All About Perforation Of The Nasal Septum

A perforation of the nasal septum is a condition that affects the nose. In some cases, it may not cause any symptoms. However, it is also associated with a high risk of complications.

Some of the causes, such as cocaine use and certain surgical procedures, such as septoplasty, increase its incidence. Both causes are more common these days.

Perforation of the nasal septum may require medical or surgical treatment. In this article, we’ll explain everything you need to know about this condition and how to identify it.

What is a nasal septum perforation?

The nose is a complex structure that is essential for the proper breathing process. It has two cavities called nostrils, which are responsible for filtering the inhaled air. This way, cleaner, wetter and warmer air can reach the lungs, preventing infection or injury.

The nostrils are separated from each other by the nasal septum. This is a structure made up of cartilage and bone that vertically divides the nose. It forms the inner wall of the nostrils. Thus, it helps to channel the passage of air.

Perforation of the nasal septum consists in the development of a hole. So it ensures that both nostrils communicate with each other and depending on how big the hole is, more or less severe symptoms can occur.

The causes of perforation of the nasal septum

The etiology of perforation of the nasal septum is very varied. This is due to the fact that, being a partially cartilaginous structure, it is sensitive to certain substances that can damage the tissue.

One of the most common causes of this problem is having nose surgery. It can appear as a complication of a rhinoplasty, especially if it is done to solve a breathing problem.

Rhinoplasty is surgery that changes the shape of the nose, both for aesthetic purposes and to improve breathing.

On the other hand, according to the MSD Manual (Spanish link), it can also be secondary to infection or trauma. In fact, continuous nose picking and nose piercings (which pass through the nasal septum) can cause this.

Other causes of this problem

Another of the most relevant causes is intranasal drug use. Specifically, the drug most closely related to this condition is cocaine. As a study at the Hospital de la Santa Creu i Sant Pau states (Spanish link), this is currently one of the main causes of this condition.

Cocaine is a drug that causes the blood vessels in the nose to constrict. Since the tissue does not receive enough blood, it becomes damaged and can perforate.

However, many drugs are also related to this problem. For example, some nasal corticosteroid sprays (Spanish link). Similarly, oxygen therapy through a mask or glasses.

Finally, another cause of this condition is exposure to chemicals or toxins. This is especially common among people who work in the chemical industry or in factories.

The symptoms caused by a perforation of the nasal septum

The symptoms depend on the size of the hole. It can be a very small one, less than an inch. Or it could be bigger, a two inches tall.

The most characteristic symptom of symptomatic cases is frequent nosebleeds. The medical term for nosebleeds is “epistaxis.” The bleeding can be heavy and alarming because the nostrils are highly vascular.

In a number of cases, the patient suffers from rhinorrhoea instead of nosebleeds. This is the medical term for a runny nose. Scabs often form around the hole, which can make breathing difficult.

It is also common for these people to experience headaches or pain in the nose themselves. Another characteristic sign of a perforation of the nasal septum is wheezing. This is when someone makes a high-pitched whistling sound when they breathe. This is because every time they inhale and exhale, air passes through the hole.

Finally, this condition can also have aesthetic consequences. According to the Herediana Medical Journal (Spanish link), the saddle nose is a deformity caused in most cases by this condition. It is characterized by a loss of height of the nose.

Therapy

There are several options for treating this condition. The choice of treatment depends on the patient’s symptoms and the size of the hole. In many cases, a medical approach is sufficient.

The medical professional may prescribe an ointment made from bacitracin or mupirocin. This ointment reduces crusting in the area of ​​the hole.

The patient can also use saline, which they administer as a spray. Like the ointment, it helps to reduce the formation of scabs and sores in the nose.

In some cases, surgery is required. The doctor may take a tissue implant from another part of the patient’s body. In fact, even artificial membranes can be placed to seal the hole.

Other Surgical Alternatives

The doctors of the Hospital Clinic de Barcelona (Spanish link) perform an alternative surgical treatment to reconstruct the perforated nasal septum. For this surgery, they use a flap that they extract from the fibrous tissue around the skull (called a pericranial flap).

First , they make an incision in the scalp, where they retrieve the tissue. Then they make an opening through the frontal bone. They then place the tissue over the nasal cavity. In this way, they reshape the nasal septum and eliminate the hole.

The advantage of this technique is that it is painless and recovers quickly. It also leaves no scars. The only scar is at the back of the skull, which covers the scalp itself.

Diagnosis

To diagnose a perforation of the nasal septum, it is important that the doctor knows the symptoms and checks the nasal cavity. For this purpose, they can resort to additional tests that allow them to see the nostrils clearly.

Endoscopy is one of the most commonly used tests. It consists of inserting a tube with a camera through the nostrils. In addition, other tools can be inserted through this tube to remove scabs. In fact, doctors can even take tissue samples.

A study published in the Journal of Radiology explains that computed tomography is one of the most useful diagnostic tests, especially in cocaine users.

Perforations in the nasal septum are preventable

It is important to note and remember that in many cases perforations of the nasal septum can be avoided. This is because it tends to happen from the inhalation of drugs or irritants.

For this reason, in addition to avoiding these kinds of destructive habits, it is essential to protect your nostrils when you work in chemical industries or factories. In addition, you should always consult your doctor if you experience any of the symptoms we have described here.