Septal Perforations and Repair

What is a nasal septum?

The nasal septum is made up of several bones and a cartilage in the front that divides the right and left sides of the nose. This “wall” of tissue is covered with soft tissue that grows and shrinks in order to heat, humidify and purify the air we breathe. Every 2 to 6 hours one side of the nose swells while the other side contracts. This “nasal cycle” allows the open side of the nose to filter air while the other side heals and recovers. The septum can become punctured leading to a septal perforation which ultimately often needs to be repaired. Below we go further into septal perforations and their repair. 

What is a septal perforation?

Any time there is a hole in the nasal septum there is a “septal perforation”. This is usually caused by loss of blood supply to both sides of the septum. Without this blood supply the cartilage will not survive. Causes include medications that prevent adequate blood flow to the delicate sides of the septum. In addition, surgery can damage both sides of the septum as can trauma or placing instruments or fingers in the nose. Exposure to chemicals or cocaine may also cause perforations. Systemic diseases like tuberculosis syphilis or fungal disease as well as nasal malignancies can cause septal perforations.

small septal perforation graphic

What are the symptoms of a septal perforation?

A hole in the septum prevents the proper airflow into the nose as the air will go from one side to the other. This can cause drying of the insides of the nose and further increase the size of the perforation. Symptoms include:

  • Crusting,
  • Nasal Obstruction
  • Bleeding
  • Whistling

If the perforation becomes large enough or there is trauma to the outside of the nose then the nose may collapse. This results in a saddle-nose deformity causing worsening of breathing and the cartilage under the nasal bones to fall inward. 

Can I medically treat a septal perforation?

Yes. A perforation may have no symptoms and you may have a hole in the septum without even being aware that its there. Saline rinses can soften crusting and help moisturize the inside of the nose. Emolients, ointments, and moisturizers can be useful to keep the nasal septum from drying out but should be cleared with your doctor before using in your nose. A septal “button” is a plastic plug that can be placed in the septum but tend to be uncomfortable. Sometimes the crusting needs to be removed by an otolaryngologist as it becomes too large to come out on its own.

saddle nose deformity from septal perforation

When does a septal perforation need surgery?

Fixing a septal perforation is necessary when the symptoms become great enough to sufficiently decrease your quality of life. A whistling nose may bother one person and another may not care. The purpose of correcting a hole in the septum is to improve breathing, correct prevent or decrease crusting, decrease expansion of the perforation, decrease whistling or lessen bleeding. Many of the procedures are performed through the nostrils if the septal perforation is small enough with no external incisions needed. The operating time is usually a couple of hours and can be performed in the office, hospital, or ambulatory surgery center. You may not want to be awake and if so then general anesthesia will be used.

After the procedure, you generally go home within an hour or two. Many times splints are placed inside the nose on both sides to protect the area of repair. With a successful surgery, your symptoms can be expected to improve or even resolve completely. Larger perforations may require an open approach with tissue flaps. Very large perforations may be too large to be closed.   




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