Septal Perforation (Hole in the Nasal Septum)
A septal perforation is a hole that forms in the septum, the structure that separates the two nasal cavities, and can lead to problems such as difficulty breathing, bleeding, or nasal dryness. Treatment depends on the size of the perforation and the symptoms, and may involve either surgical or medical methods.
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What is a Septal Perforation (Hole in the Nasal Septum)?
A septal perforation is the formation of a hole or opening in the septum.
A septal perforation occurs when a hole or opening forms in the nasal septum, the thin wall that divides the nasal cavity into two. The septum is made of cartilage and bone and separates the two nostrils. When a perforation occurs, the airflow inside the nose, the moisture balance, and other functions can be negatively affected. This condition can lead to symptoms such as bleeding, congestion, dry nose, wheezing, and is often caused by trauma, surgical intervention, infections, or chemical irritants.
What Causes Septal Perforation?
- Trauma (e.g., nasal surgery or nasal injury)
- Chronic nasal congestion or infections
- Prolonged use of nasal sprays
- Cocaine use
- Autoimmune diseases (e.g., Wegener’s granulomatosis)
Trauma:
- Surgical Intervention: During nasal surgeries, especially septoplasty or rhinoplasty, damage can occur to the septum, leading to perforation.
- Nasal Injuries: Blows to the nose or accidents can cause the septum to perforate.
Infections:
- Chronic Infections: Repeated nasal infections can weaken the septum and lead to perforation.
- Systemic Infections: Infections like syphilis or tuberculosis can also damage the septum.
Chemical and Substance Use:
- Prolonged Use of Nasal Sprays: Long-term use of steroid-based nasal sprays can irritate the septum, leading to perforation.
Cocaine Use: Cocaine damages nasal tissues and increases the risk of septal perforation.
Autoimmune Diseases:
- Wegener’s Granulomatosis: This rare autoimmune disease can cause granulomas in the nose and perforation in the septum.
- Lupus and Sarcoidosis: These autoimmune diseases can also cause damage to the septum.
Irritation and Exposure:
Exposure to Chemicals: Prolonged exposure to chemical vapors or dust can irritate the septum and lead to perforation.
- Frequent Nose Picking: Repeatedly picking the nose can damage the septum.
Vascular Problems:
Poor Blood Flow: Insufficient blood flow to the septum can weaken the tissue and increase the risk of perforation.
These are the main factors that can trigger the development of septal perforation. If the cause is not properly identified and treated, the condition can progress and lead to serious complications.
What are the symptoms of septal perforation?
- Nosebleeds
- Nasal congestion
- Wheezing when breathing
- Dry nose
- Smell disorders
The symptoms of septal perforation may vary depending on the size and location of the perforation. Here are the common symptoms:
Nosebleeds:
- When a hole forms in the septum, the delicate blood vessels inside the nose may be damaged, leading to frequent nosebleeds.
Nasal Congestion:
- The perforation can affect airflow through the nose, leading to nasal congestion. This feeling may be more pronounced if the hole is large.
Wheezing when Breathing:
- Septal perforation can cause a wheezing sound when breathing. This sound is created due to the turbulence of air passing through the perforation.
Dry Nose and Crusting:
- Due to the imbalance in moisture levels inside the nose, a feeling of dryness can increase. This may lead to crusting and discomfort inside the nose.
Nasal Discharge or Foul Odor:
- The moisture imbalance and risk of infection caused by the perforation may lead to a bad odor or discharge from the nose.
Nasal Deformity:
- Large or advanced perforations may cause a deformity in the nose’s structure. This may appear as a collapse of the septum, leading to a collapse or distortion of the nasal bridge.
Smell Disorders:
- Septal perforation may lead to a reduced sense of smell or difficulty detecting odors.
Headaches and Facial Pain:
- Abnormal airflow and dryness inside the nose can affect the sinuses, leading to headaches or facial pain.
These symptoms can vary in intensity depending on the severity and location of the perforation. The symptoms caused by the perforation may impact a person’s quality of life and may require treatment.
How is septal perforation diagnosed?
The diagnosis can be made through physical examination and endoscopic evaluation.
Septal perforation is typically diagnosed by an ear, nose, and throat (ENT) specialist. The diagnostic process may include the following steps:
Patient History:
- The doctor gathers information about the patient’s symptoms, nasal trauma, previous nasal surgeries, substance use (e.g., cocaine), use of nasal sprays, or history of autoimmune diseases. This information is crucial to understand the possible causes of the perforation.
Physical Examination:
- The doctor may use a simple light source or a nasal speculum to check the inside of the nostrils for any holes in the septum. Even small perforations can often be detected through this basic examination.
Endoscopic Examination:
- For a more detailed evaluation, the doctor may use a nasal endoscope, which is a thin, lighted tube, to examine the inside of the nose. This method allows for a better view of the size, location, and condition of other areas of the septum.
Imaging Tests:
- Imaging techniques, such as a CT scan, may be used to pinpoint the exact location of the perforation or to examine other structural issues in the nose and sinuses. This is usually necessary for larger perforations or if surgical intervention is planned.
