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Septal Perforation

The septum is the bone and cartilage in the middle of your nose, dividing the left and right nostrils. The front part of the septum is what you see between your nostrils, but the septum is actually very long and extends far back into the nose. Septal perforation is a hole in the septum that creates a communication between the right and left nasal cavities. 

Perforations can occur due to complications in surgery (septoplasty), aggressive cautery for recurrent nosebleeds, nasal trauma or fracture, infection, or from certain autoimmune diseases. They can also be caused by nasal drug abuse (cocaine).


Some patients do not experience symptoms and are unaware of the perforation. When symptoms do occur, some patients notice that they have crusting in the nose, intermittent bleeding, a feeling of nasal obstruction, or if the hole is just the right size, they will notice a whistling sound. If the perforation is very large, the structure of the nose can become unstable and the tip of the nose can droop, this is called a “saddle nose.”


Septal perforation is diagnosed by an endoscopic examination of your nasal cavity. In some cases, additional testing such as blood work or a biopsy of the perforation may be needed to rule out causes.


Sizes of septal perforations vary. Small to medium sized perforations can be surgically repaired, while larger ones are more difficult. In many cases, keeping the inside of the nose moist will alleviate most, if not all, symptoms.

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