Perforated Septum - Causes and Treatment Options

Question: My mom lives in Ocala, FL. My mom’s problem is a hole up in her sinus that seperates the left and right nostril (perforated septum). She has had a ‘button’ put in but it had to be removed about a week later, due to the hole , in her nose, being too big. She then had a filter put in but it became infected and ,also, had to be removed and her nose cleaned by suction. Every day she is blowing her nose with alot of mucus being discharged. I am very concerned because nothing seems to work and the doctor, she is seeing, doesn’t seem to know whatelse to do.

Answer: The septum is the room divider, dividing the nose into two passages.  While it is never completely straight, a deviated (twisted) septum can block air flow in the nose.  Sometimes in surgery, or often after trauma or certain medications (cocaine quite commonly), a hole (perforation) develops from one side of the nose to the other.  When small, this may cause no symptoms, or perhaps a whistling sound with breathing.  Large holes disrupt the smooth flow of air through the nose and create drying, crusting and bleeding which often cause the hole to get larger over time.  Small holes may be fixed surgically, but surgery is much less successful with large ones.

Generally, a septal button will fix a perforated septum when the holes are too large to close (plastic prosthetic septum).  It allows for a normal, smooth flow of air, and the button is generally not felt by the patient.  If the hole is too big for the usual sizes that are available, your Ear Nose and Throat Doctor or Rhinologist (Sinus Specialist) may be able to measure and have a special order one made to fit.  Sometimes, surgery may be only partially successful, that is by making the hole smaller and then more amenable to a septal prosthesis.

At times, there is no way to really get this closed.  Should that be the case,  the use of nasal saline sprays, topical moisturizing with nasal ointments, and seeing your ENT doctor for cleaning of the area should make things better.

We, of course, would be happy to see your mom here at the NY Sinus Center.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology

Co-Director NY Sinus Center