Septal perforation (a hole in the nasal septum)
A hole through the cartilage and lining between the two sides of the nose. Many are managed without surgery; closure is possible in selected cases.
A septal perforation is a hole through the wall separating the two sides of the nose. Front perforations tend to cause symptoms; ones further back are often silent and found incidentally.
Common symptoms
- A whistling sound when breathing, particularly with small front perforations
- Crusting inside the nose that bleeds when disturbed
- Recurrent nosebleeds from the edges of the hole
- A paradoxical blocked feeling from disturbed airflow
Finding the cause
The cause shapes the treatment. Previous nasal surgery is the commonest; others include steroid sprays aimed at the septum, nose picking, cocaine use and inflammatory conditions such as vasculitis, so blood tests are part of the work-up where the cause is not obvious. Mr Gane has published on cocaine-induced midline destructive lesions and their overlap with vasculitis, and works closely with rheumatology colleagues.
Assessment and treatment
Assessment sizes and locates the hole with a small endoscope and looks for the cause. Many perforations are managed well conservatively with daily saline rinses, ointment to the edges and correct spray technique. A silicone septal button can plug the hole and stop the whistling; surgical closure with flaps of nasal lining is possible in selected cases, and requires smoking and any cocaine use to have stopped and any underlying disease to be in remission.
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This page is general information and not a substitute for individual medical advice.