What’s a nasal septum perforation?

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A nasal septum perforation is a tear or puncture in the layer of tissue that separates the nostrils. The nasal septum is made up of flexible cartilage and bone that holds the shape of the nose and keeps the nasal airways open. Because the tissue is relatively thin and weak, perforations from direct trauma, severe infections, and environmental pathogens are quite common. Depending on the size of the perforation and the underlying cause, a doctor may be able to correct the problem and relieve symptoms with medication. Surgery is needed in many cases, however, to repair and strengthen the septum.

Perforations can occur for many different reasons. Trauma to the outside of the nose, such as falling or being punched in the face, can lead to a perforation of the nasal septum if the impact is strong enough. Direct trauma to the septum itself is a more common cause, as can occur with excessive nose picking, the insertion of a foreign object into the nostril, or previous facial surgery. Many infections and chronic conditions can also damage the septum, including syphilis, Crohn’s disease, rheumatoid arthritis and sarcoidosis. Finally, exposure to industrial toxins or snorted powder drugs like cocaine can irritate and eventually rupture the septum.

A small perforation of the nasal septum may not cause noticeable symptoms and the condition may not be diagnosed until a patient has a routine physical exam. When symptoms are present, they may include chronic blockage in one or both nostrils, crusting at the puncture site, and frequent nosebleeds. Some people experience a thick, foul-smelling discharge from their nose, a sign that a septal perforation is infected.

A doctor can usually identify a nasal septal perforation simply by inspecting the nostrils, but an underlying cause can be difficult to determine. To aid in a diagnosis, a doctor typically reviews a patient’s medical history, asks about possible trauma or drug use, and collects mucus and blood samples for laboratory testing. It is important that the doctor understands the cause in order to prescribe the most appropriate treatment.

If a perforation is caused by irritating drugs or toxins, the patient is asked to avoid the substances. Applying a protective and moisturizing ointment such as petroleum jelly can help reduce symptoms while the piercing heals on its own. Underlying diseases, infections, or chronic conditions are treated appropriately with medications to reduce the risk of a recurring septal perforation. When other treatments are ineffective, a surgeon may suture a silicone patch to the septum to close the tear. Cartilage grafts and other invasive surgical procedures are performed on large or recurring perforations.

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