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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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I also find it very difficult to keep clean and mine is also small. My ENT similarly is telling me that it's so small that I should not be having any symptoms and that I have a slight deviated septum which is causing dryness and crusting. I have managed to break the habit of picking at the crusts but it is incredibly hard because of the discomfort of constantly feeling that there is something in my nose. Given the fact that there are a lot of people who suffer with this you would have thought that ENT departments would take it far more seriously than they appear to do so. For example, why do they not agree to close a small perforation and let the patient actually experience for themselves whether or not is makes a difference to their lives? I for one can not convince myself that my perforation is not causing an issue and I have seen four ENT consultants reporting really horrible symptoms that prevent me from leading a normal life.





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Hi I'm 32 an had septal button since I was 11, this hole is 15mm, it is slightly wider in right nostril. My inital button was replaced after 13 years, after it came flying out in a sneeze! I was informed by my ent that the hole had become infected and in turn got larger allowing the button to come loose. I have had no issues with my second button and it's been in place for 8 years.I do not have to clean my nose in any particular way. I function normally. I have had both buttons fitted with only numbing gel and no anesthetic. I'm happy to answer any questions.





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Hi Holly, many thanks for your input. A couple of Questions if I may. Are you a UK resident? What kind of button, plastic or silicone? Once fitted are you saying you didn't have to worry about lubricating your septum every day with saline water or gel? Best regards

Hello. I just found out that I have a hole in my septum while I was cleaning out my nose with a cotton bud and antibacterial cream.i am a chronic heroine user .I did an nasal culture and staphylococcus was found.my questions are is there a link between staphylococcus and deviated septum? Am I the only person who has a hole from heroine use?and is there a possibility I did this to myself with excessive use of cotton buds?also for all my fellow cokaine users out there ,how did you manage to stop the use? It stings so bad I cry every day and haven't been sleeping, I can't imagine not using,and softer a few hours pass I'm in a terrible stare. Thank you





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I had a perforated septum about two and a half years ago, this was due to a combination of over-using nasal decongestant sprays and digital trauma. My nose used to get terribly blocked so I couldn't sleep at night, I'd then use the spray which would work for a few hours then lead to a build up of crust and mucus which I would have to work out. I would clear my nose then straight away use more spray. I ended up with about a 1cm by 1cm perforation. I went straight to my GP who referred me to an ENT consultant but as I was worried about the hole increasing I ended up going private and had surgery to close the hole. This cost around £2000 and was a success...until this month. I was unlucky enough to have to undergo two bouts of surgery for an abscess on my perineum and only a few days ago noticed the whistling noise appearing back in my septum. I immediately got back in touch with the Consultant who operated on me and he said it may have been damage caused when they put thermometer probes up my sinus during the recent surgery, which was under general anaesthetic. He said the hole is tiny at present and to leave and see if it closes on its own. Anything I've read says a hole in your septum will never close on it's own, am I wrong? To say I'm depressed and disappointed would be an understatement. I could honestly cry. I've been rinsing regularly with saline water but I think the hole is getting larger. It's so hard to sleep as the noise from my nose keeps me awake and I'm constantly worried about the septum drying out where it is exposed. Are there any other better lubricating things than just saline water? The saline drys off real quick with regular breathing. I'm also concerned about not being able to have surgery to close the hole again as the first time he used tissue from inside my nose and I doubt that's doable again. I'm considering a septal button but I have no idea if they work well or not. For those wondering, my experience of surgery is great, it works but does leave the repaired part of your septum very thin. I had no idea they stuck probes up your nose during surgery otherwise I would have asked them not to and probably could have avoided this re-occurrence.





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sorry to hear that it has reopened. I was advised to smear a small amount of vaseline in my nostrils and apparently this is a common recommendation. I've got a septal button just now. It's okay and better than not having it as far as breathing is concerned but it is irritating and as the day progresses my noses feels dry and I feel stuffed up. My ENT consultant said he will do the op but then said it could be left alone which confused me a bit - I'm due to have the op quite soon. I'm a bit concerned that if it doesn't work it could make things worse. However if it works it will obviously be better that daily discomfort and if it doesn't work and I end up with another button then at least I know that that's as good as things will get and I'll just need to live with it. I think my hole is about the same size as yours, it was caused by a trauma. Did you have open nose surgery? What was the recovery like - post op breathing etc? Did it affect the appearance of your nose? I was told that it would change a bit but not sure how?

Jo, A few questions if I may... How is the septal button? Do you still need to rinse with saline every day? How often each day? How long does one button last? Do you have to get it changed every few months? My surgery was closed and post-op breathing was difficult. Splints were kept in for 10 days if I remember correctly. It did not change the appearance of my nose.

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I have a septal perforation due to drug use. The first ent I went to was judgmental the second was not. My perforation was about .50 centimeters. But seemed huge to me. I went to see about a septal button due to whistling.. Very embarrassing and stressful. The dr. Thought I should have surgery. I was reluctant due to what I had read about surgery and its success. My surgery turned out well and has healed nicely. Recovery was a bit uncomfortable. I hope this helps.