Laboratory Tests:
- If an autoimmune disease is suspected as the cause of the perforation, blood tests may be conducted. For example, the presence of a disease like Wegener’s granulomatosis can be detected through blood tests.
Biopsy:
- If a suspicious mass or abnormal tissue is found in the septum, the doctor may take a small biopsy. This sample is then examined in the lab to check for malignancy (cancer) or other serious conditions.
These steps help to accurately diagnose septal perforation and develop the most appropriate treatment plan.
Can Septal Perforation Be Treated?
Yes, septal perforation can be treated, but the treatment options depend on the size, location, cause, and the patient’s overall health. Small perforations are usually managed with symptomatic treatments, such as moisturizing sprays or saline solutions. Larger perforations may require surgical intervention. Treatment options for septal perforation include:
Symptomatic Treatment
- Moisturizing Sprays and Gels: To reduce dryness inside the nose, saline sprays, gels, or moisturizing creams can be used. These products help keep the nasal mucosa moist, alleviating dryness, crusting, and discomfort.
- Nasal Irrigation: Nasal irrigation with saline solutions can reduce crusting and the risk of infection inside the nose.
- Antibiotic Ointments: If there is a risk of infection, doctors may prescribe antibiotic ointments to be applied inside the nose.
Temporary Closure Options
- Septal Button: For small to medium-sized perforations, a temporary solution involves inserting a septal button made of silicone or plastic. This button physically covers the perforation, reducing symptoms.
Surgical Treatment
- Flap Surgery: Flaps of mucosa taken from both sides of the septum can be used to cover the perforation. This surgical method can be performed using different techniques, depending on the size and location of the perforation.
Treatment of Underlying Autoimmune or Systemic Conditions
- If the perforation is caused by an autoimmune disease or a systemic condition, treating the underlying illness may stop the progression of the perforation and relieve symptoms.
Follow-Up and Management
- If non-surgical treatment options are preferred, the perforation is managed with regular doctor visits and appropriate care. Post-surgical follow-up is important if surgical treatment has been performed.
The treatment for septal perforation is tailored based on the size of the perforation and how much it affects the patient’s quality of life. In some cases, small, asymptomatic perforations may not require treatment and are only monitored. However, if the symptoms negatively affect the quality of life, treatment options will be reviewed.
What Surgical Technique is Used to Treat Septal Perforation?
The surgical treatment of septal perforation can vary depending on the size, location, cause, and overall health of the patient. The goal of surgical treatment is to close the hole in the septum, improve nasal function, and alleviate symptoms. One of the most commonly used and particularly successful techniques for repairing large perforations is the bipedicle flap technique.
Flap Surgery
- Mucosal Flap: Flaps taken from the mucosa on both sides of the septum are used to close the perforation. These flaps are thin tissues taken from the nasal cavity. During the surgery, these tissues are placed over the perforation and sutured to close the hole.
- Bipedicle Flap Technique: For larger perforations, mucosal flaps are taken from both nostrils and used to close the perforation from both sides. This technique is preferred for larger perforations.
Combined Surgical Approach with Septoplasty
If the perforation is due to septal deviation, septoplasty, a surgical procedure to straighten the septum, can be performed along with the perforation repair. Septoplasty eliminates the pressure that caused the perforation and helps close the hole.
Combination Methods
- In some cases, different techniques such as flap surgery, graft placement, and septoplasty may be used together. These combinations are selected based on the size and severity of the perforation.
Postoperative Care
- After surgery, nasal packing or splints may be used to support the healing of the nasal cavity. These packing devices stabilize the septum and help control bleeding.
- To reduce the risk of infection and promote faster healing, antibiotic treatment and nasal care may be recommended after the procedure.
Risks and Success Rate
- Surgical treatment is usually successful, but the larger the perforation, the more difficult it may be to achieve a complete repair. In some cases, the perforation may not completely close or may reopen.
- Postoperative complications include infection, bleeding, nasal deformity, and, although rare, the risk of re-perforation.
The surgical treatment of septal perforation should be planned and carried out by an experienced ENT surgeon. The aim of surgical intervention is to relieve the patient’s symptoms and restore nasal function.
What are the complications of septal perforation?
- Persistent Nasal Congestion
- Ongoing Nosebleeds
- Nasal Deformities
- Nasal Collapse in Advanced Cases
If septal perforation is not treated or properly managed, various complications can develop. These complications may vary depending on the size, location, and underlying cause of the perforation. Here are the potential complications of septal perforation:
Ongoing Nosebleeds
- Septal perforation can expose the delicate blood vessels inside the nose, leading to frequent and recurrent nosebleeds. The bleeding may vary depending on the size of the perforation and the dryness of the nasal cavity.
Persistent Nasal Congestion
- The perforation can affect airflow through the nasal passages, leading to a constant feeling of nasal congestion. Larger perforations can make this symptom more pronounced.
Chronic Infections
- Disruption of the normal airflow and moisture balance inside the nose can make the nasal mucosa more vulnerable to chronic sinusitis and other upper respiratory infections. These infections can cause foul odor, discharge, and inflammation inside the nose.
