Causes of Septal Perforation

A septal perforation is a hole in the septum, the bony, cartilaginous structure located between the right and left cavities of the nose. If you suspect that you or a loved one may have a septal perforation, you’re probably wondering what caused it. Read on to learn about the various potential causes of septal perforations.

Causes of Septal Perforation

A septal perforation develops as a result of reduced blood supply to the septum, which causes the cartilage to die. A number of factors can cause this reduction in blood supply, including:

  • Nose fracture or other trauma to the nose
  • Sickness
  • Inflammation
  • Infection
  • Previous nose surgery
  • Using nasal steroid sprays for a prolonged period of time
  • Diseases such as tuberculosis, cancer, syphilis or Wegner granulomatosis
  • Inhaling drugs such as cocaine
  • Inhaling dangerous chemicals

Inhaling drugs or chemicals can lead to a septal perforation by causing a narrowing of the blood vessels (vasoconstriction), which reduces the blood supply to the cartilage and membranes in the septum. This can cause tissue loss, eventually leading to a perforation.

causes of septal perforation male patient before and after photo

What Is It Like Living with a Septal Perforation?

A septal perforation can make life difficult in many ways. A runny nose, bleeding, crusting, infection and a whistling sound when breathing are just some of the issues a person with a septal perforation might experience. In addition, there are potential cosmetic issues; the main one is a deformity called “saddle nose deformity,” in which a dip or “saddle” forms as a result of the nasal bridge collapsing.

However, thanks to advances in nasal surgery technique nearly all perforations can be repaired. However, not all surgeons know the latest techniques or have the training to perform them, so it is essential that you find a qualified specialist that with extensive training and experience dealing with septal perforations.

Determining the right course of treatment for a septal perforation depends on the circumstances of the individual patient. Some patients can successfully be treated with nasal lubricants, saline sprays or gels, or even over-the-counter ointments, while others will need surgery. Sometimes a septal button can reduce symptoms of dryness or blockage. If non-surgical methods prove ineffective, or if a patient is experiencing significant pain, bleeding or difficulty breathing, surgery may be required. However, surgery to repair a septal perforation is complex. Patients with large perforations may not be good candidates for surgery, because the surgery may adversely impact blood flow to the area being treated. The success rate for surgical repair of larger septal perforations is lower than for smaller perforations. Therefore, before determining that a patient is a suitable candidate for surgery, the physician must conduct a thorough exam, assess the patient’s medical history, and possibly order tests. In truth, septal perforation repair should be considered as a last resort, and should only be performed if all other methods have proved unsuccessful.

Potential Septal Perforation Complications

No matter what the cause of a septal perforation, it is very important that patients suffering from this condition seek treatment. If a septal perforation is not repaired it can lead to a host of problems, from bleeding and crusting to nasal congestion because air can’t flow through the nasal passages properly. In some cases a septal perforation can lead to voice changes. Most patients will eventually notice a change in the appearance of the nose. And in some cases septal perforations lead to infection, a potentially serious complication.

Furthermore, as a perforation expands, it continues to compromise the stability of the nose until eventually the nasal bridge collapses. As mentioned above, this can cause a “saddle nose deformity,” which is aesthetically unappealing and interferes with the patient’s ability to breathe through his or her nose.

Unfortunately, because the septum is hidden, some patients fail to seek treatment in a timely manner.  If you suspect that you or a loved one has a septal perforation, schedule an appointment with a qualified otolaryngologist (ear, nose and throat specialist) immediately. Failing to treat a septal perforation can have serious consequences.

Choosing a Surgeon

Because septal perforation repair is such a complex procedure, it is imperative that you locate a doctor with the requisite training and experience to properly treat the condition. A qualified otolaryngologist will be able to determine the best course of action. Should surgery be recommended, make sure to choose a board-certified facial plastic surgeon with experience performing septal perforation repair.