A nasal septum perforation is a medical condition in which the nasal septum, the cartilaginous membrane dividing the nostrils, develops a hole or fissure.
This may be brought on directly, as in the case of nasal piercings, or indirectly, as by long-term topical drug use like cocaine or decongestant nasal sprays, chronic epistaxis, aggressive digital nasal cleaning (nose picking) and as a complication of nasal surgery like septoplasty or rhinoplasty. Much less common causes for perforated nasal septums include rare granulomatous inflammatory conditions like Wegener's granulomatosis. It has been reported as a side effect of anti-angiogenesis drugs like bevacizumab.
A perforated septum can vary in size and location, and is usually found deep inside the nose. It may be asymptomatic, or cause a variety of symptoms. Small perforations can cause a whistling noise when breathing. Larger perforations usually have more severe symptoms. These can be a combination of crusting, blood discharge, difficulty breathing, nasal pressure and discomfort. The closer the perforation is to the nostrils, the more likely it is to cause symptoms.
The majority of septal perforations can be managed without surgery. The hole will never close but if the open, raw trailing edge of the perforation can heal, the vast majority of symptoms resolve. The open irritated and raw surface must be continuously covered with a cream using a cotton applicator. This will prevent this area from drying out, cracking, bleeding, forming a scab and crusting up. A few months of successful application will allow the ulcerated edge to heal and reduces or resolves symptoms.
In a small percentage of patients surgery is necessary to alleviate symptoms. There are several different surgical procedures with reported success rates between 40 to 95%. Often these can't be reproduced by other surgeons which suggests the actual rate is lower.
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