Nasal Septum Perforation Causes, Healing & Repair

May 29, 2018

Many health conditions involve the nasal cavity. One of them is nasal septum perforation. Holes connecting your septum characterizes it.

Firstly, the nasal septum is the part that separates the two nostrils. Some people call it columella. It forms a boundary between the left and right airways. This means that air in the left nostril does not mix with air in the left one.

Additionally, the part is cartilaginous. This means that it is made up of muscles. In fact, it is held in position by a strong muscle known as depressor septi nasi muscle.

To make it form, this membrane contains both a bone and some cartilage. Regarding thickness, the nasal septum is estimated to be 2 mm wide. To effectively perform its functions, the uses the following five structures that make it:

  • Vomer bone
  • Ethmoid bone
  • Septal nasal cartilage
  • Crest of the palatine bone
  • Crest of the maxillary bone

Now that you know what a nasal septum is, we need to talk a little more about perforations. These are simply holes which will vary in size. Huge ones will often cause a nose deformity. Your nose may shrink inwards.

Furthermore, the location of the hole in the septum also varies i.e., the hole can either be posterior or anterior. In other words, posterior perforations are located deeper inside the nose while anterior ones are located near the exit of the nostril.

Signs and symptoms of Nasal Septum Perforation

Firstly, how can you tell if the nasal septum is perforated? What do you look at? While some cases are symptomatic, others are asymptomatic. Most anterior nasal perforations are symptomatic; the posterior ones are asymptomatic.

Wikipedia notes that perforations generally come along with some of the following symptoms:

  • Difficulty in breathing
  • Whistling sound when breathing
  • Blood discharge in the nose
  • Crusting
  • A lot of discomforts, especially during heavy breathing and at night
  • Nasal pressure

What causes nasal septum perforation

According to medscape.com, this perforation is due to many factors. Identifying the cause is the first step towards seeking the right treatment. Closing the hole alone is not enough if the causing problem is not treated. Similarly, it can recur.

Commonly, septal perforation causes are put in the following major categories:

  1. Traumatic causes
  2. Infectious causes
  3. Neoplastic causes
  4. Other environmental-related causes
Traumatic causes

As the name suggests, these are causes that are related to trauma. Many things may cause injury in the nostrils. Some of the common traumatic causes of perforation include:

  • Trauma resulting from a previous surgery
  • Trauma from rigorous and prolonged nose picking
  • Placement of a nasogastric tube
  • Cauterization for epistaxis
  • Insertion of beans or other foreign bodies in the nose
  • Turbulent airflow
  • Use of nasal cannula
  • Septal hematoma

All these traumatic events damage the nasal cavity in one way or the other. As a result, one becomes a victim of septal perforation. However, cases of trauma can be repaired.

Infectious causes

These are also called inflammatory causes since they are closely related to diseases, infections, and inflammations. Some diseases and infections will cause the nasal septum to be perforated.

Some of the common infections causes include:

  • HIV/ AIDs
  • Rheumatoid arthritis
  • Tuberculosis
  • Sarcoidosis
  • Syphilis
  • Dermatomyositis
  • Diphtheria
  • Wegener granulomatosis
  • Crohn disease
  • Systematic lupus erythematosus

Most of the above conditions come along with respiratory infections. In severe cases, these infections attack the nasal cavity. In the process, the septum may get damaged and have holes.

Neoplastic causes

Neoplastic causes are related to abnormal growth of body tissues, resulting in tumors. If this abnormal growth of cells occurs in this area, then one is likely to get perforation.

The common neoplastic causes include:

  • Carcinoma
  • Cryoglobulinemia
  • T-cell lymphomas
Environmental causes

Many environmental components can irritate your mucosal. These, among other topical vasoconstrictors, are the common substances that may irritate the nasal cavity, especially the septum.

The common mucosal irritants that may result in this condition include:

  • Chromic acid fumes
  • Inhalation of cocaine
  • Use of corticosteroids
  • Exposure to oxymetazoline
  • Renal failure
  • Lime dust exposure

Diagnosis

Commonly, patients go to hospital having noted the symptoms noted above, among them wheezing, blood discharge, difficulty in breathing, and general discomfort among others. The health practitioner can do the following to ascertain if it’s septal perforation:

  • Nasal endoscopy
  • Check for any crusting
  • Check nodular mucosa
  • Checking synechiae
  • Histologic diagnosis
  • Histopathologic evaluation
  • Laboratory culture for fungus infections

Nasal septal perforation treatments and cures

This is a complicated health condition that comes along with many problems. However, repair is possible. There are many treatment options depending on where the perforation is and the severity of the same.

The common treatment and prognosis options include:

Medical

Firstly, this involves the application of medical therapy in closing the hole on this cartilage. Secondly, most of the existing medications may not completely close the hole but may minimize the symptoms that come along with the condition.

Similarly, if the perforation causes crusting, drugs can be administered to decongest the nasal cavity. If it is because of a certain disease, then the causative disease is treated first before closing the hole.

Obturators

Ever heard of Obturators? These are prostheses that can be inserted into the nasal cavity to close the existing hole. In this case, doctors make use of nasal silastic buttons. Also, these buttons temporarily seal the holes.

However, some people react to these foreign gadgets. Therefore, it becomes quite hard for some people to live with them for many years. This implies that repairing the damage through surgery remains the only reliable option.

Perforated nose septum repair surgery

As earlier indicated, the perforations may come along with excessive pain and bleeding. Furthermore, large holes can also cause some deformity in the nose; it loses its initial shape. In these cases, surgery becomes inevitable.

The success of these surgeries depends on the size as well as their location. Small anterior ones are simple to close. On the other hand, large posterior perforations are hard to completely close.

Generally, these surgeries may pose some of the following side effects:

  • Firstly, the formation of pus in the nasal cavity after the surgery
  • Secondly, heavy bleeding
  • Thirdly, a severe headache that prolongs for days
  • Fourthly, persistent pain
  • Additionally, high fever
  • Also, a bad smell coming out of the nose.
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