Pickaxes
The edges of the opening dry out and become covered with crusts that are difficult to remove.
CONDITION / CARRY
Perforation of the nasal septum.
Perforation of the nasal septum is a through hole in the septum between the halves of the nose. It may not bother, but may cause crusting, bleeding and whistling; if care does not help, the opening is closed surgically.
CONCEPTUAL VISUALIZATION- what is it
- A through hole in the nasal septum.
- How often
- About 1% of people.
- The most common reason
- Previous operations on the nose; as well as trauma, inhaled substances and inflammatory diseases.
- How to treat
- First — care and moisturizing; if complaints remain - surgical closure.
01 / WHAT IS ITWhat is
What is
perforation of the septum.
The nasal septum is covered on both sides with a mucous membrane that nourishes the cartilage. If the mucosa is damaged on both sides in the same place, the cartilage dies, and a hole forms in the septum.
A small perforation in the depth of the nose may not cause symptoms for years. A large one or located in front disrupts the air flow: the edges of the opening dry out, crusts form, bleed, and the air whistles.
A large opening weakens the support of the back of the nose, and it can sink over time - this is how a saddle nose develops.
This is general information. The doctor will tell you how to proceed after the examination.
02 / SIGNSHow is
How is
perforation manifested.
In a summary of the 408 patients with large perforations, the most common complaints were congestion (62.0%), crusting (49.9%), and bleeding (45.7%).
Bleeding
Repeated small nosebleeds.
whistle
Characteristic whistling during breathing — more often with small openings in the front.
Congestion and dryness
The air swirls, the nose feels blocked and dry.
Sinking of the back
With large openings, the bridge of the nose may fall.
Saddle nose03 / REASONSWhy does a
Why does a
hole appear.
Perforation is most often caused by trauma or surgery, inflammatory diseases, and the use of substances through the nose.
Operations on the nose
The most frequent reason: with large perforations, the consequences of medical interventions — in 61.2%.
Distortion of the septumInjury
A blow to the nose, hematoma of the septum, in children is the most common cause (33%).
Fracture of the noseSubstances
Cocaine destroys the tissues of the middle line of the nose; the process can be stopped only by refusing to use it.
Inflammatory diseases
Some systemic inflammatory diseases affect the septum; then the underlying disease is also treated.
Unknown cause
In more than a third of patients with large perforations, the cause was not established.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Perforation usually does not require emergency care. But the opening, which is increasing, is a reason to find out the reason: some inflammatory diseases and tumors also destroy the septum.
103 immediately if:
- the nosebleed does not stop after 15 minutes of pressing.
See an ENT doctor in the coming days if:
The opening is noticeably enlarged, there are ulcers, pain, depression of the back of the nose, or bleeding for no apparent reason. If you are concerned about crusting, whistling or bleeding, make an appointment for a scheduled consultation.
05 / DIAGNOSTICSHow to define
How to define
tactics.
- Nasal endoscopy
The size and location of the hole, the condition of its edges.
- Finding the cause
Talking about operations, injuries, substances; if necessary, tests for inflammatory diseases.
- Biopsy if necessary
If the edges of the opening are changed or the cause is unclear: this excludes a tumor or an inflammatory disease that destroys the septum.
- CT scan if necessary
Assessment of the septum and sinuses for planning surgery.
06 / TREATMENTHow to treat
How to treat
perforation.
Treatment depends on the complaints and the size of the hole. Most perforations can be controlled without surgery.
01
Without surgery
- Hydration
- Nasal irrigation and crust softening ointments are the first line of treatment.
- Septal "button"
- A silicone prosthesis closes the hole without surgery; it can be removed. It is suitable for those for whom surgery is not indicated or who wants to avoid it.
02
Surgical closure
If complaints persist after treatment.
- The result
- In a meta-analysis of 64 articles (1591 patients), complete closure was achieved in 91%; through the nose or open access - the result is the same.
- Large openings
- Holes larger than 2 cm are more difficult to close: in the summary of data of 408 patients, the success rate is 84.4%. The main factor of failure is the size of the defect.
- Technique
- The opening is closed with flaps of own mucous membrane, if necessary, with a layer between them; there is no generally accepted standard, and the results of different techniques are comparable.
