Sometimes, we may notice abnormal changes in the nose area, which may occur as a result of an injury to the nasal septum. This can affect the structure and function of the nose, leading to deformities within the nasal cavity, causing the person to feel confused and anxious. Therefore, we will now in Dalili Medical learn about the concept of nasal septum perforation, its most important symptoms and causes, and how we can overcome it.

**Can a nasal septum perforation heal on its own?**

 

Yes, sometimes a nasal septum perforation can heal on its own, especially if it is small. However, it may require some medical or surgical procedures if the perforation is medium or large.

**Is it possible to live with a nasal septum perforation?**

 

Perforations in the back of the nose tend to be unnoticeable and asymptomatic, making it possible to live with them without the need for medical or surgical intervention. On the other hand, perforations in the front of the nose may cause a range of annoying symptoms.

**Is a nose piercing dangerous?**

 

Any piercing carries a risk of bleeding, but piercings in the nasal septum area may be more prone to bleeding. The piercing can also lead to the formation of a hematoma that may fester or become infected, or remain in the nose, affecting the appearance.

**How ​​can a nasal septum piercing be repaired without surgery?**

 

Many piercings do not need to be closed. Small piercings may only require frequent rinsing with saline and the use of moisturizing gels, which can be purchased without a prescription. Larger piercings may require surgical techniques to close them.

When does a nose piercing close?

 

Most piercings heal within six weeks

**Can a nasal septum piercing cause sleep apnea?**

 

A deviated septum causes nasal obstruction, which increases the patient's risk of sinusitis, especially if the deviation blocks the opening of the sinus. It can also lead to nosebleeds due to dry air currents, and the severity of obstructive sleep apnea may increase.

**How ​​effective is septal perforation surgery?**

 

The results of surgical closure were studied in 141 patients, with an average follow-up period of 39 months. Complete closure of the nasal septum was achieved in 93.6% of cases, while perforations smaller than 1.5 cm in diameter were closed in 96.7% of patients.

**Can a septal perforation cause brain damage?**

 

There is a risk of seizures or brain damage if the infection spreads to the brain. An untreated deviated septum can also lead to a serious condition called sleep apnea.

**Can you live with a septal perforation?**

 

Posterior perforations (at the back of the nose) tend to be unnoticeable and asymptomatic, making it possible to live with them without the need for medical or surgical intervention. However, anterior perforations (at the front of the nose) can cause more obvious problems.

How can you tell if you have a septal perforation?

 

A septum piercing doesn’t always cause symptoms, but possible symptoms may include nosebleeds, difficulty breathing, and a stuffy nose. You may hear a whistling sound when you breathe. In about half of cases, this occurs after surgery to treat another nasal condition.

Is a septum piercing unhealthy?

 

First, a septum piercing can damage the cartilage in your nose, which can cause it to become deformed over time. Additionally, hoop earrings can put pressure on the hole and cause it to close. Finally, both the piercing and the earrings can trap bacteria and dirt, increasing the risk of infection.

**What is a nasal septum piercing (NSP)?**

 

A nasal septum piercing, also known as a nostril, is an opening in the middle cartilage or bony nasal septum that separates the nostrils. In most cases, this piercing doesn’t cause any discomfort, but some patients who do experience symptoms may complain of frequent nosebleeds, crusting, wheezing, headaches, dryness, and congestion. Anterior perforations are usually the ones that cause complaints, while posterior perforations are often asymptomatic.

**What is the nasal septum?**

 

The nasal septum is a wall made up of cartilage and bone that divides the nasal cavity into two separate airways on the right and left sides. It is important to know that the mucous membrane that covers the nasal septum and the coils inside the nose warms, humidifies, and purifies the air before it reaches the lungs.

**What happens after surgery?**

 

After the nasal septum perforation repair procedure, the doctor immobilizes the nose with a splint that is left on for 5 to 7 days. Complete healing usually takes 2 to 3 weeks. Patients may experience a lot of nasal discharge after the dressing is removed. Patients are often advised to rinse their nose with saline to speed up the healing process. They are also asked to refrain from blowing their nose.

What are the results of nasal septum perforation repair surgery?

 

The success of the surgery depends in part on the size of the perforation and the extent to which proper aftercare is followed at home. Smokers and diabetics may have a lower success rate, as these factors can affect blood flow to the nasal septum.

**What are the causes of nasal septum perforation?**

 

A nasal septum perforation can occur as an unintended complication of previous nasal surgery, or as a result of exposure of nasal tissue to chemicals, or other injuries. Prolonged use of some steroids or nasal sprays is also associated with this condition.

**A. Injuries**

- **Surgical:** The perforation may occur during surgery to remove nasal cartilage or from the submucosal layer.

- **During surgical cauterization:** to treat epistaxis (recurrent nosebleeds).

- **As a result of repeated nose picking.**

- **During the installation of a nasogastric tube:** to deliver food to the stomach through the nose.

- **Cocaine and heroin addictionYen:** They lead to shrinkage of the blood vessels that feed the nasal septum, causing it to atrophy and then perforate the septum.

- **As a complication of blood clots:** in the nasal septum resulting from trauma or a blow to the nose.

- **Atrophy due to pressure:** as a result of placing nasal plugs for long periods.

- **Disturbed airflow.**

- **As a result of an accident:** This is rare.

**Difficulty breathing:** A large hole can sometimes lead to a disturbance in the airflow in the nose, causing a feeling of inefficiency in the nose. Breathing usually returns to normal when the septum wall is treated, provided that there is no extensive internal scarring.

Runny nose: The irregular airflow resulting from a perforated nasal septum can dry out the inner membranes, which stimulates the nose to produce fluids to maintain moisture.

