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Septal Perforation

What Is A Nasal Septal Perforation?

The nasal septum is the wall that divides your nose into left and right nasal airway passages. The nasal septum is made up of cartilage and thin bone which is covered on both sides by a thin layer of soft tissue. You can feel the nasal septum as the middle structure when you pinch the tip of your nose. A nasal septal perforation is a hole through the nasal septum.

The hole in the nasal cavity may range in size depending on the cause of the perforation. The following illustrates the symptoms, causes, and ultimate treatments for a nasal septal perforation repair when necessary.

Need a consult for nasal perforation in NYC?

 

What Are The Symptoms?

Septal perforations cause disruption in how air moves through the nasal passages, making airflow more turbulent and less smooth. The air passes from one side to the other of the nose instead of straight back into the airway. As a result, having a perforated nasal septum may cause you to experience some if not all of the following symptoms:

Bleeding and Nose Scabs

The turbulent airflow causes the inner lining of the nose to become dry. As a result, the lining may form scabs and crusts that when dislodged can cause bleeding. The bleeding is usually temporary but may require minor procedures to prevent further episodes of bleeding.

Nasal Crusting

The exposed edges of the hole in the septum prevent the delicate lining of the septum from staying moist as well as preventing humidification of the air that is inhaled. As a result, crusts and scabs form along the septal perforation and may form in other parts of the nose. This crusting can progress and cause difficulty breathing. Scabs and crusts may also cause the remaining nasal septum to become infected, requiring antibiotic treatments. Nasal crusting is usually prevented with humidifiers and nasal irrigation. However, if crusting is significant it may require a physician to remove.

Feeling of Nasal Obstruction

Large nasal perforations may give the sensation of not being able to breathe properly, similarly to nasal congestion. This is because the sensors in the nose that detect air movement may be missing. You may be breathing properly, but it feels like you are obstructed. Large crusts may also block one or both sides of the nose.

Whistling Sounds

Small perforations, especially near the nostrils, may be bothersome as they can cause a whistling noise from the nose. This is because air can move between either side of the perforation at a higher speed than other parts of the nose. As a result, a high pitched whistling noise forms.

Nasal Collapse (Saddle Nose Deformity)

A large septal perforation can decrease support of the outside of the nose and cause the nose to collapse, a condition referred to as saddle nose deformity. This “saddling” is dramatic externally and will usually block the upper nasal airway.

Experiencing similar symptoms? Consult Dr. Mourad about potential nasal septal perforation

 

MOST COMMON CAUSE OF SEPTAL PERFORATION

Nasal septal perforations are caused by disruption of blood flow to the nasal septum. Because the nasal septum has a delicate blood supply, any factor that decreases this blood flow may result in a septal perforation. Some of the most common causes of septal perforations include:

  1. Previous Nasal Surgery: Nasal surgery can cause significant disruption of the blood flow to the septum as the tissues inside the nose are manipulated, decreasing blood flow. A tear in the nasal septum mucosa on both sides will prevent blood flow to the cartilage and a hole may be formed. The risk of a perforated nasal septum increases if there is a previous history of nasal surgery.
  2. Cocaine: Long-term cocaine use is a significant risk factor for developing a nasal septal perforation. Using a drug like cocaine causes the blood vessels inside the nose to shrink: The more cocaine used over a period of time, the more the vessels shrink. If the nasal blood vessels decrease in size enough, it may result in a perforated septum.
  3. Infection: Infection may result in what is called tissue necrosis, a term used to refer to tissue death. Such infections may result in a collection of pus in the septum. As the pus collects, it may compromise the vascular blood flow to the septum, again leading to a perforated septum.
  4. Overuse of Nasal Spray: Overuse of nasal spray can contribute to the deterioration of the nasal mucosa and potentially lead to complications such as nasal septum perforation.
  5. Medical Conditions: Some medical conditions may cause nasal septal perforations. More specifically, autoimmune conditions such as Wegener’s disease (granulomatosis) and Sarcoidosis may result in diseased blood vessels, especially in the nose. It is an important consideration for your doctor to make sure that an undiagnosed illness is not recognized. Individuals with septal perforations without an obvious cause should have an autoimmune workup.
  6. Self-manipulation: Excessive scratching inside the nose can create a hole in the septum. Excessive nose picking or using instruments in the nose like Q-tips or bobby pins can traumatize the soft tissue and disrupt the nasal septum blood supply.
  7. Nasal Trauma: Trauma to the nose may result in blood collection in the septum, known as a hematoma. As the hematoma expands following the nose injury, it disrupts the blood flow which can lead to a septal perforation.
  8. Nasal Medications: Long-term use of nasal sprays such as steroids or over the counter nasal sprays may also decrease the size of the blood vessels along the septum leading to perforation.

 

Talk to Dr. Mourad about septal perforation repair

Because of the complex and potentially interconnected causes of a nasal septal perforation, it is important to consult a perforated septum specialist. Talking to a sinus expert can prevent septum deterioration.

 

Surgical techniques to treat a perforated septum

There are different treatment options for septal cartilage depending on the condition of the nose. Larger perforations might require a specialized surgical intervention. Here are a few surgical options to address nasal perforation:

Non-surgical treatment of nasal septum perforations

Non-surgical approaches to managing nasal septum perforations primarily focus on alleviating symptoms and preventing further damage. These treatments are particularly suitable for small perforations or for patients who are not good candidates for surgery. Non-surgical options include:

  • Nasal Irrigation and Moisturizers: Saline nasal sprays or irrigations can help keep the nasal cavity moist and reduce crusting around the perforation.
  • Nasal Plugs or Buttons: Nasal buttons can effectively reduce symptoms such as nasal whistling, bleeding, and crusting by providing a physical barrier.
  • Topical Treatments: Applying antibiotic or steroid creams directly to the edges of the perforation can help manage inflammation and prevent infections, which might exacerbate the condition.

