Nasal Septal Perforation: Causes, Symptoms, and Repair Options

A nasal septal perforation is a condition where a hole develops in the nasal septum, the thin wall that divides the nostrils. While it might not always cause noticeable issues, in some cases, it can lead to significant discomfort and other complications. If you’re reading this, you might have questions about what this condition means, how it develops, and what you can do about it. This guide will answer those questions and help you understand the causes, symptoms, and treatment options, so you can make informed decisions.

What Is a Nasal Septal Perforation?

The nasal septum is made up of cartilage and bone. It plays an essential role in supporting your nose, directing airflow, and maintaining proper nasal function. A perforation occurs when a hole forms in this structure, leaving an opening between the two nostrils.

The size of the hole can vary. Smaller holes can cause more issues with whistling sounds when breathing while larger ones can disrupt airflow more and lead to crusting, bleeding and even affect the structure of your nose.

Septal Perforation Diagram

What Causes a Nasal Septal Perforation?

Several factors can lead to a septal perforation. Some are related to external trauma, while others result from medical conditions or lifestyle choices.

1. Trauma or Injury

Physical damage to your nose is one of the most common causes. This could be the result of:

  • An accidental blow to the nose.
  • Repeated nasal picking, which erodes the delicate tissue.
  • A previous nasal fracture that didn’t heal properly.

2. Substance Use

Inhaled substances can be particularly harmful to the nasal septum. Prolonged use of drugs like cocaine damages blood vessels and tissues, leading to erosion over time. Even habitual use of nasal sprays or exposure to industrial irritants can contribute.

3. Medical Procedures

Surgical interventions, particularly those involving the nose, can occasionally cause a perforation. For example:

  • Septoplasty (surgery to correct a deviated septum).
  • Rhinoplasty (cosmetic nose surgery).
  • Turbinate reduction (to address breathing issues).

Sometimes, a perforation might develop after surgery due to complications, such as infection or insufficient blood supply to the tissue.

4. Chronic Infections

Infections that persist over time can weaken the nasal tissues, increasing the risk of perforation. These might include:

  • Untreated bacterial infections.
  • Diseases like tuberculosis or syphilis, which can affect nasal structures.

5. Autoimmune Diseases

Certain autoimmune conditions attack the body’s tissues, including those in the nose. Examples include:

  • Wegener’s Granulomatosis (now called granulomatosis with polyangiitis): A condition that causes inflammation and damage to blood vessels.
  • Systemic Lupus Erythematosus: An autoimmune disease that can affect multiple organs and tissues.

6. Other Causes

  • Cancer treatments like radiation therapy to the head or neck.
  • Smoking and exposure to pollutants, which damage nasal tissues over time.

Common Symptoms of Nasal Septal Perforation

The symptoms of a septal perforation depend on its size and location. Smaller holes can lead to a whistling sound when breathing through the nose while larger ones can disrupt airflow more and lead to crusting, bleeding and even affect the structure of your nose.

1. Whistling Sound

You might hear a whistling noise when you breathe through your nose. This happens when air flows through the hole in the septum, creating vibration.

2. Breathing Difficulties

A perforation can disrupt normal airflow, making it harder to breathe through your nose. You may feel as though one or both nostrils are blocked.

3. Nasal Bleeding

The edges of a perforation are often dry and crusty, leading to irritation and recurring nosebleeds.

4. Crusting and Discharge

You might notice frequent crusting in your nostrils, sometimes accompanied by a foul-smelling discharge. This happens because the natural mucus flow is disrupted.

5. Pain or Discomfort

The exposed edges of the perforation can become sore, causing ongoing discomfort.

6. Structural Changes

In severe cases, untreated perforations can weaken the nasal structure, causing visible deformities like a saddle nose (a collapse of the nasal bridge).

How Is Nasal Septal Perforation Diagnosed?

If you suspect a septal perforation, consult an ear, nose, and throat (ENT) specialist. The diagnosis typically involves:

  • A medical history review: Your doctor will ask about any injuries, surgeries, or medical conditions.
  • Physical examination: Using a nasal speculum or an endoscope, the doctor will examine the inside of your nose.
  • Imaging tests: In some cases, CT scans may be used to assess the perforation and surrounding structures.

Treatment and Repair Options

Treatment depends on the size of the perforation and the severity of your symptoms. Here are the most common options:

1. Non-Surgical Treatments

Non-surgical approaches are often the first step for most perforations or for patients who prefer a less invasive option. These include:

  • Moisturising the nasal passages: Saline sprays, gels, and humidifiers can keep the nasal tissues hydrated and reduce symptoms like dryness and crusting.
  • Nasal irrigations: Rinsing your nose with a saline solution helps clear out irritants and promote healing.
  • Antibiotic creams: Antibiotics creams can be very helpful for treating nasal crusting or local infections in the nose. They are usually used alongside nasal irrigations for short periods. 
  • Septal button insertion: A small device, like a silicone plug, can be placed into the hole to close it temporarily. This restores normal airflow and minimises symptoms.

Risks: Non-surgical methods are generally safe, but septal buttons may cause irritation, crusting or discomfort for some people.

2. Surgical Repair

Surgery is the only way to permanently close a septal perforation. It is typically recommended for  perforations that do not respond to non-surgical options or when symptoms are severe.

  • Procedure: Your surgeon will use tissue from your nose or another part of your body to create a flap that closes the hole.
  • Recovery: Recovery takes several weeks. During this time, you will need to avoid strenuous activities, blowing your nose, or exposing your nose to irritants.
  • Risks: While complications like infection, bleeding, or incomplete closure can occur, they are rare when performed by experienced surgeons.

3. Advanced Reconstruction

For large or complex perforations, advanced surgical techniques may be needed. This often involves using cartilage grafts from your rib, ear, or other areas.

  • Procedure: The cartilage is shaped and used to reconstruct the damaged septum. This technique requires specialized expertise.
  • Recovery: Recovery times are longer, typically several months, with regular follow-ups to ensure proper healing.
  • Risks: Potential risks include graft rejection, infection, or complications related to cartilage harvesting.

Recovery: What to Expect

Your recovery will depend on the treatment method used. Non-surgical treatments provide symptom relief quickly but will not heal the perforation. Surgical repairs, on the other hand, offer a permanent fix but involve downtime.

To ensure a smooth recovery:

  • Follow your doctor’s instructions for aftercare.
  • Use prescribed medications, such as nasal ointments or antibiotics, as directed.
  • Avoid activities that could harm your nose, like heavy lifting or blowing your nose.

Living with a Nasal Septal Perforation

If untreated, a nasal septal perforation can lead to chronic discomfort, breathing problems, and, in severe cases, structural deformities. However, with the right approach, many people find effective relief.

If you’re experiencing symptoms, don’t ignore them. Consult a specialist to discuss your options. Whether through simple symptom management or surgical repair, you can restore comfort and improve your quality of life.

Book a Consultation

If you’re seeking expert care for nasal septal perforation, Mr. Raj Lakhani at Rhinoplasty LDN is a leading specialist in London. With advanced specialised training and a strong background in evidence-based care, Mr. Lakhani is dedicated to delivering exceptional results. To book a consultation, visit the Rhinoplasty LDN contact page and take the first step toward expert care