What Is a Perforated Septum

What Is A Perforated Septum?

A perforated septum is a hole or gap in the skin which allows air to pass through it. Perforations are usually small and not visible unless they are very large. There are two types of perforations:

Perforate Separators (or Perforates) – These holes allow air to flow in one direction only. They may be caused by trauma such as a gunshot wound, burns from fire, or accidents like falling off a ladder. Pericardial Separators (or Pericardiocentesis) – These holes allow air to flow both ways.

They may be due to infection or other causes.

The most common type of perforation is a hole in the skin which allows air to enter your nose. This type of perforation is called a perforated septum. Other types include:

Pericarditis – A hole in the heart (pericardium).

Pericardial Cyst – Fluid buildup around the heart.

Pericardial Effusion – Fluid buildup inside the heart.

Pericardial Tamponade – Buildup of fluid around the heart that restricts its ability to pump. This is a life-threatening emergency.

Pericardial Window – A direct surgical opening in the pericardium (heart sac).

How common is a perforated septum?

It is difficult to know exactly how many people suffer from a perforated septum. This is because most people do not seek medical treatment for this condition and it can go unnoticed. Many people live with a minor perforation in their nose for years before it gets bigger (a disorder known as a perforated septum). In addition, some patients don’t realize that they have a hole in their nose until they look at it in a mirror. It is likely that more people are living with a perforated septum than you might realize.

What are the symptoms of a perforated septum?

The most common symptoms of a septal perforation are:

Obvious hole in the skin which allows air to pass through it, such as in the picture above.

A whistling sound when breathing (called stridor). This is caused by air passing through the hole and moving through upper airways.

Nasal congestion. This occurs because air is able to pass through your nose and goes into your lungs.

Facial swelling. This occurs because of the extra air or fluid buildup in the body due to a deviated septum or other conditions.

Loss of sense of smell (called anosmia). This occurs because the olfactory nerve (which transmits smell information to the brain from the nose) travels very close to a perforated septum.

What causes a perforated septum?

Common causes of a perforated septum include:

Trauma from accidents or accidents such as falling off a ladder or being assaulted.

Conditions that increase air pressure in the head such as: Idiopathic Intracranial Hypertension or pseudotumor cerebri. This is a disorder of increased intracranial (within the skull) pressure. It is also known as benign intracranial hypertension.

Chronic lung disease, such as chronic obstructive pulmonary disease or asthma. Obesity or being overweight. Pregnancy.

Infection of the upper respiratory tract or sinuses, such as an untreated middle ear infection (otitis media) that spreads to the sinuses.

Smoking. Tobacco smoke destroys healthy tissue in the body and can lead to a chronically inflamed septum.

A deviated septum can also be congenital (you are born with it).

How is a perforated septum diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for perforated septum may include the following:

A nasal swab or biopsy that is sent to the lab for analysis. This can help determine the exact cause of the problem and confirm the presence of an infection.

A CT scan or MRI that allows the physician to review the bones and soft tissues inside your nose.

How is a perforated septum treated?

Treatment of a perforated septum is aimed at correcting the cause and eliminating the resulting symptoms. Treatment may include:

Antibiotic therapy if an infection is present.

A corticosteroid nasal spray (such as Flonase or Nasonex) to shrink swollen tissues in the nose.

A saltwater rinse (such as Ocean Spray) to thin and lubricate mucus in your nose and help it drain more easily.

Decongestants such as Sudafed (pseudoephedrine) or Afrin to reduce mucus and pressure in your nose.

Nasal steroid sprays, such as Flonase or Nasonex to control swelling of the lining of your nose.

Surgical removal of large, loose nasal polyps that are causing problems. Likewise, surgery may be required if you suffer from a congenital structural problem inside your nose.

A deviated septum should not be treated with home remedies. Self-treatment could make your symptoms much worse.

When is surgery necessary?

In some cases, surgery may be necessary to correct a perforated septum or other structural problem in the nose. This can significantly improve breathing passages and eliminate infection or other symptoms. It is common for patients to experience an increase in their quality of life following corrective surgery.

Selection of the correct surgery and surgeon is an important decision. Discuss the problem and your options with your doctor to determine what the best solution is for you.

What is the long-term outlook?

Most people who have surgery to correct a perforated septum report an improved quality of life. Many people who suffer from serious symptoms and undergo surgery experience dramatic relief from their symptoms. Most people with only a minor deviation who do not experience other symptoms do not require surgery. These people often find that symptoms become less bothersome over time or can be controlled with medication.

