Perforated Septum

A perforated septum — or septal perforation — is a hole in the tissue that separates your nostrils. Your septum is made of cartilage, bone and soft tissue lining called mucosa. It separates your nasal cavity into two parts so that the air you breathe through your nose travels through two passages instead of one.

Sometimes, a hole or tear (perforation) can weaken your septum and cause symptoms. When this happens, you may need treatment. Other times, a nasal septum perforation isn’t serious and doesn’t cause issues at all. In that case, you may need to have it monitored instead of fixed.

Symptoms of nasal septum perforation

It’s possible to have a nasal septum perforation without knowing it. But when symptoms are present, they can be pesky. Symptoms include:

• Dryness and crusting inside your nose
• Dip in the bridge of your nose (saddle nose deformity)
• Nasal obstruction
• Nosebleeds
• Runny nose
• Whistling sound when you breathe through your nose

Can you feel a perforated septum with your finger?

Sometimes, you can touch the perforation, but this is a really bad idea. Sticking a finger up your nose to feel for the hole can create pressure that tears the tissue even more. Bacteria on your finger can cause an infection, making things worse.

This is why it’s best to get checked by a healthcare provider instead.

Septal perforation causes

Causes of nasal septum perforation include injuries and conditions that damage the blood vessels inside your nose. The damage can block blood flow to your septum, causing the tissue to become unhealthy. Specific causes include:

• Autoimmune diseases. Granulomatosis with polyangiitis, lupus and rheumatoid arthritis are examples of these conditions that can cause a perforation.
• Drug misuse. Using steroid nasal sprays in excess or inhaling cocaine can cause a hole in your septum.
• Exposure to chemicals. Inhaling harmful chemicals on the job, like chrome, can lead to a tear in this delicate tissue.
• Infections. Tuberculosis and syphilis are just two types of infections that can cause a perforated septum.
• Injuries. A broken nose or even excessive nose picking can cause a perforation.
• Nose conditions. Atrophic rhinosinusitis and chronic (long-term) rhinosinusitis can cause tears.
• Treatment complications. A healthcare provider may accidentally damage the tissue during surgery on your septum (septoplasty) or electrocauterization to stop excessive nosebleeds.
• Tumors. In rare cases, a tumor can cause a perforation. The most common kind associated with a perforated septum is a cancer called squamous cell carcinoma.

How doctors diagnose this condition

Your healthcare provider will ask about your medical history. It’s important to let them know about previous surgeries you’ve had. Let them know if you’re taking prescription, over-the-counter or recreational drugs. They need a complete picture of your health to make an accurate diagnosis.

They may perform a nasal endoscopy. This test uses a flexible tube with a light and camera at the end to record images of the inside of your nose.

You may need blood tests if your provider believes an infection is causing the perforation. You may need a biopsy to test for cancer cells if they find a tumor.

How is a perforated septum treated?

Treatment depends on how severe your symptoms are, the hole’s size and whether the perforation is weakening your nose’s structure.

At-home remedies and medicines

Often, there are things you can do at home for a perforated nasal septum. You may need to apply antibiotic ointments or products that contain emollients inside your nose. Your healthcare provider may recommend using a humidifier or doing regular saline rinses (nasal irrigation). These treatments keep the inside of your nose moist. This can ease your symptoms and prevent crusting that can make perforations worse.

Prosthetic button

Your provider may be able to insert a prosthetic button that fills the hole. Some are custom-made to fit, while others are premade. Your button may be a single device. Or it may come in two parts that fit together inside your nose. No matter the type, they’re made of medical-grade safe material, like silicone.

Depending on your situation, your provider may insert the button while you’re under general anesthesia (asleep). Or they may be able to numb the area and insert the button during an office visit.

If you get a prosthetic button, it’s still a good idea to keep the inside of your nose moist by using home remedies like a humidifier.

Surgery

You may need surgery to fix the hole if other treatments haven’t been successful (or if your surgeon thinks you’re a good candidate). There are various techniques your surgeon may use. They’ll tailor their approach to your specific situation.

When should I see my healthcare provider?

Contact your provider if your symptoms make you suspect a nasal septum perforation. Lots of conditions can cause symptoms similar to this condition. But you’ll need to see a provider for an accurate diagnosis and the best treatment plan.

What can I expect if I have this condition?

Nasal septum perforations don’t heal on their own, but this doesn’t mean you need repairs right away. Home remedies are often all people need to manage symptoms and keep the hole from getting bigger. You and your healthcare provider may decide that monitoring the perforation is the best bet.

If you do need a procedure, your healthcare provider will advise you about the pros and cons of surgery versus a prosthesis. They’ll let you know why they recommend one type of treatment over another.