Perforations of the Septum

ByMarvin P. Fried, MD, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine
Reviewed/Revised Jul 2023
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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)

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

  • Autoimmune disorders or infections such as tuberculosis, leprosy, granulomatosis with polyangiitis (formerly called Wegener granulomatosis), and syphilis

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

Symptoms of Perforations of the Septum

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 of Perforations of the Septum

  • A doctor's evaluation

  • Sometimes, laboratory studies and/or biopsy

Doctors examine the front part of the nose and, to view septal perforations, insert an endoscope (a flexible viewing tube) into the nose. If doctors suspect an infection or autoimmune disorder is the cause of the perforation, cultures for infection, other blood tests, and biopsy may be required.

Treatment of Perforations of the Septum

  • Medicated ointment or saline nasal spray for ulcers

  • Rarely surgery for perforations

  • Sometimes, medications to treat infection or autoimmune disorder

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.

Medications are given if the cause of the perforation is an infection or an autoimmune disorder.

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