Ask a Doctor: Septal Perforation

Introducing: Ask a Doctor

At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.

That’s why our department’s introducing Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.

Today, we discuss the causes, signs, and treatment options for septal perforation.

Prepared by: Elizabeth Schneider
Reviewed by: Dr. Sanjeet Rangarajan

What is nasal septal perforation?

A nasal septal perforation (NSP) is a communication, or hole, between the two nasal cavities due to a defect in the nasal septum.

The septum is the partition that divides the nose into its two cavities (right and left). A perforation in the nasal septum can result in airflow which can damage the lining of the nose, leading to crusting/scabs, bleeding, noisy breathing, and other issues.

A septal perforation can commonly occur near the front of the nose, just inside the nostrils, but can also occur anywhere along the length of the nasal septum as well.

What are its causes and symptoms?

There are many possible causes of NSP. The most common cause is trauma from previous nasal surgery where the tissues of the nasal septum fail to heal properly.

Other causes include external trauma such as a nose fracture, chemical irritants, cocaine use, long term use of steroids or other nose sprays, autoimmune diseases, tumors, and infection.

It is important to determine the cause of NSP once diagnosed, as many of them can be controlled with conservative measures. NSP enlargement or worsening can also occur as a result of poor nasal hygiene, or nose picking, which causes acute or chronic infections.

Nasal septal perforation symptoms vary based on size and location. But the most common symptoms include nosebleeds, crusting, nasal obstruction, facial pain, and whistling.

What simple solutions can I try at home?

To reduce symptoms at home you should avoid nose picking, and you can use a saline-based nasal spray and a humidifier.

When should I see my doctor?

You should visit your doctor if you suspect a septal perfation or have problematic symptoms related to your nose or breathing, especially if you have a history of prior surgery or one of the medical problems listed above.

How will my doctor know I have septal perforation?

Your doctor will ask you several questions about your symptoms, medical history, and habits to determine the cause of your NSP. Then, your doctor will examine the outside and inside of your nose.

Additionally, your doctor may perform a nasal endoscopy, which involves using a camera to see the inside of your nose to determine the size and location of your NSP.

What are my treatment options?

Treatment of nasal septal perforation depends on the severity of symptoms, but almost always starts with a conservative approach. Your doctor will first aim to treat the underlying cause of NSP if determined.

Medical treatment:
Medical therapies are focused on alleviating symptoms by improving nasal hygiene and avoiding irritants. Intranasal humidifiers, irrigation with saline, antibiotic ointments, and topical gels/creams may be used.

Nasal septal button:
A septal button is a prosthetic device that can be used to temporality close the hole in your septum. It is placed in office with the use of local anesthesia or in the operating room and can remain in place for 1 year or longer.

Some patients may tolerate a septal button without issues, while others may opt for surgical correction after trying a septal button. They are often used as an alternative for those who cannot or do not want surgery.

Surgical treatment:
Surgical closure of NSP is challenging and is saved for those with refractory symptoms to conservative treatments. The size of NSP is an important prognostic factor for closure success, specifically the size relative to the surrounding tissue.

There is no single technique for every NSP surgical correction. Often, surgeons use tissue from your nose or other parts of your body to create a flap of tissue on each side of the hole.

Surgical recovery:
-Your surgeon will often place a splint in your nose to protect the flaps. The splint will stay in for about two weeks.
-You should avoid picking at your nose and blowing your nose too hard.
-You should rinse your nose with saline as noted by your doctor

How can our Dream Team help?

UTHSC ENT’s Dream Team provides world class treatment in your hometown, and we’d love to hear from you!

If you have been diagnosed with a septal perforation, call us to set up an appointment for us to discuss your concerns and allow us to formulate a personalized treatment plan for you.

Call today: (901) 866-8384