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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 am 37 years old and have been a habitual nose picker since childhood. About a year ago after a sinus infection I developed scabs inside of my nose that I would pick at. About a month ago I found a hole in my septum. I am too embarrassed to see a doctor about this as I will have to fess up to picking my nose compulsively. Is this dangerous? I am afraid that if I keep picking that my nose will collapse and yet I can't stop as the scabs are so uncomfortable. Any advice would be appreciated.





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hey,try real hard,not to pick,i know it is difficult, but I found mine did begin to heal up, I to scared to use fingers cause of meningitis,i used pluckers. and I went to the doctors(2 good-looking ones)lol,talk about embarrassed, was I ever, but I laughed my way through that appoint.i am not a doc but I do not think your nose will collapse but it will surely get worse,as well try vasaline inside to take away the scratchiness of scabs soften it up in there, might help the feeling to supside. good-luck

I have a massive hole inside my nose. I've never been a drug user & not even sure how it started. As a child a was punched by a boy really hard on my nose that it wouldn't stop bleeding, may be this started it but about 15 years ago I had what I thought 2 as a spot inside my nose that was really annoying me because I could feel it & started picking at it to go & I had a massive nose bleed. I think this was the start of it because it kept scabbing up & I could feel it so would keep picking at the scabs. Now I haven't really got any septum left. I'm trying to leave it alone now because I don't want it coming down past my nostrils for all to see but I would like surgery. Could this be done as it's so severe or could half be done so at least it can't be seen so pre ounces.





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I too have a hole in my septum, I noticed it back in 2009 when I was having some bad nose bleeds and just kept picking at the dry scabs and eventually perforated my septum. I have never taken drugs in my life, I don't even smoke. I'm scared to death to go to the doctors, I'm using baby saline nasal spray and Vaseline to keep my nose moist but it's not long again before it starts to feel uncomfortable and dry again. It's causing me distress, I wake up in the night in a hot sweat just to check my nose hasn't collapsed. Does anyone else have pain in their nose? I feel pressure in mine. I don't want to feel like this anymore:(





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I noticed a septum hole into my teen years, fairly large about the size of the tip of my pinky finger, I can actually reach up my nostrils and touch my fingers together! I figured out it was from when I broke my nose as a child and the resulting trauma created horrible scabbing in my nose that I constantly picked until I wore a hole through it! The good news is the hole is now healed and not getting bigger although it is often a source of annoyance for me. It gets very dry especially in the winter months so I do my best to keep it moisturized. It whistles very loudly too and is a source of amusement for my family and friends. The worst part is that it traps crusty mucus buildup which often cannot be removed simply by blowing which results in more picking unfortunately. The best thing that has worked for me it to keep it clean and moisturized and I take hot showers and make sure it is flushed out and clear of buildup to reduce my need to pick at it. Like I said it is now stable and not growing larger and it is not such a problem that i do not feel the need to see a doctor it is just something that I have to manage sensibly. I hope these tips are helpful to people who are worried about it, it will always be a source of annoyance and minor problems but with proper care it can become very manageable so that it is not a constant bother!





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Hi Rachel How long has it taken to get to this stage , that is from when you first noticed it in your teen years until now?

In response to your question, after I broke my nose when I was a child it was pretty messed up for a few years with nosebleeds occurring a lot and I couldn't prevent myself from picking at the scabs. So I must have gradually picked my way through the septum and it was when I was a teen that I really noticed it had become a significant hole because by that time I had stopped my picking for several years and it was basically healed. I cannot give you an exact estimate of how long it took to heal because I do not exactly remember how long it took once I stopped picking at it until it was fully healed but I can tell you that I have been living with it fully healed ever since then and I am now almost 25. As with all things healing takes time and care. Do whatever you can to stop yourself from picking at it! As a child I couldn't stop myself and I obviously didn't know the damage I was doing but as we grow up we tend to lose habits such as that. I believe I stopped picking at it constantly while I was still in elementary school and then i didn't think about it again until I noticed the hole once I was older and by that time it was all healed. So it will take time but you can speed up the healing process by keeping your hands off and treating it like any other injury. Using healing ointments could be helpful for softening scabs so they aren't so bothersome while you are getting through the healing process. Consult your doctor or pharmacist for advice on what products are safe and effective and once it is fully healed it is much easier to manage. I hope this has been helpful!

