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Conditions

Nasal Septal Perforation

Nasal septal perforation (Photo from Wellcome Trust)

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'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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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...

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.

Show all replies in this thread

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...

Earlier in the year I was diagnosed with a “huge” nasal septal perforation. I had a nasal septal button fitted that was 28mm diameter with a centre core of 6mm diameter, it was fitted complete at this size. I was told this is what is normally used but usually cut down to fit. I was also told due to not having much cartilage left at the base of my nose where nostril openings are, that it may not be successful. When I went for a follow up appointment I was sure the button had moved. The ENT doctor said it had and I thought he was going to adjust it but he rather just pulled it out. He went on to say nothing more can be done. I wonder if anyone could offer any advice on getting a solution, if anyone knows of any doctors or techniques available via the NHS within the UK that could help me? BACKGROUND: I have had continued problems with my nose for over 10 years, with repeated GP visits. Around 4.5 years ago, I was admitted to hospital with chest pains (centre and below left ribcage). I was diagnosed with Pneumonia and Pleuracy. After leaving hospital, I also developed shingles and continued to have the pain/ discomfort in centre of chest, got increased issues with reflux and had increasing problems breathing... I was finally diagnosed with Asthma in January of this year and appear to be responding to the symbicort medication but unfortunately the problems caused by the septal perforation aggravate my Asthma and make life quite miserable – after being relatively symptom free for a month, those issues are now more heightened and it has confirmed the perforation is the reason I feel continually weak and tired... If anyone can offer any help or advice I would appreciate. I am going back for second opinion but am hoping a specialist of nasal surgery or someone who has had similar issues but got them resolved may be able to comment? Thanks in advance





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I dont have any anwers but I wanted to say that now I dont feel alone. I didnt kno this is a common condition. Iv had my nose problems for 5yrs and recently developed a hole. Five years ago my nose started scabbing evertime I blew it. The scabs wouldnt blow out so I had to use my finger. So embarrassing. My dr said to use saline nose spray to keep it moist. Im wondering if the saline made my cartridge thin?

"So embarrassing. My dr said to use saline nose spray to keep it moist. Im wondering if the saline made my cartridge thin?" Get over the embarrassment and stop picking your nose with your finger (trauma is a common cause and finger picking is one of those)... a little embarrassment is a small price to pay to not end up in the situation I am in... Look up nasal septal perforation via google... lots of info... I am not sure about saline solution making worse? I used it for years after seeing an ENT 'specialist' I now have a "HUGE" hole but I also used to clean my nose with wet wipes... Tbh I do not remember having a septum, so don't know when this dates to for me and can't confirm issues with saline... Various Rhinitis nasal sprays can cause or contribute to a septal perforation... I am not sure with regards the "nasal douche" if it is to keep moist? as salt tends to draw out moisture? I though it was to fight infection? Whilst it is not a long term solution Naseptin has proved someway helpful, as it does also soften scabs and helps them to come out when blowing nose and also consequently helps reduce amount of force used in trying to dislodge, which has to be better... I think it also has antiseptic qualities... the first week I used it was amazing it cleared out all top of my nose, which I guess was sinuses and sinusitis as I have since learned... Dependant on size of hole it may be worth pursuing ENT to get checked if any medical reason for erosion and consideration of the fitting of a septal button... This should also help improve any symptoms you may have relating to the perforation. The button should also help with scab formation as it settles... My advice is to question as much as you feel necessary... Surprisingly after over 10 years of struggling the onus has been put on me by my gp this very day and apparently I should have found out more etc... So ask until you are satisfied and ask again to be sure... Research as much as you can and do not be bullied by a GP who has little or no knowledge or experience in the subject matter... Seems long winded and maybe over cautious but I have since had pneumonia, pleurisy, developed asthma and it severely restricted my life :( and is immiserating... so on that note please stop picking with finger as you are risking further problems that you would live to regret... If you can't find any help, I did find petroleum jelly and the vics version useful as they also soften inside nose scabs and "crusting" as the doctors call it. the vics can help give sense of easier breathing to at night... the ENT i saw said was ok although I get impression he wasn't as convinced with vics in nose... but no reason to not put under nostrils... and apply naseptin or vaseline carefully with a qtip internally... Think about how it affects you and discuss those with your doctor as reasons for a potential referal? Good luck!