B. Infections: This condition is considered a complication resulting from the following diseases:

- Nasal septum abscess

- Lupus erythematosus

- Leprosy

- Syphilis

- Sarcoidosis (protein deposits in body tissues)

- Acquired immunodeficiency syndrome (AIDS)

- Crohn's disease

- Rheumatoid arthritis

- Dermatomyositis

C. Medications: Long-term use of nasal sprays, especially those containing cortisone.

D. Tumors: These include benign and malignant tumors such as:

- Cancer of the nose and nasal septum

- Lymphoma

**Surgery:** Procedures such as septoplasty, rhinoplasty, and sinus surgery may lead to a perforation in the nasal septum.

**Prolonged use of nasal steroids or decongestants:** Some steroid nasal sprays can irritate the mucous membrane of the septum, leading to a perforation if used for long periods.

**Excessive and repetitive nose picking.**

 

**Autoimmune diseases:** Certain systemic diseases, such as kidney and vascular diseases, as well as collagen-related vascular disorders, such as lupus, rheumatoid arthritis, and polychondritis, can contribute to a perforated septum.

**What are the symptoms of a perforated septum?**

 

Patients can experience a variety of painful and bothersome symptoms that make daily life more challenging. Patients may experience one or more of the following symptoms, requiring lifestyle adjustments to cope with these symptoms.

**Nasal crusting:** When the walls of the hole open, crusts form and increase in size with breathing, requiring frequent nasal irrigation and multiple medical visits to remove these crusts. Sometimes, the crusts may emit a foul odor that others can easily notice, but patients cannot because their nostrils are blocked.

**Nosebleeds:** The delicate tissues in the pierced area may bleed unexpectedly at inopportune times. Blood loss can be severe if repeated, which can also lead to nasal airway obstruction.

**Wheezing:** Airflow through the nose can produce a continuous whistling sound if there is a small perforation.

**Nasal valve collapse:** If there is a large perforation, the support for the outer part of the nose may be weakened, causing it to collapse or collapse as shown in the following image.

How is a nasal septum perforation (NSP) diagnosed?

 

There are two main methods for diagnosing a nasal septum perforation:

1. An internal examination of the nose is performed by slightly opening the wings of the nose using a specific instrument, which makes it easier to detect the perforation in the front.

2. Detecting the perforation in the back requires an endoscopic examination.

Both methods are painless and take a short time.

Can a nasal septum perforation heal naturally without surgery?

 

In some cases, especially when the perforation is small, spontaneous healing can occur without surgical intervention. However, the larger the hole, the less likely it is to heal naturally.

Nasal washes, ointments, and topical creams can help gradually promote the healing process of the hole.

It is important to note the importance of repairing the hole if it does not heal on its own, given the risks associated with continuing the hole in this sensitive area.

**How ​​is a nasal septum perforation (NSP) treated?**

 

**Nose creams:** Some creams containing petroleum jelly or panthenol, in addition to antibiotic ointments, are used in the nostrils to prevent dryness and crusting.

**Humidifiers:** A humidifier can be used while sleeping to avoid dryness during the night.

**Nasal wash:** An alkaline nasal wash or saline solution is prescribed to help remove crusts.

**Silica plugs:** A silica plug can be used, and antibiotics may be prescribed to prevent secondary infection.

**Surgical cutting and reattachment:** This method involves cutting a portion of the damaged nasal septum and reattaching the remaining tissue, and is the most common and successful method for repairing a perforated nasal septum.

**Galvanic implant:**

This method uses a skin implant from the back of the ear to close the hole in the nasal septum, and is less common and usually used in more complex cases.

**Metal implant:**

This method involves using a small piece of metal to close the hole in the nasal septum, and is suitable for small cases and multiple perforations.

**Medical treatment**

Medical treatment aims to relieve symptoms rather than directly treat the perforation. To achieve this, a saline solution can be used to wash the inside of the nose, in addition to drops, sprays or ointments containing petroleum jelly, glycerin derivatives, vitamin A and vitamin E, as these substances help moisturize the mucous membrane and reduce fluid loss from it.

**Septal button (or septal prosthesis)** A septal button can be used as a temporary or permanent solution. Soft silicone buttons, which are inserted into the opening, close the opening between the nasal cavities.

**Surgical Intervention** The decision to have surgery is madeAfter the failure of conservative treatments with medications.

There are several surgical options, and the choice between them depends on the size and location of the hole, in addition to the patient's general health condition. The available options include the following:

- **Septum button**: An artificial button is installed to close the hole, but this solution may face many problems, as the immune system considers it a foreign body, which leads to inflammation and bacterial or viral infections, which requires periodic follow-up with a specialist doctor.

**Scalp repair**: In the case of large holes, a piece of scalp tissue is used.

What should be considered after nasal septum perforation surgery?

 

Taking the necessary precautions after nasal septum perforation surgery contributes to accelerating the healing process. It is important to protect the nose from external factors, so it is recommended to avoid using nasal moisturizers that contain oils.

You should eat foods rich in water, and stay away from smoking. It is also preferable not to insert any foreign objects into the nose or tamper with it with your fingers.

You should also pay attention to the cleanliness of the nose, and these are some precautions that can be followed after surgery.

In addition, avoiding strenuous sports during the recovery period is an important thing that patients should consider.

Avoid lifting heavy weights, bending over, touching, picking or cleaning the nose vigorously.

Wash the nose according to the doctor's instructions, and sneeze with the mouth open.

It is also recommended to avoid sports and exercises for a certain period, and to adhere to the scheduled appointments for check-ups with the doctor.