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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 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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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?

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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Hi I am in need of desperate help my nose is starting to loose its shape and collapse on one side, it is getting worse and worse each day and I can't get it off of my mind, where is the best place to get help that deals with these problems regularly. Thank you





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How do you "keep it clean" and remove the crusting and resulting mucus buildup? I have been using earbuds and picking where necessary to clear and did not realise this could make it worse? I have just been to an ENT in London and she was wholly unhelpful in giving any advice beyond telling me surgery is not an option and did not offer any insight in the best way to manage this on a day to day basis. I struggle to breathe through my nose and as a result get very tired quickly during any kind of excercise - I am 28 and have to sit down to recover after climbing a set of stairs! The amoutn of times a day I need to clean my nose of mucus and crusting just to be able to halfway breath is crazy and I'm really struggling on a day to day basis to deal with this problem. Has anyone tried the buttons? Do they help? Thanks very much for any feedback! I'm at my wits end...





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Hi Cass I had a button fitted a month ago. I'm not sure how much difference it is actually making. My breathing feels a lot more natural which is good. One nostril feels fine, I wouldn't know it was there. the other one feels constantly tickly, as if there is something stuck up my nose - which there is - a septal button. I never experienced the breathing difficulties you described, either pre or post button. I was getting quite a bit of mucus/post-nasal drip and that is still the case. It tends to get worse as the day goes on. The thing that I find gives me most relief is eating ice-lollies. My perforation was caused by an external trauma. It doesn't appear to have got any bigger over time according to the ENT. He suggested trying the button before considering surgery. I was told that the button would not preclude future surgery but also that the surgery is not guaranteed and can make things worse. I've certainly not felt worse as a result of the button but maybe not quite as much of an improvement as I would have liked.

Should also have added that ENT recommended breathing steam - which I have found helpful. Picking is not a good idea.

I live in Ohio. Weather changes are frequent. Which leads to me having migraines and I get super congested. My PCP put me on Flonase which when I first started using it, it was life changing. But now I am having trouble with my left nostril. It gets clogged up with dried, bloody chunks. Also I have noticed, when I stink my finger in my left nostril, with a tissue on my finger, it feels like there is a pretty good size hole developing on my right size, where my nasal cavity is. I have never used recreational drugs. The only things that ever go up my nose are: Flonase, saline spray and tissues. I don't know if this is something to worry about, or not a big deal.Any info would be greatly appreciated!!





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ive had my perforation in my septum since I wss around 12 years old I am now 51 and there is hardly any seprum left. I have seen the ENT consultant at my local hodpital and apparently there is nothing they can do. How is it a famous actress snorted cocaine yet she had her nose sorted. Money talks it appears seeong that imnot well off I will just have to put upwwith it. My perforation is not due to using drugs either. I am embarrassed by it I snore very loudly and my nose whistles





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HI Yvonne what was the cause of the perforation and why do you think it has been enlarging? Have you had any kind of treatment in the past?

Well I was told the same and after seeking a second opinion from another ENT consultant, he fitted a nasal septum button. This is a simple easy and quick procedure and usually only requires half a day in hospital





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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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