Pain when touching the nasal septum is common and often causes concern, but it is usually related to minor, easily treatable irritations. The nasal septum is the wall of cartilage and bone dividing the two nostrils. Its sensitivity means it responds quickly to inflammation or physical disruption. Identifying the source of discomfort requires understanding the structure of the septum and the various factors that can affect it.
The Septum: Anatomy and Sensitivity
The nasal septum is a complex structure made up of bone and cartilage, covered by a thin, specialized tissue called mucosa. This mucosal lining is rich in tiny blood vessels and nerve endings, which are branches of the trigeminal nerve. The presence of these sensory nerves makes the septum highly reactive to pressure, temperature changes, and physical contact, explaining why even a light touch can cause pain.
The blood supply to the septal cartilage comes entirely from the overlying mucoperichondrium, the layer beneath the mucosa. This arrangement makes the cartilage vulnerable. If the mucosal layer is separated from the cartilage—for example, by fluid collection—the cartilage can quickly lose its blood supply and become damaged. This susceptibility underlies the sensitivity of the septum to inflammation and disruption.
Common Sources of Acute Irritation
The most frequent causes of septal pain upon touch relate to environmental factors or minor physical trauma. Dry air, often exacerbated by heating systems, can cause the delicate nasal mucosa to dry out, leading to cracking, crusting, and irritation. This dryness exposes nerve endings and causes sharp pain or tenderness when the area is touched or when crusts detach.
Minor habits like aggressive nose blowing or nose picking can directly injure the sensitive lining of the septum. Even trimming nasal hairs can create small cuts in the nasal vestibule, allowing common bacteria like Staphylococcus to enter. This can result in a localized infection known as nasal vestibulitis, characterized by redness, swelling, and pain that makes the septum tender.
A new or irritated septum piercing is another common cause of localized tenderness, as the healing process involves inflammation around the puncture site. Ongoing inflammation from seasonal allergies or a mild upper respiratory infection can also cause nasal tissues to swell. This swelling increases pressure and makes the septum feel sore or tender when pressed. When these acute irritations are addressed with simple measures like saline sprays or antibiotic ointments, the pain often resolves quickly.
Underlying Conditions Causing Septal Pain
When septal pain is persistent or severe, it may indicate a more chronic or structural medical condition. Nasal vestibulitis, if left untreated, can progress to a localized abscess.
A deviated septum, where the dividing wall is pushed to one side, can be a source of chronic discomfort. This structural misalignment can cause the septal lining to rub against the opposing nasal wall. It can also expose the mucosa to excessive, drying airflow, leading to dryness, crusting, and localized pain when touched. Chronic sinusitis can also cause pressure and inflammation within the nasal cavity, which may be felt as tenderness when pressing on the septum.
More serious issues involve a collection of fluid or pus separating the cartilage from its blood supply. A septal hematoma is a collection of blood between the cartilage and its lining, typically following trauma, presenting as a soft, boggy swelling. If a hematoma becomes infected, it turns into a septal abscess, defined by increasing pain, fever, and the presence of pus. A septal perforation—a hole in the septum—can cause chronic dryness, whistling noises, and painful crusting aggravated by touch.
Warning Signs and When to See a Doctor
While many cases of septal pain are minor, certain accompanying symptoms warrant medical attention. Any pain that is rapidly worsening or is accompanied by a fever, chills, or spreading redness and swelling on the outside of the nose should be evaluated immediately. These symptoms can indicate a spreading infection requiring oral or intravenous antibiotics.
A sudden change in the shape of the external nose is a serious sign. For example, the development of a “saddle nose” deformity—a collapse of the nasal bridge—suggests destruction of the underlying septal cartilage. This is a consequence of an untreated septal hematoma or abscess and needs urgent intervention. Other signs requiring a medical consultation include persistent, unexplained heavy bleeding, pain lasting longer than a week despite home care, or suddenly worsening difficulty breathing.