Perforated Septum: Symptoms, Causes and the Best Treatment Options

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A perforated septum, sometimes called a nasal septum hole or septal perforation, occurs when a gap forms in the thin wall of cartilage and bone that separates the two nasal passages. When a hole develops in the nasal septum, it can disrupt breathing, cause crusting or bleeding, and in some cases alter the external shape of the nose. The ranges from small, asymptomatic defects to large perforations that cause significant functional and cosmetic problems.

At Centre for Surgery in Baker Street, London, we provide expert diagnosis and advanced treatment for conditions the nasal septum, including nasal cartilage and complex nasal reconstruction. Our consultants are highly experienced in both and take a personalised approach to every case, from minor symptomatic management to major reconstructive procedures.

What is a Perforated Septum?

The nasal septum is a central wall made up of cartilage at the front and bone further back, lined on each side by a thin mucous membrane. This structure divides the nasal cavity into left and right sides, directing airflow and providing structural support to the nose. A septal perforation develops when both sides of this lining and the underlying cartilage are damaged simultaneously, forming a direct opening between the two nostrils.

The size of a nasal wall defect can range from a few millimetres — often a characteristic whistling sound during breathing — to several centimetres, which may result in significant nasal collapse and a visible change in the shape of the nose from the outside. Smaller perforations are often located anteriorly, towards the front of the septum, while larger ones may extend further back towards the bony portion.

Causes of a Perforated Septum

There are numerous possible causes of a nasal septum perforation, and establishing the underlying cause is an important part of selecting the most appropriate treatment.

Nasal trauma is one of the most common causes. A blow to the nose that disrupts the blood supply to the cartilage, or a septal haematoma — a collection of blood between the lining and the cartilage — that is not promptly drained can lead to cartilage death and subsequent .

Previous nasal surgery, including septoplasty or rhinoplasty, can occasionally result in perforation when the lining is torn on both sides simultaneously during the procedure, the blood supply from a segment of cartilage. This is a recognised but uncommon complication of nasal surgery.

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Overuse of topical nasal sprays — particularly vasoconstrictors such as oxymetazoline — can impair blood flow to the septum over time, leading to ischaemic damage and eventually perforation. Intranasal drug use, most notably cocaine, is a well-recognised cause due to its direct vasoconstrictive and tissue-toxic .

Inflammatory and autoimmune conditions including granulomatosis with polyangiitis (formerly Wegener’s granulomatosis), sarcoidosis, lupus, and relapsing can cause septal destruction as part of their systemic effects. Certain infections, including tuberculosis, syphilis, and fungal infections, may also cause in some cases. Chronic exposure to irritating chemical fumes or dusts in occupational settings is an additional recognised risk factor.

Symptoms of a Perforated Septum

The symptoms of a perforated septum depend significantly on the size and location of the perforation. Small perforations located near the front of the septum often cause a high-pitched whistling sound when air passes through during breathing — this is sometimes the first sign that alerts patients to the problem. Nosebleeds are another common symptom, as the edges of the perforation are to crusting and cracking, leading to bleeding particularly in dry environments or on waking in the morning.

Nasal crusting is a persistent complaint for many patients, as the turbulent airflow created by the perforation leads to drying and mucous accumulation around the edges of the defect. A sensation of nasal blockage, dryness, or congestion is also frequently reported, despite no structural obstruction being present. Some patients notice a reduced sense of smell as a result of the disrupted airflow patterns.

Larger nasal septum holes may cause more pronounced symptoms including discomfort, a persistent sense of something being wrong within the nose, and in advanced cases, changes in the external shape of the nose. When sufficient cartilage has been lost, the bridge of the nose may begin to sink inward — a condition known as a — which can become a significant cosmetic concern as well as a functional one.

Non-Surgical Treatment for a Perforated Septum

Not all septal perforations require surgical repair. When symptoms are mild and the underlying cause has been addressed, conservative may be sufficient to keep the comfortable. saline sprays or rinses help to maintain moisture within the nose, reduce crusting, and keep the edges of the perforation clean. Applying a thin layer of ointment or gel around the inside of the nose can also help protect the vulnerable tissue and reduce . Using a humidifier in sleeping areas is often recommended, particularly during the winter months when indoor air tends to be drier.

A nasal septal button — a small silicone prosthesis designed to fit within and seal the perforation — is a non-surgical option for patients whose perforation is a suitable shape and size for this device. When properly fitted, a septal button can relieve whistling, significantly reduce crusting and bleeding, and restore a more normal pattern of nasal airflow almost immediately. It requires periodic removal and cleaning, and is not suitable for all perforations, but for the right it represents an effective and reversible management option.

Surgical Treatments for a Perforated Septum

Surgical repair of a septal perforation aims to close the defect by reestablishing a continuous mucosal lining across the septum. The procedure involves delicately lifting the mucosal lining away from the edges of the perforation and carefully advancing or local tissue flaps to cover both sides of the defect. A is often placed between the two layers to provide structural support and a scaffold for healing.

The surgical approach varies depending on the size and of the perforation. Smaller, anteriorly located can sometimes be through the nostrils using a closed technique. Larger or more posterior perforations typically require an , where a small incision across the columella provides wider access to the internal structures of the nose. The success rate of repair is influenced by the size of the defect, the quality of the remaining tissue, and whether any underlying inflammatory condition has been fully treated before surgery is attempted.

is a surgical technique designed to straighten and stabilise the septum. In the context of a perforated septum, it may be performed concurrently with perforation repair to address any coexisting deviation or structural irregularity that could impair the outcome of the repair. When together with perforation repair, it ensures the septum heals evenly and that nasal breathing is fully restored across both sides of the nose.

When a nasal perforation has caused visible collapse or deformity of the bridge — particularly in cases of saddle nose where the nasal dorsum has sunk due to loss of septal cartilage support — a may be recommended. This combined procedure addresses both the internal aspects of the septum and the external cosmetic concerns, using cartilage grafts to restore nasal height, projection, and integrity.

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At Centre for Surgery, we are leaders in nasal and facial plastic surgery, providing expert treatment for septal and related nasal conditions using the most advanced reconstructive techniques . Our consultants combine extensive surgical experience with a precise understanding of nasal anatomy, ensuring that every patient receives a treatment plan tailored to their specific perforation, symptoms, and goals. We offer a full continuum of care from initial and conservative management to complex surgical repair and long-term follow-up.

For expert advice or to book a consultation, contact Centre for Surgery, Baker Street, London W1U 6RN.
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Centre for is a CQC-regulated private hospital on London’s Baker Street, delivering plastic and cosmetic surgery through GMC-registered specialist . Our expertise spans facial procedures including and , , for men, and body contouring procedures such as and . Patient safety, surgical excellence and natural-looking results sit at the heart of everything we do.

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