Ive got a extra large nasal septal perforation. After years of not realising what the problem was and many doctors visits I finally had a septal button fitted earlier this year. I had the standard 28mm diameter button fitted, with an internal diameter of 6mm. Unfortunately it moved and was removed during my post op consultation. The consultant said it would not stay in place and nothing else can be done. Has anyone experienced this and do you have any advice? Has anyone had a made to measure septal button or knows anything about them? Does any one have any advice regarding any further treatment as this is making my life a misery? Do you know any useful websites or consultants that may offer further advice? Any help or advice will be gratefully received.





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I have a hole since ive always picked my nose since I was young. I have a little bit of pressure and always have a sinus headache probably because if this. But I'm only breathing through one misrule because of this. I noticed I don't have crustations or whistling when im sleeping. If I leave my nose alone, will I ever gain my other misrule back. I know they say the skin dies and it'll get worse after time causing the collapse.. not sure what to do now. Can't sleep with the stress of this.





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I have had a large hole for several years. Have been to ENT and he assured me it would not collapse and surgery is not always the best thing .. just to keep it clean using saline rinse and moist using ointment. I use to have severe nose bleeds, but none since developing hole. The hole can never repair...I use to suffer terrible anxiety but Dr was very reassuring so now I just live and accept it.

Hi Anna, what Saline rinse do you use? I was worried about collapse but seeing your comment has reassured me somewhat, though I think my nose has changed shape a little over the 5 years. Did the ENT specialist/doctor say why it wouldn't collapse?

Since this hole, I cannot breath out of one nostril.. will I ever get that back by leaving my nose alone. Or will it be forever closed?

I went to ENT End of January of 2015 due to all of a sudden horrible nosebleeds. I was having them a few times a week and they lasted a long time. ENT tells me I have a Hole in my septum of course asks me about drug use, I said no just tons of bad sinus infections for a lot of years. Dr tells me I must have a CT Scan, and Surgery to close it. The nosebleeds have given me major anxiety since they come out of the blue, Dr said to use Bacitracin Antibiotic ointment in the nose and keep it moist. The nosebleeds stopped for 3 months and now out of nowhere started again and Im really nervous. Does any know if I continue to use the Ointment everyday and SAline drops, will the nosebleeds stop? My nose only whistles when my sinus's act up which is during the spring time from Allergies. Any Suggestions please as I cant live like this anymore.





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Hello all appreciate hearing your posts! I have recently developed a nasal perforation due to the use of fluctocasone (a nasal decongestant). I saw a ent doctor and had surgery to close it. For the procedure a mucosa flap was cut, rotated, and stitched into place. The procedure unfortunately did not work. I am seeking a second opinion and having the size of the hole monitored. Currently it is between 5-6mm. My question and concern here is does the hole get bigger over time? Thanks!





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for a hole of 5-6 mm you may be able to have a septal button fitted... Whether or not the hole gets bigger can depend on a number of factors, whether or not you clean out your nose and whether or not there are any other reasons for the hole - fungal, bacterial etc... The worst thing you could do is pick your nose or clean out aggressively with tissue / wet wipe, this will likely enlarge the hole... with a hole of your size a button could likely be successfully fitted and would hopefully help stop any further bleeding or crusting issues you may have...

Thanks for the response! I am hoping it does not getting any worse.

Thanks for the response! I am hoping it does not getting any worse.

Hello all appreciate hearing your posts! I have recently developed a nasal perforation due to the use of fluctocasone (a nasal decongestant). I saw a ent doctor and had surgery to close it. For the procedure a mucosa flap was cut, rotated, and stitched into place. The procedure unfortunately did not work. I am seeking a second opinion and having the size of the hole monitored. Currently it is between 5-6mm. My question and concern here is does the hole get bigger over time? Thanks!





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