Septal Perforation: Causes, Symptoms & Diagnosis
A septal perforation is an opening in the nasal septum, the structure that separates the left and right sides of the nose. For example, symptoms can range from mild irritation to persistent bleeding, crusting, whistling and nasal obstruction.
What Is a Septal Perforation?
The nasal septum is the wall of cartilage and bone that separates the two nasal passages. A septal perforation develops when an opening forms through this structure.
However, the effects of a perforation vary. People may have few symptoms, while others experience recurrent nosebleeds, crusting, irritation, abnormal airflow, whistling or difficulty breathing comfortably through the nose.
In addition, the size and position of the opening, the health of the surrounding tissue and the underlying cause all influence how the condition should be assessed and managed.
Read the detailed background →Septal Perforation Location
For example, the position of the opening within the septum can influence symptoms and the pattern of airflow through the nose.
Septal Perforation Size
Similarly, small and larger perforations can behave differently and may require different approaches to symptom management or treatment.
Septal Perforation Cause
Therefore, establishing why a perforation developed can be important before deciding whether further investigation or treatment is appropriate.
Symptoms of Septal Perforation
For this reason, symptoms differ from person to person and may be influenced by the size and location of the perforation and other nasal conditions.
Whistling
Altered airflow through the nasal septum can produce a noticeable whistling sound when breathing.
Nosebleeds
Dryness and irritation around the edge of the perforation may contribute to recurrent bleeding.
Crusting
Disrupted airflow and drying can cause crusting to develop within and around the perforation.
Nasal Obstruction
However, patients may describe congestion or a sensation of restricted airflow despite the presence of an opening.
Irritation & Discomfort
Dryness, inflammation and crusting may lead to discomfort or tenderness inside the nose.
Recurrent Nasal Problems
In addition, people may experience repeated irritation, discharge or other associated nasal symptoms.
Causes of Septal Perforation
A septal perforation can develop for several different reasons. Therefore, establishing the possible cause is an important part of assessment because it may affect further investigation and treatment.
Previous Nasal Surgery
For example, a perforation can occasionally occur following procedures involving the nasal septum.
Trauma
Similarly, direct injury or repeated trauma to the nasal septum can damage the tissue.
Medical Conditions
In addition, certain inflammatory, autoimmune or other medical conditions may affect the tissues of the nasal septum.
Nasal Exposure or Irritation
Repeated exposure to substances or significant irritation can damage the lining of the septum.
Can a Septal Perforation Cause Complications?
However, not every perforation progresses in the same way. Larger or symptomatic perforations may require closer assessment where nasal function or structural support is affected.
Persistent Nasal Symptoms
Ongoing crusting, bleeding, dryness or obstruction may significantly affect comfort.
Enlargement
Over time, perforations may change, particularly where the surrounding tissue remains unhealthy or irritated.
Structural Problems
Significant loss of septal support can, in some cases, affect the structural stability of the nose.
How Is Septal Perforation Diagnosed?
First, diagnosis normally begins with a detailed medical and surgical history followed by examination of the nose.
Clinical History
Next, symptoms, previous nasal surgery, trauma, medications and relevant medical history are reviewed.
Nasal Examination
Examination helps assess the location, approximate size and condition of the tissue surrounding the perforation.
Nasal Endoscopy
In addition, endoscopic examination may provide a more detailed view of the nasal cavity and associated structures.
Further Investigation
Finally, additional tests may be considered when the history or examination suggests an underlying medical cause needs to be investigated.
When Should You Arrange an ENT Assessment?
For example, consider arranging an assessment if you have a known septal perforation that is causing persistent symptoms, or if you suspect a perforation following nasal surgery, trauma or another medical problem.
This website is not an emergency service. If you are experiencing severe bleeding, significant breathing difficulty or another urgent medical problem, seek appropriate urgent medical care.
Septal Perforation FAQs
The questions below address common concerns patients raise when first learning about the condition.
View all FAQs →A true established perforation generally requires assessment rather than assuming that the opening will close spontaneously. Management depends on its cause, size, symptoms and surrounding tissue.
No. Treatment is individual. For example, some patients may be managed with non-surgical measures, while surgery may be considered for selected symptomatic perforations.
Septal perforation is a recognised potential complication of procedures involving the nasal septum, although there are also several other possible causes.
Video consultations are available for an initial discussion. An in-person examination may still be required before a definitive diagnosis or treatment plan can be made.
Discuss Your Septal Perforation With Mr Hassan Elhassan
In addition, Mr Hassan Elhassan is a Consultant ENT Surgeon with experience in nasal and sinus surgery, including the assessment and management of this condition.