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Conditions

Nasal Septal Perforation

Nasal septal perforation (Photo from Wellcome Trust)

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When former Eastenders actress, Daniella Westbrook, was photographed at the British Soap Awards in 2000 with her septum eroded from excessive coke-snorting, she not only became the poster girl for the ravages of cocaine, but also brought nasal septal perforation into the limelight. The septum, composed of cartilage and thin bone, can develop a hole in the cartilage, not only through cocaine use, but also as a complication of previous nasal surgery, excessive nose picking, trauma, cancer, or diseases such as tuberculosis or syphilis. As damage reduces blood supply in the septum, the cartilage begins to die, and a hole develops. Many septal perforations don’t need to be closed, and small perforations may need only frequent rinsing with prescription saltwater solutions and applying lubricating gels. Septal ‘buttons’ can also be inserted to fit the hole, which can be an alternative to surgery. However, there are various surgical techniques available for larger perforations, which can be performed under general anesthesia.

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Hi Sue, I have now had a second opinion from one of UK's most respected Rhinoplasy consultant surgeons. My hole is too big to have either a specially molded prosthetic or any kind of grafting surgery done. I was told no one in the UK would do it. It is estimated at 30mm or more and there is nothing much left... I would urge anyone who has problems with this not to be embarassed but to be persistent and find out as much info as possible I am pondering setting up a page with refernces, info and a place for people to discuss as this, along with the asthma I have now developed have been ruining my life over the last 5 years (my first ENT consultation was 2005) and it does seem to be something that GP's ignore... Even after having a button fitted and attending emergency GP and A&E with problems I could not get help... I was not even offered advice or warned about the massive 1" long .5" wide blood and mucus clots would cough if in very unnerving and uncomfortable manner. I agree with Sue pursue the issue with your GP's... I also have been diagnosed with rhinitis and asthma and all the specialst said I can do is try to keep it clean and lubricated (Sterimar and aquagel)... pursue a surgical solution whilst it is small and do as much research as you can before hand... I was blamed by my GP for not doing research myself... hmmm sadly I never got paid 50k a year to do such research...





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I wish you would set up a page as it seems to be more common a problem than what I first thought!!!!! It would really help people as in the UK information is so difficult to find. In Anerica they close very large perforations so I don't understand why they can't do it here.

thanks Tara, I am not so well up on setting up pages but I believe it can be done on facebook so may well do so in order that others don't have to suffer my fate. At least it will be something positive to think about at a time where everything often seems dark and hopeless... I will post here if I make a start and I do have some links and such that would likely be useful... My interpretation is that research and spending within the NHS is limited so things such as septal perforation are very low down on list in UK and 90% of health professionals I have seen ask the cocaine question first of all, so there also seems to be an element of it is your own fault tough luck! My figuring is that in the states during the 70's and 80's there were a lot of very wealthy people from rock stars, to hollwyood types and wall street folks using cocaine and thus developing the problem... Having a private healthcare system those folks can obviously afford to pay and with that being so widespread and a much larger population in the US, it would be viable to make such surgeries and research viable? In my own case it seems my gp's either did not investigate my nose or did not even realise what the septum is as they claimed there was no septal deviation in notes of two recent examinations... no deviation because there is hardly any septum... I hada potholing society contact me to see if they could start leading group expeditions to explore! :(

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Hi i haven't got a hole yet but I went on a silly coke binge as I had my heartbroken so it was my escape ! Lasted about 2 months every morning wake up with horrible scabs in my nose only way to breathe is to pick them out but is that a bad idea ? I haven't done the coke in 6weeks and it's still not healing my cartlidge looks really thin should I see a doctor or just buy some saline and resist picking? Is there really anything else a doctor would tell me over that ?





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Hi Anna, Yes you should stop picking. There are lots of things your doctor could do but from my experience they seem really uninterested as do some consultants (from my experience) To be honest given the scabbing I think you could possibly find naseptin cream very useful it really helped for me to soften the "crusting" and blood clots to a point they would loosen with blowing... Naseptin is only supposed to be used short term though and a doctor may not prescribe in your case... I am now also using "aquagel" on advise of consultant along with sterimar... You should go and see your doctor and insist on some help to deal with the irritating scabs and crusting. the temptation to pick your nose to clear the rubbish can be extremely great and if it wakes you in the night as mine always has done, you sometimes aren't so conscious to stop that instinct... Seek medical help before you end up with a perforation and obviously seek alternative means of help rather than cocaine if you have issues :)

I was just diagnosed with a perforated septum. i picked my nose when I could not otherwise reomove what was blocking my paassages..almost everyday. It is weird to admit but that is what I did.my dr.said there is nothing that can be done, I will live a long an dhealthy life, the whistle will come and go, and there does not seem to be any other purpose accroding to him for the septum, accept for the whistle. So t is a pain. Itis not lfe threatening and your nose will not cave in, and no one can see it and in the big picture, I think we could do worse. I am going to go with this!





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Exactly what my Dr said Susan! Had a large perforation for years..don't worry at all... plenty of people with life threatening situations so this is not a biggie at all ..

My perforation is tiny but it causes dry crusting. I have seen four ENT consultants and one of them is a specialist. He also said that mine was so small that it isn't worth repairing and yet I feel as though it is making me feel ill. However, the anxiety and stress that can come with this is also likely to cause nose symptoms and I am stressed about mine.

