Ulcers and holes (perforations) in the nasal septum may occur as a result of nasal surgery; repeated injury such as that resulting from 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); oxygen inhaled through the nose; or diseases such as tuberculosis, leprosy, granulomatosis with polyangiitis (formerly called Wegener granulomatosis), and syphilis. Frequent use of cocaine snorted through the nose causes ulcerations and perforations 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.

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.

Last full review/revision October 2012 by Marvin P. Fried, MD