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Perforations of the Septum

by Marvin P. Fried, MD

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

  • Nasal surgery

  • Repeated injury (such as 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 may include crusting around the nostrils and repeated nosebleeds. People who have small perforations in the septum may make a whistling sound when they breathe.

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

For ulcers, bacitracin ointment or mupirocin ointment reduces the crusting, as may saline nasal spray. Doctors can sometimes surgically repair 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.

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