Nasal Deformities
- Large or advanced perforations can lead to structural collapse of the nose. This may result in a collapse of the nasal bridge (saddle nose deformity) or loss of support at the nasal tip. These deformities can cause both aesthetic and functional problems.
Smell Disorders
- A hole in the septum can affect airflow inside the nose, which can impact the sense of smell. This can result in a reduction in the ability to smell (hyposmia) or a complete loss of smell (anosmia).
Dry Nasal Passages and Crusting
- The perforation can disturb the normal moisture balance of the nasal cavity, leading to chronic dryness and crusting. The crusts can cause discomfort and irritation inside the nose, which can increase the risk of bleeding.
Pain and Discomfort
- Depending on the size and location of the perforation, there may be a constant feeling of discomfort, tenderness, or pain in the nose. This is especially noticeable when the nasal tissues are dry or infected.
Psychosocial Effects
- Nasal deformities and chronic nasal congestion can negatively affect a person’s self-confidence and social life. Chronic symptoms can significantly reduce quality of life.
Headaches and Facial Pain
- The perforation can interfere with the function of the sinuses, leading to sinusitis, which may result in headaches or facial pain.
These complications depend on the severity of the septal perforation, and early diagnosis and appropriate treatment are crucial to preventing these issues. Timely treatment can prevent the development of these complications.
How does septal perforation affect quality of life?
Septal perforation can negatively impact quality of life in various ways. The effects depend on the size of the perforation, its location, and the severity of the symptoms it causes. Here are the main effects of septal perforation on quality of life:
Breathing Difficulties
- Septal perforation can disrupt airflow in the nasal passages, making breathing more difficult. Nasal congestion or wheezing can make it harder to breathe, especially during sleep or physical activity.
Chronic Nosebleeds
- Recurrent nosebleeds can disrupt daily activities and cause a persistent discomfort. This means the individual must be constantly cautious to prevent nosebleeds, negatively affecting quality of life.
Dry Nasal Passages and Crusting
- Dryness and crusting inside the nose can lead to ongoing discomfort and irritation. This may require frequent nasal cleaning, which can cause both physical and psychological distress.
Smell Disorders
- Septal perforation can reduce the sense of smell. A loss or decrease in the sense of smell can diminish the enjoyment of food and limit the ability to detect environmental hazards (such as gas leaks), which can affect quality of life.
Pain and Discomfort
- Constant discomfort, pain, or tenderness inside the nose can make daily activities more difficult. This pain becomes more pronounced if the nasal tissues are dry or infected and can make it harder for the person to concentrate.
Aesthetic and Psychosocial Effects
- Nasal deformities caused by septal perforation can negatively affect self-esteem. Visible deformities like a collapsed nasal bridge or a deformed nasal tip can lead to anxiety and stress in social and professional settings.
Sleep Disorders
- Breathing problems can reduce sleep quality. Difficulty breathing during sleep can lead to symptoms similar to sleep apnea, causing chronic fatigue, headaches, and general feelings of weakness.
Sinusitis and Headaches
- The perforation can disrupt sinus function, leading to chronic sinusitis. This can cause frequent headaches, facial pain, and overall discomfort.
Social and Occupational Effects
- Chronic nasal symptoms can make social interactions more difficult and affect job performance. Frequent nosebleeds or nasal congestion can be disruptive during meetings or social events.
General Health Effects
- Constant irritation and risk of infection inside the nose can affect overall health. Chronic infections may lead to broader health issues.
Septal perforation can become a condition that requires constant management in daily life. Therefore, if the symptoms significantly impact quality of life, treatment or proper management is recommended. Untreated perforations can cause these effects to worsen over time..
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I went to the doctor with a complaint of symptom perforation. He said that he could easily close it after the examination. I had my surgery in April 2024. He also performed deviation and nose tip aesthetics. My priority was, of course, to repair the perforation. Thank God, the hole closed and I also had a beautiful nose. My recovery process is still ongoing, it was a long and difficult surgery, but I can breathe healthy. During this process, Ms. Ayşegül was always just a phone call away. I also thank him very much for his interest.
I applied to my doctor with the complaint of septal perforation. I had surgery. It has been 5 months since my surgery and I am seriously relieved. Thank you very much to my doctor and his team...
Septal perforation Due to a nose surgery I had years ago, there were 2 huge holes and no cartilage was left in the nose. I could breathe very hard because all the cartilage in my nose had worn away. I did a lot of research and consulted many doctors. They said it was a very risky surgery, they said we couldn't do it. I tried a lot, I researched a lot, and lastly, Mustafa Deniz. I met my doctor Yilmaz, I found his clinic and went to be examined, he said that it was a risky surgery but he could do it. Actually, I had some fears, but after the examination, he made me overcome that fear. I had septal performance and plastic surgery. It took about 11 hours. It took 4 months. I got excellent results. The holes in my nose were closed, with the cartilage taken from the rib. My nose has become more beautiful again than before. I can breathe very easily. I would like to thank my teacher Mustafa very much. He is a very good teacher, I think he is the best in this field.
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Anesthesia Type: General
Operation Time: 2-3 Hours
Pain: Mild
Length of hospital stay: 1 night
Recovery Time 7 days
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