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
The perforation of the septum at the Dr. Valikhnovsky Institute of Surgery is being closed in the direction of "New Nose".
DIRECTION TO THE CLINIC
A new nose
Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors.
Go to direction
What do we do in this condition
- Closure of perforation — with flaps of own mucosa, if necessary with a layer.
- Reconstruction of the partition — if the opening is large and the partition needs to be restored.
- Silicone splints with air ducts — instead of tampons after surgery; allow you to partially breathe through your nose.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
Publications by topic
- Article on the principles of diagnosis and treatment in reconstructive surgery of acquired nasal defects — Clinical Surgery, 2009 (PubMed).
How is the treatment in us
- ConsultationConversation, endoscopy, evaluation of the hole size.
- The reasonExamination to rule out diseases that destroy the septum.
- PlanMaintenance or surgery — and how to close the hole.
- OperationClosure of the opening with mucosal flaps.
- RecoverySplints instead of tampons during healing; the doctor will explain what is possible and what should be avoided after the operation.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
Can the perforation close itself?
No, the hole in the septum does not overgrow itself. But if it doesn't bother you, treatment may not be necessary.
Is surgery necessary if the perforation does not bother?
Not necessarily. Most perforations can be controlled with hydration and care. Surgery is offered if complaints remain.
How successful is the closing?
In a meta-analysis of 1591 patients, the hole closed completely in 91%. The bigger the hole, the more difficult it is: with holes from 2 cm — 84.4%.
Can hormonal sprays cause perforation?
Only isolated cases are described. But in case of bleeding or crusting on the background of sprays, you should see a doctor.
What is a septal button?
Silicone prosthesis that closes the hole without surgery. It can be removed; suitable for those for whom surgery is not indicated or desired.
Does perforation happen in children?
Yes. In a study of 27 children, crusting (73%) and bleeding (58%) were the most common complaints, and the causes were trauma, medical interventions, and tumors. The opening was surgically closed in 4 out of 6 operated patients.
What size hole can be closed?
Small and medium holes are closed most often. For holes up to 2.5 cm, an endoscopic flap with a vessel has been described, with a success rate of 84.6% in a review of 16 studies (148 of 175 patients). The larger the opening, the more difficult the operation.
Why is the nose whistling?
The air passes through a small hole in the front of the partition and swirls. Large holes whistle less often.
Sources
10 sources · reviews, guidelines and studiesShowCollapse
- Surgical repair of nasal septal perforations: A systematic review and meta-analysisInternational Forum of Allergy & Rhinology, 2022doi:10.1002/alr.22965 ↗
- Surgical repair of large nasal septal perforation: a systematic review and meta-analysisEuropean Archives of Oto-Rhino-Laryngology, 2026doi:10.1007/s00405-025-09913-9 ↗
- Success of Anterior Ethmoidal Artery Flaps for Nasal Septal Perforation Repair: A Systematic ReviewLaryngoscope, 2026doi:10.1002/lary.70719 ↗
- Nasoseptal Perforation: from Etiology to TreatmentCurrent Allergy and Asthma Reports, 2018doi:10.1007/s11882-018-0754-1 ↗
- State-of-the-art: septal perforation repairCurrent Opinion in Otolaryngology & Head and Neck Surgery, 2023doi:10.1097/MOO.0000000000000857 ↗
- Endoscopic approach for management of septal perforationEuropean Archives of Oto-Rhino-Laryngology, 2019doi:10.1007/s00405-019-05490-w ↗
- Repair of Septal PerforationsFacial Plastic Surgery, 2022doi:10.1055/a-1883-0539 ↗
- Cocaine induced midline destructive lesionsRhinology, 2014doi:10.4193/Rhino13.112 ↗
- Safety of intranasal corticosteroidsAnnals of Allergy, Asthma & Immunology, 2016doi:10.1016/j.anai.2016.06.009 ↗
- Nasal septal perforation in children: Presentation, etiology, and managementInternational Journal of Pediatric Otorhinolaryngology, 2017doi:10.1016/j.ijporl.2016.12.003 ↗
The figures on the page are from these sources.
Is the nose whistling
or bleeding?
Describe the complaints and whether there were any surgeries or injuries to the nose. The doctor will tell whether care is enough or whether the hole should be closed.