Nasal septal perforation is a full thickness defect of the nasal septum which results in a communication between the right and left nasal airways.
Symptoms of nasal perforation relate to its size and location and include:
1) A sensation of nasal obstruction (as a result of turbulent air flow)
2) Dry, irritated nasal mucosa (a result of reduction of nasal temperature and humidity)
3) Increased mucous production (a.k.a secondary rhinorrhea)
4) New intranasal crusting
5) Low grade bleeding (epistaxis) in cases where the mucosa fails to heal completely.
6) Pain (as the result of a low grade infection of underlying structures)
7) A whistling sound during nasal breathing.
8) Collapse of the support structures (resulting in saddle nose deformity)
Causes of nasal septal perforations include:
1) Iatrogenic: These cases resulting from previous nasal septal surgery are the most common cause.
2) Trauma: These cases may result after a traumatic injury that causes nasal septal fracture & septal hematomas.
3) Inflammation: These cases occur in patients with systemic inflammatory of auto-antibody conditions such as: Lupus, Crohn’s disease, polyarteritis nodosa, antiphospholipid antibody syndrome, rheumatoid arthritis, sarcoidosis, Wegener’s granulomatosis, leprosy and tuberculosis.
4) Infection: These cases occur less frequently as a result of infection with Syphilis, HIV, fungus or varicella.
5) Neoplastic: Other rare causes include carcinoma, T-cell lymphoma and cryoglobulinemias.
6) Nasal drug use: Cocaine abuse is the worst and most common offender. However, overuse of over-the-counter nasal sprays like oxymetazoline, phenylephrine and menthol inhalers have also been implicated.