Nasal Septal Perforation: Symptoms, Causes, and Effective Treatments

Nasal septal perforation occurs when a hole forms in the wall between the nasal passages, causing symptoms like nasal obstruction and nosebleeds. This article explores the causes, symptoms, diagnosis, and treatment options both non surgical and surgical.

Key Takeaways

Understanding Nasal Septal Perforation

Nasal septal perforation occurs when a hole in the septum forms in the bony and cartilaginous wall that separates the nasal cavities. This perforation disrupts normal airflow, often leading to discomfort and other complications. While some individuals may not notice any symptoms, others might experience significant issues such as nasal obstruction and recurrent nosebleeds.

Gaining knowledge about nasal septal perforation is crucial for effective management. Learning about the anatomy and development of these perforations underscores the need for timely diagnosis and treatment.

Anatomy of the Nasal Septum

The nasal septum is a complex structure composed of cartilage and bone, covered by delicate skin and mucosa. It is made up of three primary layers: soft cartilage, solid bone, and mucosal skin. These components work together to regulate airflow and maintain overall nasal anatomy and function.

The cartilage and bone and cartilage provide support and separation between the nasal passages, ensuring that air flows smoothly through the left nasal cavities. Any disruption to this structure, such as a perforation, can lead to significant issues with nasal airflow and function, particularly affecting the underlying cartilage.

Symptoms and Diagnosis of Septal Perforations

The presence of a septal perforation can lead to various symptoms, ranging from mild to severe, depending on the size and location of the hole. As the perforation worsens, it can obstruct airflow, sometimes resulting in a whistling sound during breathing. Untreated septal perforations can also lead to a persistent cycle of nasal irritation and discomfort due to excessive dryness and crusting.

Diagnosing a septal perforation involves a thorough examination by a healthcare professional.

Common Symptoms

Common symptoms of a perforated septum include:

• Nose bleeds
• Foul odours
• Crusting
• Infrequent whistling sounds
• Obstructed breathing
• Snoring

Patients may feel a blockage in the nasal passage even when it is actually open due to the perforation. Those with hereditary hemorrhagic telangiectasia (HHT) often experience recurrent nose feeling and may have large septal holes.

If left untreated, septal perforations can cause progressively severe symptoms such as chronic nasal obstruction and bleeding. Ongoing irritation and tissue damage may also lead to infections.

Diagnostic Tests

Diagnostic tests for a perforated nasal septum include nasal endoscopy and rhinoscopy. Septal perforations are usually diagnosed through a routine nasal exam. Alternatively, a nasal endoscopy may be performed for the diagnosis as well. During the examination, the nasal septum is examined using a nasal speculum, often aided by a headlight or mirror for better visibility.

Plastic surgeons assess the size of the perforation to determine its impact and necessary treatment. Patients may discover their septal perforation through evaluations for recurrent nosebleeds or nasal pain.

Causes of Nasal Septal Perforation

Common causes of a perforated septum include:

• Trauma
• Infections
• Drug abuse
• Nose ring damage
• Prior surgeries

Surgical procedures can also lead to perforations in the nasal septum. Certain medications, such as nasal decongestants and corticosteroids, can irritate the nasal lining and contribute to perforations.

Conditions such as chronic nose picking or excessive use of nasal decongestants can also contribute to the formation of septal perforations. Additionally, exposure to chemical irritants and dust at work or during hobbies can lead to damage of the nasal lining and possible perforations.

Traumatic Injuries

Nasal injuries can stem from physical impacts, such as blows to the face or accidents that damage the nasal structure. Repeated irritation or trauma to the nasal lining can also result in septal perforations. Traumatic injuries to the nose are significant contributors to nasal septal perforations.

Recognising that traumatic injuries can cause septal perforations emphasizes the need to protect the nose from physical harm and seek immediate medical attention if an injury occurs.

Infections and Autoimmune Conditions

Conditions like Granulomatosis with polyangiitis (GPA) are autoimmune diseases that can lead to septal perforation. Granulomatosis with polyangiitis is one of the most frequently identified autoimmune conditions associated with nasal septal perforation. Systemic lupus erythematosus has also been documented to cause nasal septal perforations in some cases.

