Causes and risk factors
Nasal septum is a delicate part of the nose. Perforation occurs as a result of trauma to the nose or nasal fracture such as a head injury. It can occur due to infection in the nose. Long-term medications, drug abuse such as cocaine, or use of nasal decongestants and nasal steroids can lead to perforation of the septum. Autoimmune disorders and diseases like TB, syphilis, leprosy, and septal abscess can cause septal perforation. Malignant conditions like tumors and granuloma are predisposing factors for this disease. It can occur following a nasal surgery. Piking of nose [rhinitis sicca], nose piercing can cause this condition.
Clinical presentation
Patient complains of irritation and crusting at the site of perforation. Epistaxis occurs in an attempt to remove the crust. Patient experiences whistling sound during breathing. Foul smelling nasal discharge may occur. Obstructed nasal breathing and snoring occurs. There is an increased susceptibility to infection. Nasal collapse and cosmetic deformity occurs.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. Routine hemogram is done. VDRL test should be performed. Biopsy may be required.
Treatment
Treatment regimen involves a nasal disinfectant cleansing and debridement, attaining increased humidification and moisture inside the nose such as with oil, ghee, alkaline douche etc., treating the associated nasal infections, prevention of increase in size of perforation, surgical closure of perforated septum, or nasal reconstruction surgery.
