Symptoms, Causes and Diagnosis of Nasal Septum Perforation

Symptoms, causes and diagnosis of nasal septum perforation - Diagnosis of nasal septum perforation - Causes of nasal septum perforation - Symptoms of nasal septum perforation - Nasal septal perforation symptoms - Nasal septal perforation repair in Istanbul, Turkey

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A hole of the nasal septum ​​(perforated septum)

Nasal septum perforation usually occurs due to surgical trauma and other traumatic causes (such as finger nose mixing and cocaine use). Apart from these, it can also occur due to systemic diseases that can hold the nose. Because septal perforation can be associated with many systemic diseases, it is essential to have a detailed medical history assessment. The causes of septal perforation are numerous and varied. Inflammatory diseases such as collagen vascular diseases, sarcoidosis and Wegener granulomatosis can cause septal perforation. In addition, it can cause septum holes in infected processes such as, for example, tuberculosis, syphilis and fungal diseases. Rarely, septal perforation is the first finding of sinonasal malignancies (nose and sinus cancers). Drug use should be monitored. Chronic use of vasoconstrictive nasal sprays and steroid nasal sprays may cause septal perforation. In addition, the use of cocaine may cause septal holes. Work with industrial gases, such as contact with wood dust, nickel treatment processes, and skin layering, may result in the development of sinonasal malignancy and septal perforation (more information can be found on the   Septal Perforation - Medical Aspects Clinical Presentation link). ​Similar link >> Intranasal Closure of Small Septum Perforations With Double-sided Cartilage Button Graft



Symptoms, causes, diagnosis and treatment  of nasal septum perforation

The paranasal sinus tomography of the patient with nasal septum perforation seen during the endoscopic nasal examination above is shown below.



Symptoms, causes, diagnosis and treatment  of nasal septum perforation

Causes of Nasal Septum Perforation

The causes of septum perforation can be summarized as follows:

Traumatic causes

◙ Previous surgery
◙ Intra-nasal cauterization for nosebleed
◙ Nasal mixing
◙ Nasogastric tube insertionSeptal hematoma arising from any blunt trauma
◙ Battery or other foreign object escaping into the nose
◙ Chronic nasal cannulae use
◙ Turbulence airflow

Inflammatory or infectious causes

◙ Sarcoidosis
◙ Wegener granulomatosis
◙ Systemic lupus erythematosus
◙ Tuberculosis
◙ Syphilis
◙ AIDS
◙ Diphtheria
◙ Crohn's disease
◙ Dermatomyositis
◙ Rheumatoid arthritis
◙ Neoplastic causes
◙ Cancer
◙ T-cell lymphomas
◙ Cryoglobulinemia

Other reasons

◙ Ingestion substances (eg cocaine, topical corticosteroids, long-term oxymetazoline or the use of phenylephrine)
◙ Chromic acid smoke
◙ Renal failure

Symptoms of Nasal Septum Perforation

Nasal septum perforation may cause linear jet air currents in the nose, causing scabs in the nose, sounding in the form of whistling, bleeding, and dryness in the nose.



Symptoms, causes, diagnosis and treatment  of nasal septum perforation

In patients with nasal septum perforation, drying occurs in the nasal secretions due to impaired nose physiology and abnormal acceleration of the nasal airflows. If the perforation diameter is small and set in the front, it may cause a whistle or whistling sound. Due to chronic dryness and thickening of the secretions, a nasty smelling nasal discharge may develop over time. The high-velocity airflow impinging on the perforation edges can cause excessive drying, scaling and bleeding in the mucous membranes in this region. Over time, all mucosal areas within the nose can be affected and beside the complaint of nasal instability; dry, cold and unfiltered air will pass through the lower respiratory tracts, so the airways in this area can be affected in the same way.

Diagnosis of Nasal Septum Perforation

Most of septal perforation is detected incidentally during a routine physical examination. Since the posterior perforations are generally asymptomatic when compared with the anterior holes, the importance of septal perforation is important. Nasal endoscopy may be helpful in evaluating all septum. the position and diameter of the hole should be noted. In the adjacent photo, septum perforation is observed, which is small and located locally. It is seen that there are few crusts on perforation edges. Such septum holes may be recognized by chance during endoscopic nasal examination.

Nasal endoscopic examination is usually sufficient for diagnosis. Paranasal sinus tomography is useful in measuring available perforation dimensions.



Symptoms, causes, diagnosis and treatment  of nasal septum perforation

In the above photograph, a paranasal sinus tomography section of a patient with nasal septum perforation of approximately 3.5 x 1.5 cm is seen. Towards the end of the sections, it appears that the inferior turbinates are approaching to the perforation region. In patients with nasal septum perforation, there is a rapid air leak from one nasal cavity to the other nasal cavity in varying amounts of perforation. In these regions where the dry, fast, particulate air is the most sharply pointed to the nasal turbinates, the reflexes of the nasal turbinates are stimulated by the reflex reflex mechanisms. For this reason, in patients with nasal septum perforation, nasal turbinates are prone to regrowth and nasal obstruction is more likely to occur. Without perforating; the operation of nose surgery alone will not be enough for a permanent comfortable nose breathing. When you click on the photo, you can see the perforation areas, which can be viewed in large size and marked with arrow marks.


Symptoms, causes, diagnosis and treatment  of nasal septum perforation

Links to more detailed information about causes, classification, indications, treatment of nasal septum perforations:

• https://www.youtube.com/watch?v=_OBeLAPq850
• https://www.burun-estetigi-rinoplasti.com/2019/01/nazal-septum-perforasyonu-ameliyati.html
• http://www.muratenoz.com/2017/08/nazal-septum-perforasyonu-onlemler.html

Nasal Septum Perforation Due To Cocaine Abuse

In the photos below, the patient with a history of nasal cocaine use for approximately 8 months shows endoscopic examination photos and paranasal sinus computed tomographs. Dense crusting and bleeding areas on the perforation edges attract attention.

Before and After Photos of Patient Who Has Nasal Septum Perforation 

In the photos below, the patient, who had a nasal operation 4 times before, and nasal septum perforation was revealed, there are photos taken during the endoscopic examination and images of sinus tomography before the surgery

We performed open technique septum perforation repairing surgery to the patient who has a hole in the nasal septum approximately 2 cm in diameter (nose surgeries and septum perforation surgery has been performed 5 times before) (You can look the video and photos on the below). We placed cartilage on both the subcutaneous tissue and the outer part in the middle of the hole in the septum. Nasal septum is a structure that divides the nasal cavity vertically, and punctures in this structure may cause rapid air passage through the hole and associated symptoms (rash in the nose, dryness, crusting, nasal discharge, and darkening of the discharge ...). When the hole remains for a long time and the diameter of the hole can gradually grow. Especially in 4 cm and larger septum perforations, the possibility of complete closure with a single operation decreases.

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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