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I have a hole in both sides of my septum and my nose continuously feels blocked and whistles I have never taken drugs and I am not a habitual nose picker the pain is gradually getting worse,I'm awaiting appointment from ent,any advice would be grateful





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I'm so embarrassed but last year I had a severe nose bleed which lasted 4.5 hours, ever since I have had really bad scabs, I'm a picker and I tried but they got so big I couldn't leave them. I discovered this week I have now got a hole. I'm actually distraught. I am trying my hardest to leave it alone but as it gets to the end of the day the scab is that big and irritating I try and clear my nose a bit and it comes out whilst blowing my nose. I have been to the doctors and all though she couldn't see it (I explained that was because the scab was in the hole) anyway she has put me forward for an appointment with ENT but explained that there is a long waiting list. I'm worried that until I have appointment the hole will get bigger. If I manage to leave the scab is it possible to heal on its own? Also, is there anything I can do in the mean time, it's very dry and irritating, thanks





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Try nasal rinsing,bit uncomfortable but you buy a plastic bottle and some sachets from boots and use sterile water and if done daily will keep it at bay and the irritation should disappear. I have seen an ENT consultant and don't want an operation so this is the best thing for me, had three months of dreadful nosebleeds and clotting which ended with me having a hole,can't stop looking and thinking it will all give way; good luck

I put neosporin in my nose where it has been eroded, I have no hole from one side to the other but it is greatly indented from my left side of my nose to my right. Is neosporin a good idea to put there or what do I do?





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I put neosporin in my nose where it has been eroded, I have no hole from one side to the other but it is greatly indented from my left side of my nose to my right. Is neosporin a good idea to put there or what do I do?





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Jo - in my experience if you do not have an underlying disease such as Wegeners and you are not damaging it by repeated picking then it will probably stay about the same rather than enlarging as regards treatment if it is 5-6mm it can probably be closed but not all ENT surgeons do this sort of surgery becasue 1. its difficult and fiddly and 2. the results are not that great even if you are the best surgeon on the planet. Some ENT surgeons advocate making the hole bigger to stop the whistling. While this works I find it a bit counter intuitive. I like the idea of surgical closure - if it does work you can basically stop a life of minor but irritating nasal problems. As regards cocaine abuse, personally, if someone previously used it but no longer does I dont a have problem treating them. We treat smoking, alchohol and sport related injuries and I try not to be too jugdemental about others. Mike





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To be honest a large number of the perforations we see are becasue people are injuring the spetum by habitulaly picking. Generally speaking putting ANYTHING up your nose is a bad idea and this includes your fingers, cotton buds, tissues and so on. All of these are harder than the nasal septal mucosa and will damage it. If your nose is full of goo or scabs although it is massively temtping to grab them with your fingers of tweezers it is much better to try and rinse them out with saline (the NeilMed sinus rinse kit is very good for this) Using vaseline, glycerol or a range of other emmolients is then helpful to soften and hard scabs and reduce their reccurence.

Thanks very much Mike. What about a septal button, would that be worth trying before surgery? I would just like to alleviate the symptoms the worst of which is uncomfortable dryness. I don't have whistling, I do get an occasional itchy/ very mild stinging sensation. I don't go near it with my fingers.

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I am greatful I found this sight. I have a hole in my septum which started from continueous sinus infections over the last year which created sores which I then began picking almost to obsession to get the scabs and blood clots that formed out so I could breath and because they drove me crazy. I did not realize I could do this kind of damamge by picking at sinus scabs. I am nervous to go to my doctor now to ask for advice as I work in the medical field with the doctors and medical assistants that would be treating me. I know their first thought will be that I am a possible drug user which could affect my job if anybody breaks confidentiality. Is it possible that I did damage 30 years ago when I was using cocain on a regular basis for several years? I would not have been surprised if this had happened to me then but now it just seems like some freak thing I don't want to explain to anybody.





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hi Lynnette,your story sounds just like mine,with cocaine use over 20 yrs ago,i went to the ENT an was so embarreset because both the doctors were young and really good-looking!lol,lol,all I could do was make jokes. I felt it was taking the attention off me,it wasn't,specially when the young doc went to remove the otton balls I had up there,to stop my nose fr running,he said"woow do you ever have them up there deep"i was never so embarrest.but in your sit.maybe you can go to a different place,where the doctors don't know you. but really the ones you do know, should act in a professional manner,and if you are wooried about your job, explain to them,there are all sorts of ways this could have started. not only drug use. and hold your head high!. idid when I left those good-looking docs,lol





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