A perforated septum is a hole in the nasal septum, the vertical plane of tissue that separates the nostrils.
The nasal septum is a thin structure in the middle of the nose. In front, it is cartilage, further back it is bone. On either side, it is covered with mucus membranes. The cartilage depends upon the blood vessels in the mucus membranes on either side for its nutrition. If that blood supply is shut off, the cartilage dies, producing a hole or perforation.
Causes and symptoms
There are several causes of a perforated septum.
- Wearing ornaments in the nose. To hang an ornament from the middle of the nose requires that the tissue directly in front of the septal cartilage be pierced or perforated.
- Sniffing cocaine. Cocaine is a potent vasoconstrictor, which means that it causes small blood vessels to close. It is used in nose surgery because it shrinks mucus membranes, permitting better visualization and access into the nose. Used continuously, tissues are deprived of blood and die. The nasal septum is the most vulnerable to this effect of sniffing cocaine.
- Getting the septum cauterized. Nosebleeds usually come from the front part of the nasal septum, which is rich in blood vessels. Uncontrolled repeated bleeding from these vessels may require cautery—burning the vessels with electricity or chemicals to close them off. Injudicious cautery of both sides of the septum has in the past led to death of tissue and consequent perforation.
- More and more people are having cosmetic surgery done on their nose. The procedure, called rhinoplasty, occasionally damages the septum's blood supply.
- Contracting certain diseases. Several diseases— typhoid, syphilis, systemic lupus erythematosus, and tuberculosis—can infect this tissue and destroy it.
- Being exposed to harmful vapors. Toxic air pollutant-like acid fumes, phosphorus, and copper vapor—and sometimes even cortisone sprays—can destroy nasal tissue.
Perforation is not serious. It causes irritation, mostly complaints of dryness and crusting. Sometimes air blowing past it whistles. Picking at the crusts can cause bleeding.
Surgical repair is not difficult. The surgeon may devise a plastic button that fits exactly into the defect and stays in place like a collar button.
Saline nasal sprays may be sufficient to control symptoms and prevent the need for surgery.
Nosebleeds from the septum can usually be controlled with pinching. Vaginal estrogen cream has also been used successfully to toughen the blood vessels.
Ballenger, John Jacob. Disorders of The Nose, Throat, Ear, Head, and Neck. Philadelphia: Lea & Febiger, 1991.
J. Ricker Polsdorfer, MD
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