Nasal Septum Perforation

Nasal Septum Perforation
28
Jan

Nasal septum perforation is a condition that occurs when a hole forms in the nasal septum. It leads to complaints such as nasal obstruction, bleeding, crusting, and difficulty breathing. Trauma, surgical interventions, or infections are among the most common causes.

Symptoms of nasal septum perforation usually begin with difficulty breathing. Because the airflow inside the nose becomes irregular, dryness and noisy breathing may also develop. Over time, this condition reduces quality of life and requires treatment.

Diagnosis is confirmed through endoscopic examination and imaging methods. In small perforations, moisturizing sprays and creams may be used. In larger openings, surgical repair options are evaluated.

If left untreated, chronic infections and advanced nasal deformities may develop. Therefore, early diagnosis, appropriate treatment, and regular medical follow-up are important. Surgical success rates vary depending on the size of the perforation and the patient’s overall health status.

Symptoms Symptoms include nasal dryness, frequent nosebleeds, crusting inside the nose, whistling sounds during breathing, nasal obstruction, and difficulty breathing.
Causes Nasal surgeries, trauma, long-term use of nasal sprays, infections, autoimmune diseases (e.g., granulomatous diseases), and exposure to chemical substances can cause septum perforation.
Diagnostic Methods An intranasal examination is performed for diagnosis. Endoscopic evaluation assesses the location, size, and condition of surrounding tissues. If necessary, additional tests may be conducted to evaluate the presence of an underlying disease.
Treatment Options In small perforations, moisturizing sprays, gels, or ointments are used to relieve symptoms. Surgical repair may be required for larger perforations.
Surgical Repair Methods Surgical repair is performed using different techniques depending on the size of the perforation. Small perforations can be closed by suturing tissues. Larger perforations are supported with local tissue flaps or cartilage grafts taken from the ear or rib.
Preoperative Preparation A detailed intranasal examination is performed before surgery. Blood-thinning medications should be discontinued, smoking should be stopped, and other precautions recommended by the physician should be followed.
Postoperative Care After surgery, nasal packing or silicone splints may be placed and are typically removed after 1–2 weeks. Moisturizing sprays and ointments are used to prevent nasal dryness. During the healing process, the nose should be protected from trauma.
Complications Complications such as recurrent perforation, bleeding, infection, crusting inside the nose, and obstruction may occur. Therefore, regular follow-ups and recommended care are important.

What Is Nasal Septum Perforation?

Nasal septum perforation is the formation of a hole in the structure called the septum that divides the nasal cavity into two. This hole can impair breathing function and cause uncomfortable symptoms. Causes include trauma, previous nasal surgeries, infections, or exposure to chemical substances. Symptoms include nasal dryness, bleeding, and whistling sounds during breathing.

What Causes Nasal Septum Perforation?

Many factors play a role in the development of nasal septum perforation. The main causes include:

  • Trauma: Damage to nasal structures resulting from physical impact.
  • Autoimmune diseases: Conditions such as Wegener’s granulomatosis can damage nasal tissues.
  • Infections:
    • Syphilis
    • Fungal diseases
    • Tuberculosis

These infections can lead to weakening of the nasal septum.

  • Medical interventions: Procedures such as elective surgeries or cauterization performed to stop nosebleeds may increase the risk.
  • Bad habits:
    • Drug use
    • Steroid-containing nasal sprays
    • Vasoconstrictive sprays

Use of these products can weaken nasal tissues and predispose to perforation.

In individuals with suppressed immune systems, the risk caused by opportunistic infections increases further. The combination of these factors plays an important role in the development of nasal septum perforation.

How Common Is Nasal Septum Perforation?

The prevalence of nasal septum perforation is higher among certain occupational groups. Individuals working in specific industrial environments are particularly at high risk. Chromium plating workers historically experienced various nasal health problems due to exposure to chromium mist. These problems include inflammation, erosion, and septal perforation. Today;

  • Woodworkers,
  • Metalworkers,

are exposed to harmful substances such as nickel dust. This not only increases the risk of nasal septum perforation but also carries a risk of intranasal cancer. Workers in these occupational groups may face various nasal health problems due to harmful particles inhaled from the air. Therefore, understanding how prevalent nasal septum perforation is among individuals with certain risk factors is important for preventive measures and early diagnosis.

What Happens During Nasal Septum Perforation?

Events occurring during nasal septum perforation are shaped by various factors affecting nasal anatomy and function. First, the blood supply of the septum plays an important role. Branches of the maxillary artery supply this area, and any damage can put the health of the cartilage at risk. In addition:

  • Changes occur in nasal airflow.
  • These changes in airflow cause drying of the mucosal surface.
  • The dried mucosa becomes more prone to crusting and bleeding.

During this process, increased turbulence disrupts laminar airflow. As a result, irregularities in airflow increase the sensation of nasal obstruction and may even cause a whistling sound. This condition becomes more pronounced during daily activities such as rest, sleep, or physical exertion. Therefore, nasal septum perforation can lead to significant problems both physically and in terms of comfort.

