What Is a Perforated Septum?

Symptoms of a perforated septum will vary from person to person. Often, the symptoms will depend on the size of hole in your septum. These can be classified as:

• small (smaller than 1 centimeter)
• medium (between 1 and 2 centimeters)
• large (bigger than 2 centimeters)

A doctor will be able to determine the size of the perforation.

You may never know you have a perforated septum. Many people don’t have symptoms. Symptoms will vary in severity and may include:

• wheezing through the nose
• crusting of the nose
• scabbing in the nose
• feeling of obstruction in the nose
• nosebleeds
• runny nose
• nose pain
• headache
• malodorous smell in the nose

A perforated septum can occur for many different reasons.

Some causes of a perforated septum include:

• previous surgery on the nose
• trauma, like a fractured nose
• intranasal steroid, phenylephrine, or oxymetazoline spray
• cocaine use
• certain types of chemotherapy
• autoimmune disorders, particularly Wegener granulomatosis with polyangiitis
• certain infections

You may also be at increased risk for a perforated septum if you work with particular chemicals, such as mercury fulminate, arsenic, cement, and those used in chrome plating.

If you work in these environments, you can reduce your risk of a perforated septum by:

• changing the chemicals used
• reducing chromic acid mist
• using the right protective equipment
• practicing good hygiene

You can decrease the risk for a perforated septum by:

• using a humidifier in your bedroom
• using saline-based nasal spray
• avoiding nose picking
• avoiding cocaine

It’s possible that you have no symptoms from your perforated septum. You may have no reason to visit the doctor if symptoms are absent or undetected. You should visit your doctor if you suspect a perforated septum or have problematic symptoms related to your nose or breathing.

A visit to your doctor for a perforated septum may involve:

• questions about your symptoms, health history (including prior surgeries and medication use), and habits (such as drug use)
• examination of the outside of your nose
• one or more procedures to examine the inside your nose, including rhinoscopy, nasal endoscopy, or palpation of the septum
• biopsy of the perforation
• possible laboratory testing, especially if a medical cause is suspected

Diagnosis of the perforated septum will lead to a treatment plan directed by your doctor. Your doctor will aim to treat the underlying cause (if found), decrease the symptoms caused by the perforated septum, and close the hole if possible or necessary.

There are many first-line treatments you can try to reduce symptoms of a perforated septum, such as:

• irrigating with saline sprays in the nose
• using a humidifier
• applying an antibiotic ointment

Another nonsurgical method involves using a prosthesis in the nose to plug the hole in your septum. This is described as a prosthetic button. Your doctor can insert the button with a local anesthesia. The prosthetic may be a generic-sized button or one custom made to your nose. These buttons can seal your septum and may reduce symptoms. There are certain button types available where you can remove the button daily for cleaning purposes.

It may be necessary to try surgery to repair your septum and eliminate the hole. Your doctor may only be able to repair a small hole in the septum. This can be a complicated surgery that only specialized doctors can perform. This type of procedure requires general anesthesia and an overnight hospital stay for monitoring and recovery. Your doctor may cut your nose on the underside and move tissue to fill the hole in your septum. Your doctor may even use cartilage from your ears or ribs to repair the septum.

Home-based remedies may be enough to alleviate symptoms and require no recovery time.

More severe cases of a perforated septum may require a prosthetic or surgery. Having a prosthetic inserted may just be as simple as going to the doctor for a visit. Recovering from repair surgery will take much longer. It may be several weeks before you’ve fully recovered from surgery, and you may have splints in your nose for a few weeks following the procedure, as well.

Another condition that affects the nasal septum is known as septum deviation. This is different from a perforated septum. A deviated septum describes when the septum is not centered, and is unbalanced too far toward the right or left side of the nose. This can obstruct the airway on one side of the nose and lead to other symptoms like congestion, snoring, and sleep apnea. You could have some similar symptoms to a perforated septum, like bloody noses or headaches.

A trip to the doctor will help to diagnose your nasal condition. Correcting a deviated septum is a much simpler process than fixing a perforated septum. Often, the procedure to correct a deviated septum can be done in 1­–2 hours, and you typically go home afterward on the day of the procedure.

You may have a perforated septum and have no symptoms. Or you may be acutely aware of the condition because of significant symptoms. Your doctor can diagnose the condition and help you find the most appropriate treatment.