What can I do to prevent or relieve perforated septum?

Avoid excessively dry air by using a humidifier in your home. Avoid exposure to second-hand smoke, which can make the symptoms of a perforated septum worse. Tobacco also causes the membranes and tissues in your nose to deteriorate, which can lead to a perforated septum.

When should I call my healthcare provider?

If your symptoms worsen or haven’t improved in 10 days, call your healthcare provider.

Note the onset of any of the following: fever, increased pain, or pus coming from your nose. These may signal a bacterial infection that needs antibiotic therapy.

When should I seek immediate medical care?

Seek immediate medical care if you experience a seizure or faint due to prolonged coughing.

See a doctor immediately if your pain is not relieved by taking over-the-counter (OTC) analgesics, such as acetaminophen or ibuprofen.

See a physician immediately if you develop a bad cough after an infection clears up.

Note any fever that develops along with your other symptoms. A fever is common with nosebleeds but also may indicate a more serious infection.

See a physician immediately if you have any of the following symptoms: increased pain, continued bleeding, or pus coming from your nose. These may signal a more serious infection that needs to be treated with antibiotics.

Tips & Warnings

If you have trouble breathing because of a perforated septum and don’t have medical insurance, or if your insurance doesn’t cover the cost of surgery, see if your community has a free health clinic.

If symptoms worsen or haven’t improved in 10 days, call your healthcare provider.

A perforated septum may be a complication of asthma. Also, the structural integrity of the nose can be compromised by some asthma medications. If you have asthma and experience ongoing nasal problems, be sure to discuss this with your physician.

Don’t attempt to try to remove a perforation in your own septum. Attempting to repair a perforated septum yourself can easily make the situation worse, causing a divot or hole that is larger than the original perforation.

Home treatment with a decongestant or anti-inflammatory medication may help shrink swollen tissues and relieve pressure. Avoid using a hot vapor humidifier to moisten dry air, though, as this can cause your perforation to enlarge.

Make sure you’re getting enough Vitamin A, which helps keep mucous membranes healthy. Good food sources of the vitamin include dark green, leafy vegetables, such as spinach or kale; liver; and fortified dairy products.

If you’re a smoker, talk to your doctor about strategies to help you quit. Smoking makes it harder for wounds to heal and can make nosebleeds more likely.

Most people find that their perforation heals within two weeks. Without treatment, a minor perforation usually heals within a few days. A large perforation may take up to three months to heal.

Don’t pick at the scab that forms over the hole in your septum, as this can cause tender tissue around the hole to become infected. It can also make the hole larger, which may require additional medical treatment.

If you’ve had a perforation in your septum before, you’re more likely to get one again. Follow all of your medical provider’s instructions about how to care for the area so that it has the best chance to heal completely.

When you blow your nose, do it gently. Don’t use a dry cotton swab or other object to “sweep” out dried blood, as this may push the dried blood deeper into your septum and cause larger chunks of dried matter to form.

Sources & references used in this article:

Acoustic honeycomb with perforated septum caps by E Ayle – US Patent 8,413,761, 2013 – Google Patents

Classification of the suprapatellar septum considering ontogenetic development by T Zidorn – Arthroscopy: The Journal of Arthroscopic & Related …, 1992 – Elsevier

A novel Pezizomycotina‐specific protein with gelsolin domains regulates contractile actin ring assembly and constriction in perforated septum formation by MAA Mamun, T Katayama, W Cao… – Molecular …, 2020 – Wiley Online Library

Method of manufacturing a non-metallic core having a perforated septum embedded therein by CJ Williams, RA Coleman – US Patent 4,816,097, 1989 – Google Patents

Method of making a cellular core with internal septum by JL Diepenbrock Jr, MD Nelsen, MF Harp – US Patent 4,257,998, 1981 – Google Patents

Honeycomb core with internal septum and method of making same by MF Harp, JL Diepenbrock Jr, MD Nelsen – US Patent 4,265,955, 1981 – Google Patents

Non-perforated septum supra-patellaris mimicking a soft tissue tumor by P De Mot, P Brys, I Samson – JBR BTR, 2003 – researchgate.net

Complete heart block with perforated interventricular septum following contusion of the chest by C Paulin, IL Rubin – American heart journal, 1956 – Elsevier

Perforated container cap with septum by PM Petrosino, J Crouch, K Frake… – US Patent App. 29 …, 2008 – Google Patents