What Are the Symptoms of Nasal Septum Perforation?

Symptoms of nasal septum perforation include various manifestations that can reduce patients’ quality of life. Patients commonly complain of nasal obstruction. Whistling-like sounds may occur due to air passing through the nostrils, especially becoming noticeable during deep breathing. The following list includes common symptoms of this condition:

  • Nasal obstruction
  • Whistling-like sounds
  • Nosebleeds
  • Intranasal crusting

Additionally, chronic sinusitis symptoms may also be observed, indicating long-term sinus inflammation. Patients may suffer from persistent nasal discharge or unpleasant odors from the nose. These symptoms can be particularly bothersome during daily activities. Inflammatory conditions may cause excessive crusting inside the nose, further worsening breathing problems. The severity of the disease and duration of symptoms are important factors in determining the treatment approach. Symptoms are closely related to the patient’s overall health status and lifestyle. Therefore, obtaining a detailed medical history during examination is of great importance.

How Is Nasal Septum Perforation Diagnosed?

Diagnosis of nasal septum perforation is based on the patient’s medical history and current examination findings. In patients who have previously undergone septoplasty, direct biopsy and extensive laboratory testing are usually not required. However, when the cause of perforation is unclear, biopsy and pathological examination of tissue samples are recommended. Patients are informed that biopsy may enlarge the perforation. Biopsy is usually taken from the posterior margin where damage is minimal.

Laboratory tests:

  • ANCA
  • ANA
  • RF
  • ESR
  • CRP
  • FTA-ABS
  • ACE

If tuberculosis is suspected, a PPD test or other relevant tuberculosis tests may be requested. A CT scan of the sinuses may also be performed to assess disease extent and sinus condition. All these diagnostic methods play a critical role in determining the most appropriate treatment plan.

How Is Nasal Septum Perforation Treated?

Treatment of nasal septum perforation varies depending on the patient’s condition and severity of symptoms. Initially, medical management is prioritized. This approach aims to keep the nasal cavity moist. Water-based gels without petroleum and saline solutions are used. These products help prevent nosebleeds and crusting while minimizing the risk of aspiration.

Moisturizers used in medical management:

  • Water-based gels
  • Saline solutions

As a non-surgical option, nasal septal prostheses may be preferred. These prostheses mechanically close the hole. They are usually made of medical-grade synthetic materials. Although prostheses have a low risk of infection, they require continuous moisturization during use. Tolerance to prostheses varies from person to person.

Features of nasal septal prostheses:

  • Made of medical-grade synthetic material
  • Require continuous moisturization
  • Carry a low risk of infection

In individuals with autoimmune disease, surgical repair is generally not recommended regardless of whether the disease is active. This should be considered carefully, as it may negatively affect the course of systemic diseases. Treatment options are personalized based on the patient’s overall health and characteristics of the septal perforation.

What Are the Complications of Nasal Septum Perforation?

Repair of nasal septum perforation may result in various complications. This condition usually requires surgical intervention. However, in some cases, undesirable outcomes may occur after treatment. These complications, which directly affect patients’ quality of life, are listed below:

  • Persistent perforation
  • Scarring at the donor site
  • Continuation of nosebleeds
  • Problems related to wound healing
  • Persistent nasal obstruction
  • Need for a second surgical intervention
  • Foul-smelling nasal discharge
  • Worsening of existing symptoms
  • Crusting
  • Air leakage causing whistling sounds

These complications may increase the need for additional treatments and interventions for the patient. Problems observed especially during the healing process highlight the importance of treatment methods and follow-up care.

Nasal Septum Perforation: Diagnostic Approaches and Treatment Methods

Differential Diagnosis: In the diagnosis of nasal septum perforation, tumors, infections, and autoimmune diseases should primarily be excluded. Each requires serious and systemic treatment.

Surgical Oncology: If biopsy results indicate a tumor, appropriate referrals are made. The most common septal tumor is squamous cell carcinoma. Other types include adenocarcinoma and malignant melanoma. Surgical excision with wide margins is the main treatment method. Radiation therapy may also be applied when necessary.

Radiation Oncology: If a tumor is detected on biopsy and adjuvant therapy is required, relevant referrals are carried out.

Related Studies and Ongoing Trials: A clinical study is being conducted in China for nasal septal perforation repair. This study evaluates the safety and efficacy of collagen membranes and umbilical cord mesenchymal stem cells.

Medical Oncology: In cases where tumors similar to those requiring radiation oncology involvement are identified and additional treatment is necessary, appropriate referrals are made.

Staging: Although there is no official staging system, perforations are classified as small, medium, and large based on size.

Prognosis: Chronic crusting may cause enlargement of the perforation and various symptoms. These include nosebleeds, pain, foul odor, and loss of support. With moisturization methods, these conditions can be managed and may remain stable for long periods.

Last Updated: January 28, 2026

Leave a Reply

Your email address will not be published. Required fields are marked *

Call Now Button