Septum perforation: causes, symptoms and treatment

Nasal septum perforation is a pathology that affects the nose. It is a problem that, in some cases, may not cause any symptoms. However, it is also associated with a high risk of complications.

Its incidence increases due to the fact that, among its causes, is the consumption of cocaine and certain surgical procedures, such as septoplasty. Both situations are more frequent today.

Septum perforation may require medical or surgical treatment. Therefore, in this article we explain everything you need to know about this entity and how to solve it.

What is septum piercing?

The nose is a complex structure essential for the breathing process to be carried out correctly. It has two cavities called nostrils that are responsible for filtering the air. Thus, it can reach the lungs cleaner, wetter and warmer, which prevents infection or injury.

The nostrils are separated from each other by the nasal septum. It is a structure of cartilage and bone that vertically divides the nose. It constitutes the internal wall of the pits. In this way, it helps to better channel the passage of air.

Septum perforation consists of the appearance of a hole. There is a communication between both nostrils and, depending on how large the hole is, more or less serious symptoms may appear.

Causes of perforated septum

The etiology of septum perforation is very varied. This is because, as it is a partly cartilaginous structure, it is sensitive to certain agents that can damage the tissue.

One of the most frequent causes of this problem is having performed a surgical procedure in the nasal area. It can be a complication after a rhinoplasty, especially when it is done to eliminate a respiratory problem. Rhinoplasty is a surgery that allows you to modify the shape of the nose, both for aesthetic purposes and to improve the quality of breathing.

On the other hand, according to the MSD Manual, it can also be secondary to infection or trauma. Here we could include the fact of continuously picking the nose. Even the placement of piercings through the septum.

Complications of rhinoplasty include the possibility of a perforation in the septum.

Other causes of this problem

Another of the most relevant causes is intranasal drug use. Specifically, the one most associated with this pathology is cocaine. As expressed in a study carried out at the Hospital de la Santa Creu i Sant Pau, it is one of the most important origins today.

This substance causes the blood vessels in the nose to constrict. Therefore, when not enough blood arrives, the tissue is damaged and can be perforated.

However, not only are drugs associated with septum perforation, but many medications are also linked. For example, some medicinal corticosteroid sprays. In the same way, the use of pure oxygen through a mask or nasal goggles.

By last, Another cause of this pathology is exposure to chemicals or toxins. This occurs, above all, in people who work in chemical industries or factories

What symptoms does a septum perforation cause?

Symptoms of a septum perforation will depend on the size of the hole. It can be a very small one, less than one centimeter, or even reach two centimeters.

In cases where there are symptoms, this is usually based on recurrent nosebleeds. Nasal bleeding is given the medical name for epistaxis. It can be abundant and alarming, because the nostrils are highly vascular.

In some cases, a runny nose appears instead of bleeding. It is the term used to refer to a runny nose. In addition, it is common for scabs to form around the hole, leading to a feeling of obstruction when breathing, as if it were blocked.

It is also common for these people to experience headaches or pain in the nose itself. Another characteristic sign of a septum perforation is wheezing. They are a high-pitched whistling sound that occurs when breathing. It is because air passes through the hole with each inspiration or expiration.

Lastly, septum piercing can have cosmetic consequences. According to the Herediana Medical Journal, the saddle nose is a malformation that is due, in most cases, to this pathology. It consists of a nose with a more drooping nasal tip.

You may be interested: Why is my nose bleeding? 10 main causes


There are different ways to treat this pathology. The choice depends on what the symptoms are and the size of the hole. In many cases, a medical approach is sufficient. An ointment made from bacitracin or mupirocin is used. It is a substance that reduces the formation of scabs in the area of ​​the hole.

A saline solution can also be used. This should be administered as a nasal spray. Like the ointment, it helps reduce the formation of scabs and ulcers.

In some cases it is necessary to resort to surgery. This can be done using a tissue implant from another part of that person's body. Even artificial membranes are placed to seal the hole.

Keep reading: What is turbinoplasty and what does it consist of?

Other surgical treatment

At the Hospital Clinic in Barcelona they perform an alternative surgical treatment to reconstruct the perforated nasal septum. For this surgery they use a flap obtained from the fibrous tissue that surrounds the skull (it is called pericranial flap).

First, an incision is made on the scalp, from where the tissue is obtained. Then an opening is created through the frontal bone. From there the tissue is introduced until it is housed over the nasal cavity. Thus a complete septum is reshaped and the perforation is removed.

The benefit of this technique is that it is painless and has a quick recovery. Also, there are no scars; only in the back of the skull, which is concealed by the scalp.

The nose has an intermediate septum which is the septum. There the perforations are located.

How is a septum perforation diagnosed?

To diagnose a septum perforation, it is important that the doctor knows the symptoms and looks at the nasal cavity. For this reason, complementary tests are used that allow the graves to be seen clearly.

Endoscopy is one of the most widely used tests. It consists of introducing a small tube that carries a camera through the nostrils. In addition, through this tube other tools can be introduced that help remove scabs. Even tissue samples can be obtained.

A study published in the Journal of Radiology explains that computed tomography is one of the most useful tests for diagnosis. Especially in cocaine users.

Septum perforation can be avoided

It is important to highlight and remember that, In many cases, septum perforation can be prevented. This is because it tends to appear from the inhalation of drugs or irritants.

For this reason, in addition to avoiding these types of habits, it is essential to protect the nostrils in the event that you work in chemical industries or factories. In addition, you should always consult a doctor in the event that some of the symptoms that we have mentioned appear.

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