Perforated Septum: Symptoms, Causes and the Best Treatment Options

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A perforated septum, sometimes called a nasal septum hole or septal perforation, occurs when a gap forms in the thin wall of and bone that separates the two nasal passages. When a hole develops in the nasal septum, it can disrupt breathing, cause crusting or bleeding, and in some cases alter the external shape of the nose. The condition ranges from small, defects to large that cause significant functional and cosmetic .

At Centre for Surgery in Baker Street, London, we provide expert and advanced treatment for conditions affecting the nasal septum, including nasal cartilage and nasal reconstruction. Our are highly experienced in both and take a personalised approach to every case, from minor symptomatic management to major reconstructive procedures.

What is a Perforated Septum?

The nasal septum is a wall made up of at the front and bone back, lined on each side by a thin mucous . This divides the nasal cavity into left and right sides, directing airflow and providing structural support to the nose. A septal perforation develops when both sides of this lining and the underlying cartilage are damaged simultaneously, a direct opening between the two nostrils.

The size of a nasal wall defect can range from a few millimetres — often producing a sound during — to centimetres, which may result in significant nasal and a change in the shape of the nose from the . Smaller perforations are often anteriorly, towards the front of the septum, while larger ones may extend further back the bony portion.

Causes of a Perforated Septum

There are numerous possible causes of a nasal septum perforation, and the underlying cause is an important part of selecting the most appropriate .

Nasal trauma is one of the most common causes. A blow to the nose that the blood supply to the cartilage, or a septal haematoma — a collection of blood between the lining and the cartilage — that is not promptly drained can lead to cartilage death and perforation.

Previous nasal surgery, including or rhinoplasty, can occasionally result in when the lining is torn on both sides during the procedure, removing the blood supply from a segment of cartilage. This is a recognised but complication of nasal surgery.

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Overuse of topical nasal sprays — particularly vasoconstrictors such as oxymetazoline — can impair blood flow to the septum over time, leading to ischaemic damage and . Intranasal drug use, most notably cocaine, is a well-recognised cause due to its direct and effects.

and autoimmune with polyangiitis (formerly Wegener’s granulomatosis), sarcoidosis, lupus, and can cause septal destruction as part of their . infections, tuberculosis, syphilis, and fungal infections, may also cause in some cases. exposure to irritating fumes or dusts in certain settings is an additional risk factor.

Symptoms of a Perforated Septum

The of a septum depend significantly on the size and location of the . Small perforations located near the front of the septum often cause a whistling sound when air passes through during breathing — this is sometimes the first sign that alerts patients to the problem. Nosebleeds are another common symptom, as the edges of the perforation are vulnerable to crusting and cracking, leading to particularly in dry environments or on waking in the .

Nasal is a complaint for many patients, as the turbulent created by the leads to drying and mucous around the edges of the defect. A sensation of nasal blockage, dryness, or is also frequently reported, despite no being present. Some patients notice a reduced sense of smell as a result of the patterns.

Larger nasal septum holes may cause more pronounced including discomfort, a sense of something being wrong within the nose, and in cases, changes in the shape of the nose. When sufficient cartilage has been lost, the bridge of the nose may begin to sink inward — a condition known as a — which can become a significant concern as well as a functional one.

Non-Surgical Treatment for a Perforated Septum

Not all septal require repair. When symptoms are mild and the underlying cause has been addressed, may be to keep the patient comfortable. saline sprays or rinses help to moisture within the nose, reduce crusting, and keep the edges of the perforation clean. Applying a thin layer of ointment or gel around the inside of the nose can also help the tissue and reduce . Using a in areas is often recommended, particularly during the winter months when indoor air tends to be drier.

A nasal septal button — a small prosthesis designed to fit within and seal the perforation — is a option for whose perforation is a suitable shape and size for this device. When fitted, a septal button can relieve whistling, significantly reduce crusting and bleeding, and a more normal pattern of nasal airflow almost immediately. It requires and cleaning, and is not for all perforations, but for the right patient it an and management option.

Surgical Treatments for a Perforated Septum

Surgical repair of a septal perforation aims to close the defect by reestablishing a continuous mucosal lining across the septum. The involves lifting the lining away from the edges of the and or local tissue flaps to cover both sides of the defect. A is often placed between the two layers to and a scaffold for healing.

The surgical approach varies on the size and of the perforation. Smaller, anteriorly can sometimes be through the using a closed technique. Larger or more posterior perforations typically require an , where a small incision across the columella provides wider access to the internal structures of the nose. The success rate of perforation repair is by the size of the defect, the of the remaining tissue, and whether any underlying inflammatory condition has been fully before surgery is .

is a surgical to straighten and stabilise the septum. In the context of a perforated septum, it may be performed with repair to address any coexisting or that could impair the outcome of the repair. When together with perforation repair, it ensures the septum heals evenly and that nasal breathing is fully restored across both sides of the nose.

When a nasal has caused visible or deformity of the bridge — particularly in cases of saddle nose where the nasal dorsum has sunk due to loss of septal cartilage support — a may be recommended. This combined procedure both the aspects of the septum and the external cosmetic concerns, using grafts to restore nasal height, projection, and structural .

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At Centre for Surgery, we are leaders in nasal and facial plastic surgery, providing expert treatment for septal perforation and related nasal conditions using the most reconstructive techniques available. Our consultants combine extensive surgical experience with a precise of nasal anatomy, that every patient receives a treatment plan to their specific perforation, symptoms, and goals. We offer a full of care from initial assessment and management through to surgical repair and follow-up.

For expert advice or to book a consultation, Centre for Surgery, Baker Street, London W1U 6RN.
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