Certain chronic inflammatory conditions can lead to the destruction of nasal cartilage, resulting in perforations. Autoimmune diseases like GPA can cause inflammation that contributes to nasal septal perforation.

Drug Use and Chemical Exposure

Cocaine use constricts blood vessels and damages the nasal mucosa, leading to necrosis. When the mucosa is damaged, the underlying nasal septal cartilage becomes perforated due to lack of blood supply.

Drug use, particularly cocaine, and exposure to chemical irritants can significantly impact the nasal septum, highlighting the importance of avoiding such substances to prevent septal perforations.

Complications from Untreated Septal Perforations

A perforated septum disrupts normal airflow, causing recirculation of air. Excessive drying occurs in the nasal mucosa as a result, leading to chronic crusting, nasal congestion, bleeding, and potential infection. When this happens, it can be difficult to breathe properly.

Symptoms of untreated septal perforations include:

• Over drying
• Crusting
• Infection
• Enlargement of the perforation

Untreated septal perforations typically enlarge over time and become more symptomatic. A septal perforation can also lead to alterations in the shape of the nose if substantial in size, complicating surgical closure.

Structural Issues

The nasal septum serves as the foundation for nasal stability. Structural issues such as nasal collapse and instability can arise from a perforated septum. Severe septal perforations can lead to a saddle nose deformity, where the structure of the nose collapses.

Individuals with larger perforations and small perforations may experience noticeable changes in the shape of their nose, emphasising the importance of timely treatment to prevent such complications.

Chronic Problems

The presence of a foul-smelling discharge can be associated with a perforated septum. Chronic problems such as infections, crusting, and worsening symptoms can arise if septal perforations are not treated promptly.

Recognizing these chronic issues underscores the importance of seeking medical attention from a doctor and following treatment plans to manage symptoms effectively.

Treatment Options for Nasal Septal Perforation

 

Identifying the underlying cause of a septal perforation helps in formulating effective treatment strategies. Maintaining nasal moisture can alleviate symptoms and prevent crusting, while daily nasal irrigation clears crusts and ensures nasal hygiene.

There are various treatment options available, including medical, minimally invasive, and surgical methods, depending on the size of the perforation. The main goals of treatment are to make the patient symptom-free and to restore nasal function and appearance.

Non-Surgical Treatments

Humidification, antibiotic ointments, and irrigation are recommended for managing smaller septal perforations. Antibiotic cream, saline spray, and the use of a dehumidifier are among the non-surgical treatments for a perforated nasal septum.

The purpose of a prosthesis in the treatment of a perforated septum is to block the hole and reduce symptoms. These non-surgical options can be effective in managing symptoms and preventing further complications.

Surgical Repair Techniques

When non-surgical treatments are insufficient, plastic surgery is necessary for nasal septum perforation. Surgical repair is performed under general anaesthesia, often using tissue from the ears or rib cage.

Most patients are best with permanent septal perforation repair for septal perforations. Surgical techniques vary, and it’s important to choose a method that fits the specific needs of the patient.

At Kensington Medical our rhinoplasty surgeons have the experience in this type of procedure, along with treating a saddle nose or treating the nasal dorsum, which can be due to a perforated septum. To find out more or to book a consultation to see how we can resolve this issue contact us here.

Choosing the Right Specialist for Treatment

Selecting a Rhinoplasty specialist with a strong focus on nasal issues is crucial.

At Kensington Medical we are here to help. Our plastic surgeons have extensive experience in this procedure and can put your mind at ease. Book a consultation to discuss the options. In some cases not only is the nasal septum requiring repair but it has also impacted other parts of the nose such as the dorsal bridge and base or addressing a deviated septum.

Find out about our London based expert nose surgeons here. 

Living with a Perforated Septum

Summary

Nasal septal perforation is a condition that can significantly impact one’s quality of life. Understanding its anatomy, symptoms, causes, and treatment options is crucial for effective management. Whether it’s through non-surgical methods or surgical repair, addressing the condition can prevent complications and improve nasal function and appearance, leading to a boost of confidence.

If you suspect you have a septal perforation, contact us or call to find out about the treatment options.

Frequently Asked Questions