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Hi I wanted to tell you that I have had 4 opps and it created a1 cm by 2 cm perforation in the nose, my nose collapsed at the front after 3 months. I have just came back from LA where I have had the surgery to try and fix this problem, if you need help just let me know and I will try and help you

Hi Crystal What made you go to LA and can I ask the cost? Did you have bay boos in the UK done first? Thanks

can anyone who has had surgery comment on how it has affected the shape and external appearance of your nose





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I am a former cocaine user, and I have a HUGE perforated septum due to long term use. My question is, has anyone ever had their nose collapse from lack of a septum? That is my biggest fear. I'm scared to go to an ENT because I've had a few that judged me... Like I chose to be an addict and have this terrible nasal condition. Would it be better to get it checked out by a plastic surgeon?

I went to LA because no one in England was really trying to help me. I went to the best but because of the size of the hole I was getting a 8 percent, 30 percent and last a 40 percent. I hated it so much I did not care about the distance. It's been 6 weeks post opp and things look great. The cost on the other hand was prity high but well worth it. 13,000 mine was a big mess though!!! Good luck

Hi im concerned I may have a peforated septum I have had problems with my nose from a very young age and had it quaterised in my teenage years...I also took a wrong road and had bit of a cocaine addiction in my early 20's which clearly has caused damage im now 30 and and for the past few years i have a daily ritual of picking and clearing which again has probaly caused even more damage...now I know some of this was caused by myself and im too ashamed to go to the doctor as they will say it was all down to the drugs even though I have proof of nasal issues that pre-date that...im not really sure of the overall damage and to be honest after reading lots of stuff I have freaked myslef out thinking my nose is going to collapse at any moment and people will assume its because of drugs which it partly is . I dont really want to go to the docs as my addiction was kept a secret and I managed to defeat it all by myself with no medical help and I have never re-lapsed so I do feel a sense of pride but to go in and say all taht I just feel they will judge me and tell me to get lost and live with the effects of my mistakes...





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The doctors won't judge you at all. They will ask you what symptoms you have and then they will discuss treatment. If you ask to see an ENT consultant they will oblige although it is best if you could see one who has experience of septum perforation. There is no need to feel ashamed so please - just go and ask the doctor. In this country ENT consultants seem reluctant to do anything about perforations whereas in the states there appears to be far more consultants fixing holes (presumably for a fee). My own perforation is very small and several consultants have told me that it will not be causing any symptoms but I do have symptoms that have caused a lot of anxiety. So, get to the doctors and ask for help.

My sons nasal septum was damaged by a cpap machine being fitted tightly when he was in the neonatal unit. As a consequence he does not have a nasal septum and I was wondering if I could obtain advice on what procedures are available to rebuild his nasal septum or who I can speak too to obtain advice. He has visited a NHS plastic surgeon but I wanted to see if I could get some independent advice. Thanks.





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Does he have problems related to it? What is your concern? What problem does he display?

Hi Judith, My son doesn't have a problem related to it. His nose tip is not supported so kind of hangs down. I would say his problem is more cosmetic. We were given two options to rebuild his nasal septum. The first was to remove some skin from his stomach side and apply it to his nose and hope this skin naturally attaches itself to his nose. The alternative sounds a bit horrifying whereby they will take skin from behind his ear over his head and attach it to his nose. This last option has a better success rate. What I wanted to know was which option would give a better natural finish. I don't want to put my son through any unnecessary pain but he wants it done as his pears at school are now starting to ask him about his nose which is starting to annoy him a lot, as well as bullying as a result of him being different. And if he does want to go through with it I would rather he did a procedure that gave the better as natural as possible finish. So could do with advice of different options available be it NHS or private. He would then need a second operation to ensure both nasal holes are similar in size. Thanks, Sukhi.

His nasal septum surgery appointmentioned has been fixed for first week in Feb 2016. His plastic surgeon has recommended the first option as he believes it would be easier for my son than the second option. I would like further independent advice on this. If you email me, I can email you by return a mobile number to contact me on as I would be happy for you to contact me on either my email address or mobile number. Thanks, Sukhi.

I have had yet another ENT consultation with regards to my septum perforation. Again, the consultants have said that mine is so tiny (and I agree that it is) that there is no way that it is causing me the symptoms I describe, which are constant dryness and irritation particularly in the right nostril. It was suggested that I have a slight deviated septum and that this is causing the issue but I don't accept that because I haven't always had the symptoms. The ENT guy I saw can operate to close this perforation but won't because he says it is too small and that again it won't help matters. I am at a complete loss as to how I manage this. I was told to use a nasal spray (ocean) and vaseline but to be honest it kind of does little to help. I almost feel as though I am thought of as lying about my symptoms -- or is it the case that there is indeed very little anyone can do and I have to mentally cope with it for the rest of my life.





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So large perforations can not be fixed then???





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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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