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Has anyone had their septal hole repaired? If so who is the best surgeon in the UK? Most experts are in the US but I cannot find a surgeon here who fixes holes like they do in the states.





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I had mine fixed by Charles East in London. Press your GP for a referral. Long waiting list but amazing surgeon.

Hi Linda, You will have to research consultants in your area and try to find one who at least specialises in nasal issues, preferably rhinoplasty. It can be a long process to research ENT consultants at all your local hospitals (where you may be referred by NHS appointment system)... even then through the appointments system, it is pot luck who you get referred to as the NHS system has no mechanism to refer you to an appropriate specialist... I telephoned the hospital outpatients team leader and she was extremely helpful and understanding the situation she asked the consultant if he would see me, which he agreed... sadly in my case, this has gone on so long and the hole is now too big to be operated on :(

Does anyone have any solutions so far for the perforated septum? I have two holes in my septum because of picking dry blood. I don't really have any problems with it during the day, but at night when I sleep it start to whistle, that drive me mad. I can't get a good night sleep because of it. My mouth is constantly dry during the night because I breath through my mouth. I was thinking about this silicone buttons, does anyone tried that. and how is it working. I know I should just go and see a ENT, but I dread any operations.





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before go sleep I make small wet ball out of toilet paper and press it in nasal perforation from both side by fingers. In morning I removing it.

Thanks Sly, I used to put a small piece of wet cotton in my nose, not in the perforation though, but the cotton got dry, and it just didn't work for me. I will try the toiletpaper, at least it won't whistle :)

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Ive got to see the ent dr on the 29th of this month. My dr said i need to have a biopsy taken and will need surgery to close the hole in my nose. I'm really nervous. How long will i be in hospital for ? Will i have black eyes after the ip i'm worryin myself sick about it all.





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Hope your op went well Debbie

I've had a septal hole since I was 17, and am now 50. Septal stoppals were tried but were never successful. Lots of nose bleeds over the years. Unfortunately it's so uncomfortable I can't leave it alone. Now I'm worried as I have severe throbbing in the inside of my nose, and my glasses feel sore on the bridge of my nose. Have had a lot of sinusitis which is very painful, but more recently some pressure in back of neck, top of head and what appears to be mid-brain pressure/sensations. I'm actually very scared but drs just don't appear to be interested. Any suggestions?





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I would wonder if the pain you're having isn't sinus pressure related. Don't believe it's related to your spectacular perforation.I have the hole from picking at dry crusts. Embarrassing but true. If you were not a picker, you might have an ENT doctor or internal medicine doc check you for an autoimmune problem.

Hi Karen, you really need to stop picking your nose, it will only make it worse and you introduce debris and bacteria via your fingers, which may well cause infections... When you see a consultant it is ear nose and throat as they are all connected... I have had headaches, bad earaches, sinusitis, inflamed, itching watering eyes, the feeling of constantly wanting to sneeze and more... If you are having nose bleeds and crusting you could perhaps speak to the doctors about use of something such as naseptin or sterimar and perhaps a gel lubricant such as aquagel... These things bring some relief both in terms of they moisturise and after recently starting to use the sterimar it does seem to have cleansed an area that was troublesome at base of my nose that is problematic after having button removed. After being told my hole is too big to operate on I am now stuck with "keeping it clean as best you can"... Picking your nose will likely make things worse both in terms of trauma and infection Insist on some help. If you feel you are not being helped, make a complaint, perhaps contact PALS for help and support... I understand very much and know how soul destroying and devastating it can be, despite the indifference of medical professionals...

Im setting up an appointment with my dr to find out what can be done about the hole in my nose. Iv had nose problems for 5 yrs and now a hole in the cartlidge dividing my nostrils has developed. Are there certain questions I need to b asking my dr?





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see my post and reply below I cover several things to get you started thinking about this...

Don't get a nose button please don't do it you Will regret it the rest of your life

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I also consistently pick my nose and I have dried blood on the cartilage most of the time due to my constant picking. I can feel that my cartilage is getting thinner and can't stop picking my nose. This is embarrassing for me and I don't really talk about it. However; I am really beginning to worry about my strange addiction and am looking for any advice I can't get. Thanks in advance.





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I'd suggest that you use a saline solution rinse to keep your nasal passages moist, also don't use your finger to pick your nose, blow it instead. I wish I knew about saline rinse before I started picking at the bloody scabs, I wouldn't have this hole now :(

You need to stop picking! This is how I got the hole in my nose. I picked the same scab for 5 years and one day, I picked it and I saw blood coming from both of my nostrils and started to whistle out of my nose. Now I have to deal with this hole the rest of my life. My doctor said there are surgeries, but are usually very unsuccessful. Pretty much you have to learn to live with it. Buy a NettiPot, or any nasal saline, and use that for a few days to see if your stabbing goes away.

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Has anyone has a biopsy done because of the perforation? Please share your experience





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Yes I had a biopsy taken. I still don't understand what the letter means but at least it was confirmed no issues with erosive diseases...

I had a biopsy because my ENT said the septal perforation could be related to an autoimmune problem but I didn't have that, based on biopsy results.

I had a biopsy because my ENT said the septal perforation could be related to an autoimmune problem but I didn't have that, based on biopsy results.





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It looks like no one else has asked this question, so please fill in the rest of your details below.





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