Causes, Symptoms, and Treatment of Nasal Septum Perforation

Cocaine users are at a significantly higher risk of developing septal perforation. A septal perforation is a disease that affects the nose. In some cases, it may not cause any symptoms, but in many cases, there is a high risk of complications. Some causes, especially cocaine use or certain surgical procedures, such as septoplasty, increase the incidence.  A septal perforation may require medical or surgical treatment. Let’s learn about the characteristics and solutions of nasal septum perforation.

What is septal perforation?

The nose is an essential organ for the proper breathing process and has a complex structure. Two openings, called nostrils, filter the air you breathe. In this way, the air is cleaner, moister, and warmer so it can reach the lungs and prevent infection or injury.

The nostrils are separated from each other by a septum. A structure composed of cartilage and bone that divides the nose vertically. The nasal septum makes up the inner wall of the nostrils. Thus, it helps air to pass through.

Perforation of the nasal septum consists of the development of a hole. Therefore, the two nostrils are connected to each other, and depending on the size of the hole, more or less severe symptoms may appear.

Causes of septal perforation

There are many different causes of septal perforation. Partly because it is a cartilaginous structure, it is sensitive to certain substances that can damage the tissue.

One of the most common causes of this problem is surgery in the nasal area. It can appear as a complication of rhinoplasty, especially if you have had surgery to remove breathing problems. Rhinoplasty is an operation to reshape the nose for aesthetic purposes and to improve breathing.

On the other hand, according to the MSD manual, it may be secondary symptoms caused by infection or trauma. In fact, continuous nose picking and septal piercing (piercing through the septum) can cause this problem.

Other causes of nasal septum perforation

Another most relevant cause is intranasal drug use. In particular, the drug most associated with this disease is cocaine. Cocaine is now one of the main causes of this disease, according to a study conducted at San Pau Hospital.

Cocaine is a drug that constricts blood vessels in the nose. Therefore, if there is not enough blood supply to the tissue, damage can occur and perforation can occur.

However, various drugs have been implicated in this problem. So do some nasal corticosteroid sprays, for example. The same goes for oxygen therapy through a mask or glasses.

Finally, another cause of this disease is exposure to chemicals or toxic substances. This mainly happens to people who work in the chemical industry or factories.

Symptoms of septal perforation

Symptoms depend on the size of the hole. It can be a very small hole less than half an inch. Or it could be larger, by an inch or more.

If symptoms are present, the most characteristic feature is frequent nosebleeds. The medical term for nosebleeds is “nasal bleeding.” The nostrils have strong blood vessels, so bleeding can be heavy and worrisome.

In some cases, patients suffer from rhinorrhea instead of nosebleeds. A runny nose is a medical term for a runny nose. Also, a scab often forms around the hole, which can make breathing difficult.

It is common for people who suffer from this symptom to have a headache or pain in the nose itself. Another characteristic sign of septal perforation is wheezing. It produces a high-pitched whistling sound when breathing. This is because each time you inhale and exhale, air passes through the hole.

Finally, the disease can also have aesthetic consequences. According to the Herediana Medical Journal, saddle nose is a deformity most often caused by this disease. It is characterized by a concave nose bridge.

Treatment of septal perforation

The choice of treatment method depends on the patient’s symptoms and the size of the hole. In many cases, a medical approach is sufficient. Your healthcare professional may prescribe an ointment made with bacitracin or mupirocin. This ointment reduces the formation of scabs at the puncture site.

The patient may also use saline administered as a spray. Like ointments, they help reduce the formation of scabs and ulcers.

In some cases, surgery may be required. The doctor can take it from another part of the patient’s body and do a tissue transplant. In fact, even artificial membranes are placed to close the hole.

Other surgical alternatives

Doctors at the University Hospital of Barcelona perform an alternative surgical treatment to reconstruct a perforated septum. For this operation, a flap isolated from the fibrous tissue surrounding the skull (cranial periosteal flap) is used.

First, the scalp is incised to collect tissue. Then make a hole through the forehead bone. The tissue is then placed over the nasal cavity. In this way, the shape of the septum is changed and the hole is removed.

The advantage of this surgery is that it is painless and quick to recover. It also leaves no scars. The only scar is on the back of the skull, which the scalp itself covers.

Diagnosis of septal perforation

For the diagnosis of septal perforation, it is important for the doctor to know the symptoms and to check the nasal cavity. For this, you can rely on complementary tests to clearly see the nostrils.

It consists of inserting a small tube with a camera through the nostril. Another tool may also be inserted through this tube to remove the scab. In fact, doctors sometimes take tissue samples.

A study published in the Journal of Radiology described computed tomography as one of the most useful diagnostic tests, especially for cocaine users.

Nasal septal perforation is preventable

It is important to note and remember that in most cases, septal perforation can be avoided. This is because it tends to occur due to inhalation of drugs or irritants.

So, in addition to avoiding these kinds of destructive habits, protecting your nostrils is essential if you are working in the chemical industry or factories. You should also talk to your doctor if you start to experience any of the symptoms described above.