A nasal septum perforation is a tear or puncture in the layer of tissue separating the nostrils. The nasal septum is comprised of flexible cartilage and bone that maintains the shape of the nose and keeps the nasal airways open. Since the tissue is relatively thin and weak, perforations due to direct trauma, severe infections, and environmental pathogens are fairly common. Depending on the size of the perforation and the underlying cause, a doctor may be able to correct the problem and ease symptoms with medications. Surgery is necessary in many cases, however, to repair and reinforce the septum.
Perforations can occur for many different reasons. Trauma to the outside of the nose, such as falling or getting punched in the face, can cause a nasal septum perforation if the impact is forceful enough. Direct trauma to the septum itself is a more common cause, as can occur with excessive nose picking, inserting a foreign object into the nostril, or a previous facial surgery. Many infections and chronic conditions can also damage the septum, including syphilis, Crohn's disease, rheumatoid arthritis, and sarcoidosis. Finally, exposure to industrial toxins or snorting powder drugs such as cocaine can irritate and eventually rupture the septum.
A small nasal septum perforation may not cause noticeable symptoms, and the condition may go undiagnosed until a patient undergoes a routine physical examination. When symptoms are present, they may include chronic obstruction in one or both nostrils, crusting at the site of the puncture, and frequent nosebleeds. Some people experience thick, foul-smelling discharge from their noses, a sign that a perforation of the septum is infected.
A doctor can usually identify a nasal septum perforation by simply inspecting the nostrils, but an underlying cause may be difficult to determine. To aid in a diagnosis, a physician typically reviews a patient's medical history, asks about possible trauma or drug use, and collects samples of mucus and blood for laboratory tests. It is important for the doctor to understand the cause in order to prescribe the most appropriate treatment.
If a perforation is caused by drugs or irritating toxins, a patient is instructed to avoid the substances. Applying a protective, moisturizing ointment such as petroleum jelly can help reduce symptoms while the perforation heals on its own. Underlying illnesses, infections, or chronic conditions are treated appropriately with medications to reduce the risk of a recurring nasal septum perforation. When other treatments are ineffective, a surgeon can suture a patch of silicone to the septum to close the tear. Cartilage grafts and other invasive surgical procedures are performed on large or recurring perforations.