Empty Nose Syndrome Treatment: Treatment Options for Nasal Cripple

Question: My daughter, age 46 does not have a septum. In her late twenties, she had tried cocaine and supposedly lost the septum at that time. She has had two surgeries to clear her sinus and to no avail. She is called a “nasal cripple.” My concern is that nothing can be done and she is chronically ill with an infection and has been of leviquin for years. She has a hard time breathing at nite, so she is always tired. Do you have any suggestions on where to go next? What are her options for Empty Nose Syndrome treatment? Any advice would help. Thank you!


Thanks for your question. We have quite a bit of experience dealing with this issue at the NY Sinus Center.

Many things can cause a hole in the septum, including the use of cocaine. One should first make sure that the hole was not caused by a medical illness, as a hole in the septum can be a sign of a life-threatening illness. Cocaine diminishes the blood flow to the nose and can cause the tissues to become inflamed, infected and often causes the death of the tissue locally. For any treatment to be successful, one must first get the patient to stop using. One must also find a doctor who is invested in non-judgementally helping his or her patient, no matter how the hole occurred. Treatment of septal perforations frequently requires a lot of work and commitment from both the doctor and patient.

Problems are caused by persistent inflammation in the area and the hole itself. We treat the inflammation by cleaning the nose and sinuses back to normal healthy tissue- (debridement)- sometimes opening blocked sinuses either with minimally invasive procedures or ballooning the sinuses open (balloon sinuplasty). However, the lack of a septum itself causes dryness, crusting and further inflammation. That is treated with sprays, washes and moisturizing. Nasal hygiene is the most crucial part of care.

Sometimes we can put in a prosthetic “button” to bridge the hole inside the nose- which classically helps the symptoms. Lastly, smaller holes can be repaired- although larger perforations usually won’t be closed successfully.

It’s never perfect, but usually, patients with large septal perforations can be helped.

I hope this helps clear things up…

Robert Pincus MD
Co-director NY Sinus Center