14 Jun Septal perforation: Where does a hole in the nasal septum come from?

Various triggers can lead to a so-called septal perforation. This is a hole in the septum, i.e. the nasal septum. As it is not intended by nature at this point, the perforation can lead to various complaints and unpleasant symptoms. How a septal perforation can occur, how a hole in the nasal septum manifests itself and how we can treat it in our ENT practice in Frankfurt in the following.

Basic knowledge: Structure of the inner and outer nose

The nose consists of an outer part (nasal framework) and an inner part (nasal cavity). The nasal septum divides this into the right and left nasal cavities. As a rule, both are approximately the same size - unless there is a Curvature of the nasal septum before. In this case, one main cavity is larger than the other. The nasal septum consists mainly of bone, with cartilage at the front. As an important support, it has a decisive influence on the shape and direction of the outer nose (read our blog post on this: Crooked nose: what to do?).

The nose is connected to the outside world via the two nostrils. There are also inner funnel-shaped openings (Choanen) that connect the two nasal cavities with the nasopharynx.

The paranasal sinuses adjoin the nasal cavity. These are air-containing cavities. Small channels connect them to the nasal cavity. The paranasal sinuses can become inflamed if these small channels are blocked (sinusitis).

Then there are the turbinates, which protrude from the two lateral nasal walls into the nasal cavity in the form of three thin hook-shaped bony lamellae. They are covered with cavernous tissue and mucous membrane.

The nose and nasal cavity are lined with a special mucous membrane that protects against harmful substances that can enter the body via the air we breathe.

Septal perforation: How does it occur?

A nasal septal perforation is a hole in the nasal septum. There are various reasons why this can occur. These include

• Injuries to the facial area due to accidents
• Repeated injuries, e.g. due to manipulation such as frequent nose picking or insertion of objects
• Repeated bilateral sclerotherapy of blood vessels in the nasal mucosa of the nasal septum for Nosebleed
• Pressure on the nasal septum
• Tumours in the area of the nasal septum
• Frequently recurring inflammation of the connective tissue surrounding the nasal cartilage
• Mucosal damage after surgical procedures on the nose
• Chronic inflammation of the nasal mucosa, which destroys the nasal septum in the long term
• Nasal spray addiction (long-term use of nasal spray including corticosteroids and over-the-counter phenylephrine or oxymetalocin sprays)
• Prolonged inhalation of oxygen through the nose, e.g. via nasal masks
• Effects of vascular diseases and diseases such as tuberculosis, leprosy, granulomatosis with polyangitis or syphilis
• the effects of toxic substances such as acids, chromium, phosphorus, sulphuric acid, copper vapour or industrial dust
• Drug abuse - especially frequent snorting of cocaine

Special case: hole in the nasal septum due to septum piercing

The so-called septum piercing has been a trend for years. If everything goes well, the thin membrane in front of the cartilaginous part of the nasal septum is pierced with the piercing. However, getting this piercing is not that easy, which is why women and men who want this type of piercing are strongly advised to go to a studio with an excellent reputation where experienced piercers work.

Each nasal septum is individually shaped and often has irregularities. The cartilage can be hit when piercing - this is very painful and can lead to subsequent problems such as bleeding, inflammation of the piercing area, swelling, allergies or the formation of an abscess.

In addition, the hole in the septum - if the piercing is removed and no longer worn - can remain permanently. If it is too large because a piercing with a large diameter has been worn, there is a high risk that it will not grow back on its own. The remaining hole in the septum is then a potential source of infection or similar.

Septal perforation: symptoms and consequences

A hole in the nasal septum does not necessarily lead to symptoms. Some patients experience no symptoms at all. In this case, we discover the hole more by chance during an examination of the nose. However, this is not always the case.

Septal perforation can also lead to unpleasant symptoms. This can be a dry nose with the formation of crusts and plaque. Bacteria can settle on these crusts and cause inflammation, which is accompanied by yellow and sometimes foul-smelling mucus. Frequent nosebleeds or whistling noises when breathing through the nose are also possible. Some sufferers also report Pain in the nose. In some cases, the septum hole obstructs nasal breathing by causing the airflow in the nasal septum to collide with the posterior wall of the hole. As a result, the air can no longer be optimally channelled.

If too much supporting and stabilising cartilage substance is lost due to progressive perforation, this can even lead to changes in the external shape of the nose. It then becomes visible and can be very noticeable in some cases.

Hole in the nasal septum: how the diagnosis works

In order to detect a hole in the septum, we carry out an examination of the inner nose. The first step is to use a so-called nasal spreader. This expands the nostrils and holds them open. This allows us to illuminate the inside of the nose with a special lamp and examine the mucous membrane. Next, we perform a rhinoscopy. To do this, we insert a nasal endoscope into the inside of the nose and can thus examine the condition of the nasal mucosa, the nasal cavities, the nasopharynx and the front area of the paranasal sinuses. Of course - and in this case above all - we can examine the nasal septum and determine whether there is a hole in the septum.

Treatment of a hole in the septum

How the septal perforation is treated depends on the history of its development and the symptoms caused by the hole. One possible therapy is the use of special ointments that promote the healing of the mucous membrane. Nasal rinsing with salt water can also be helpful.

If the hole is very large, is in an unfavourable location, leads to restrictions/severe discomfort or to an externally visible deformation of the nose, surgery may be advisable. The aim of septal perforation surgery is to permanently close the opening in the nasal septum. This is possible by moving various mucosal flaps inside the nose. We also remove cartilage tissue from another part of the body (e.g. the ear), which we implant into the nasal septum to close the defect.

It is also possible to perform an aesthetic rhinoplasty at the same time. During this procedure, we can also remove nasal humps, equalise the nasal saddle, correct a malposition of the nasal septum or correct the tip of the nose, for example.

Rhinoplasty Frankfurt

We are your experienced partner for the treatment of a septal perforation. With conservative measures or, if necessary, the Nasal septum surgery or the functional plastic rhinoplasty we help you to breathe easy again.

ENT Frankfurt: Dr Thomas Fischer & Dr Albrecht Linke

Your specialists for ear, nose and throat medicine, who will provide you with professional and individualised advice, examinations and treatment in all matters relating to ENT medicine, functional plastic surgery and the aesthetic treatment of changes to the facial skin.

Our news articles are prepared for you to the best of our knowledge and belief and are intended for general education. They are in no way a substitute for medical advice, diagnosis and treatment and are not intended to encourage self-diagnosis or self-treatment. Please always contact your ENT specialist in Frankfurt directly if you have any health complaints!

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