Septal Perforations Symptoms, Causes, and Fixes with Dr. Samir Undavia
If you’ve been told you have a “hole in your nose,” you’re likely dealing with a septal perforation. In this episode of We Nose Noses, Dr. Samir Undavia walks through what that means, who to see first, the most common causes (from prior nasal surgery to medication technique and trauma), how ENTs pinpoint the reason, and the realistic treatments, from saline care and ointments to septal buttons and surgical repair. Clear, step-by-step guidance to help you breathe easier and decide next steps from the experts at NJENT.
What you’ll learn:
- What a septal perforation is and the key symptoms
- How ENTs figure out the cause and what tests they use
- Treatment options at a glance: care, buttons, surgery
Think you have a septal perforation? Schedule a consult with NJ ENT & Facial Plastic Surgery to get your perforation characterized, identify the cause, and review the best treatment for your symptoms and goals.
Discovering a hole inside your nose can be alarming. Many patients first hear this diagnosis from a primary care doctor or notice light passing through when looking in the mirror. In most cases, what’s described as a “hole in the nose” is actually a septal perforation, or a hole in the nasal septum—the thin wall dividing the left and right sides of the nose.
The septum plays a crucial role in directing airflow smoothly through the nasal passages. When it develops a perforation, patients may experience a range of symptoms, including whistling, crusting, nosebleeds, nasal pain, infection, and difficulty breathing.
Understanding the Causes
The most common cause of a septal perforation is previous nasal surgery, such as a septoplasty, rhinoplasty, or sinus surgery. During these procedures, if the blood supply to the septum is disrupted, tissue damage can occur, leading to a small hole that may enlarge over time.
Another frequent cause is drug use, particularly cocaine. Cocaine acts as a powerful vasoconstrictor, cutting off blood flow to nasal tissues and resulting in tissue death. Chronic use of nasal sprays such as Afrin or incorrect long-term use of steroid sprays like Flonase can also contribute to perforations by damaging the septal lining.
Trauma, whether from an injury, aggressive nose picking, or packing following surgery or a nosebleed, can also result in a hole. Less commonly, systemic diseases, infections, or autoimmune conditions can cause inflammation and erosion of the septal tissue.
Diagnosis and Evaluation
When a septal perforation is suspected, it is important to consult an ear, nose, and throat (ENT) specialist or a facial plastic surgeon. These specialists can use a small camera to examine the inside of the nose, assess the size and location of the perforation, and evaluate surrounding structures such as the turbinates or sinus openings.
If the cause of the perforation is not immediately clear, the physician may order additional tests. Blood work can help identify inflammatory or autoimmune conditions, while imaging such as a CT scan provides detailed information about nasal anatomy and the extent of the defect.
Treatment Options
Treatment depends on the cause, size, and symptoms of the perforation. For many patients, conservative management is the first step. Hydration and saline rinses are essential to keep the nasal passages moist, reduce crusting, and promote comfort. Saline should be isotonic, as plain water can worsen irritation. Some patients also benefit from applying a light layer of ointment or topical antibiotic to reduce dryness and prevent bleeding.
For those with persistent symptoms, a septal button may be recommended. This small medical device acts as a barrier between the two sides of the nose, preventing airflow through the hole and improving breathing and comfort. While effective for some, septal buttons can feel uncomfortable and may require periodic replacement.
When feasible, surgical repair offers a more permanent solution. This procedure typically involves repositioning nasal tissue flaps and placing grafts to close the perforation. Because the surgery requires precision and specialized skill, it should be performed by a facial plastic surgeon with experience in septal reconstruction.
When to Seek Expert Care
Not all perforations require surgery, but it’s important to have an expert evaluate your condition to determine the best approach. At NJENT and Facial Plastic Surgery, Dr. Samir Undavia and his team specialize in the diagnosis and treatment of septal perforations. Patients from across the country and beyond seek their expertise for both functional and aesthetic nasal concerns.
For those experiencing symptoms of a hole in the nose, whether it’s whistling, crusting, or recurrent bleeding, prompt evaluation can provide clarity and relief. Early diagnosis and appropriate treatment can prevent complications and help restore normal nasal function.
