal septum can arise from various factors, often involving damage to its blood vessels, leading to tissue breakdown. Trauma is a common cause, including injuries from physical blows to the nose, or even persistent nose picking, which can create ulcers that eventually break down the tissue.
Prior nasal surgeries, such as septoplasty or rhinoplasty, are also recognized contributors. Additionally, repeated cautery used to stop recurrent nosebleeds can sometimes lead to a perforation.
Intranasal drug use, particularly cocaine, can cause significant damage due to chemical irritation and reduced blood flow to the septal cartilage. Overuse of certain nasal sprays, such as decongestants or steroid sprays not directed away from the septum, may also erode the nasal lining.
Certain medical conditions can contribute to septal perforations. These include chronic inflammatory or autoimmune diseases like Granulomatosis with Polyangiitis (GPA), lupus, and sarcoidosis, which can cause tissue inflammation and scarring. Less commonly, chronic infections such as tuberculosis or syphilis can also result in septal perforations. Occupational exposure to irritating chemicals, like chrome, is another potential cause.
Symptoms You Might Experience
Symptoms of a perforated septum can vary widely depending on the hole’s size and location, with some individuals experiencing no symptoms. One common symptom, particularly with smaller perforations, is a whistling sound during breathing, which occurs due to turbulent airflow passing through the opening.
Nasal crusting and scabbing are frequently reported, resulting from the drying effect of air flowing through the perforation. This dryness can also lead to frequent nosebleeds, as the exposed edges become more prone to bleeding.
Some individuals may experience a sensation of nasal obstruction or difficulty breathing through the nose, even if the nasal passages are not physically blocked. This can be due to altered airflow dynamics. Other possible symptoms include nasal discharge, a foul odor, or localized pain or discomfort, though pain is not always present. In cases of very large perforations, the structural support of the nose can be affected, potentially leading to a change in its external shape, known as a saddle nose deformity.
How It Is Diagnosed and Treated
Diagnosing a perforated septum begins with a medical history, where a healthcare provider inquires about past nasal trauma, surgeries, medication use, and intranasal drug use. The primary method for identifying a perforation is a physical examination of the nasal cavity, often performed using a nasal speculum or endoscope. This allows for a clear, magnified view of the septum to confirm its presence and assess its size. In some instances, additional tests like blood work or a biopsy may be conducted to rule out underlying systemic conditions, such as autoimmune diseases or infections.
Treatment approaches for a perforated septum fall into two main categories: non-surgical management and surgical repair. Non-surgical methods primarily aim to alleviate symptoms and prevent the perforation from enlarging. These often involve conservative measures to keep the nasal passages moist, such as regular use of nasal saline sprays or gels. Humidifiers can also help by increasing the moisture in the air, which reduces dryness and crusting inside the nose. Applying topical emollients like petroleum jelly around the edges of the perforation can also provide moisture and trap irritants.
For more persistent symptoms, a septal button, which is a prosthetic device typically made of silicone, can be inserted into the perforation. These buttons are designed to physically block the hole, reducing symptoms like whistling, crusting, and nosebleeds by re-establishing more normal airflow. A healthcare professional can insert these devices, which may be custom-made or trimmed to fit, often under local anesthesia. While effective for symptom management, septal buttons require regular cleaning and may not be tolerated by all patients.
Surgical repair is considered when non-surgical treatments do not adequately manage symptoms or for larger perforations. The goal of surgery is to close the hole, which is often a complex procedure. Techniques typically involve using tissue grafts to bridge the defect. These grafts can be taken from the patient’s own body, such as cartilage from the ear or rib, or fascia (a type of connective tissue), or even tissue from inside the nose itself. The surgeon typically creates mucosal flaps from the lining of the nose to cover the graft on both sides, effectively reconstructing the septum.
Success rates for surgical closure vary, with smaller perforations generally being easier to repair than larger ones. After surgery, patients may have temporary splints in their nose for a few weeks to aid healing, and are often advised to avoid strenuous activities and nose blowing during recovery.