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Perforations of the Septum

By Marvin P. Fried, MD, Professor and University Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

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Inside the nose is the nasal cavity, which is divided into two passages by the nasal septum. The nasal septum is composed of both bone and cartilage and extends from the nostrils to the back of the nose.

Ulcers (sores) and holes (perforations) in the nasal septum may occur as a result of

  • Nasal surgery

  • Repeated injury (such as from repeatedly picking the nose)

  • Cosmetic piercing

  • Exposure to toxins (such as acids, chromium, phosphorus, and copper vapor)

  • Chronic nasal spray use (including corticosteroids and over-the-counter phenylephrine or oxymetazoline sprays)

  • Pure oxygen inhaled through the nose, as is delivered through nasal prongs or a nasal mask

  • Diseases such as tuberculosis, leprosy, granulomatosis with polyangiitis (formerly called Wegener granulomatosis), and syphilis

  • Frequent use of cocaine snorted through the nose (because it decreases blood flow)

Symptoms

Symptoms may include crusting around the ulcer or perforation and repeated nosebleeds. People who have small perforations in the septum may make a whistling sound when they breathe.

Diagnosis

  • A doctor's evaluation

Doctors examine the front part of the nose and, to view septal perforations, insert an endoscope into the nose.

Treatment

  • Medicated ointment or saline nasal spray for ulcers

  • Rarely surgery for perforations

For septal ulcers, bacitracin ointment or mupirocin ointment reduces the crusting, as may saline nasal spray.

Doctors can sometimes surgically repair septal perforations using a person’s own tissue from another part of the nose or with an artificial membrane made of a soft, pliable plastic. Most perforations do not need to be repaired unless bleeding or crusting is a major problem.