Nasal septum perforation repair surgery

For more significant septal perforations, surgical intervention is often necessary to repair the defect and restore normal nasal function. Septal perforation repair is a surgical procedure aimed at correcting issues within the nasal septum, including perforations, using cartilage grafts. The complexity of the surgery depends on the size, location, and cause of the perforation. Surgical options for repairing a septal perforation include:

  • Local Flap Techniques: This involves using the patient’s own tissue, taken from the surrounding nasal lining, to close the perforation. Using a local flap of tissus from the patient’s nose is often preferred for smaller perforations.
  • Tissue Grafting: For larger perforations of the nasal passages, grafting material, either from the patient (autograft) or from a donor (allograft), may be necessary to close the gap. Common graft sources include cartilage from the ear or rib, or soft tissue from other areas of the body.

 

HOW CAN DR. MOURAD HELP WITH SEPTAL PERFORATIONS?

Dr. Mourad is an Otolaryngologist and Facial Plastic Surgeon with extensive experience in all sizes of septal perforation repair. After a thorough history and examination, you will learn how big your perforation is and what options for closure exist. We will check your medical benefits to let you know what to expect so there are no surprises. If you think we can help please give our office a call.

Deviated Septum

THE NASAL SEPTUM AND THE DEVIATED SEPTUM

We have all heard about the “deviated nasal septum” but what exactly is it? Should every nasal septum be completely straight? If I can’t breathe, is it the result of this deviated septum? First, let’s start with the definition of a nasal septum.

 

WHAT IS A NASAL SEPTUM?

The nasal septum is a key structure within the nose, made up of cartilage and bone: it is the wall of bone and cartilage covered with moist soft tissue that divides the left and right side of your nose. It starts in the front of your nose and divides your nostrils and continues until in the back into your nose it ends and the breathing passages join again. The two separate chambers ensure that airflow is evenly distributed through each nasal cavity.

This division is crucial for the proper functioning of the nose, including air filtration, humidification, and temperature adjustment before the air enters the respiratory tract.The nose normally will swell on one side and decongest on the other side (the nasal cycle) so it is normal for breathing to “flip back and forth” between sides of the nose.

 

WHAT IS A “DEVIATED NASAL SEPTUM”?

Nasal septum deviation, often referred to as a deviated septum, is a condition where the septum shifts away from the midline, causing one nasal passage to become narrower than the other. Keep in mind that all nasal septums have bends in them: There is no such thing as a perfectly straight septum.

A septum is termed “deviated” when it is crooked enough to block the breathing on one or both sides of the nose. If you don’t have trouble breathing then you don’t have a “deviated nasal septum”: It may be bent, but if that doesn’t bother you then you don’t need to do anything about it. However, this shift can significantly affect a person’s breathing, leading to various nasal symptoms and impacting their quality of life.

WHAT CAN CAUSE THE NASAL PASSAGE TO DEVIATE?

  • Trauma, such as from an accident or injury, is a leading cause of septal deviations. This can include incidents like automobile accidents or sports injuries.
  • A minor deviation may not present noticeable symptoms but can occur naturally or develop with age. As the structures of the face change, the septum might not maintain its central position.
  • Severe deviation can occur naturally in the body, affecting airflow and leading to bothersome symptoms. Some people are simply born with a deviated nasal septum.

Being able to breathe better from your nose can dramatically improve your quality of life.

WHY IS A DEVIATED SEPTUM IMPORTANT?

Humans are physically designed to normally breathe through our noses. This makes a deviated septum more than just a structural issue; it can lead to a series of complications that impair breathing, disrupt sleep quality, and decrease the sense of smell, to name a few. These complications can significantly reduce a person’s quality of life, making it a health concern that often requires medical treatment.

In some patients, a deviated septum can lead to nasal obstruction, sleep apnea, high blood pressure, heart and lung failure and even heart attacks.

SYMPTOMS OF A DEVIATED SEPTUM

DIFFICULTY BREATHING THROUGH THE NOSE OR SLEEP APNEA

Obstructed nasal breathing and sleep apnea are common in individuals with a deviated septum. The blockage can cause snoring and interrupted sleep, significantly affecting sleep quality.

RECURRING NOSEBLEEDS

A deviated septum can lead to frequent nosebleeds due to dryness and irritation in the nasal cavity, indicating potential obstruction or damage.

PERSISTENT NASAL CONGESTION (ONE OR BOTH NOSTRILS)

Nasal congestion, often one-sided, is a typical symptom of a deviated septum. This can hinder daily activities and disrupt sleep by making breathing through the nose challenging.

CHRONIC SINUSITIS

Chronic sinusitis, marked by ongoing sinus inflammation and infection, is frequently caused by a deviated septum. Symptoms include sinus pressure and nasal discharge, impacting overall well-being.

HEADACHE AND FACIAL PAIN

Individuals with a deviated septum may experience regular headaches and facial pain due to altered airflow and sinus pressure, often worsened by associated sinus infections.

 

ARE THERE OTHER REASONS NOT TO BREATHE WELL?

Yes. You may also have inferior turbinate hypertrophy which is swelling of the tissue on either side of the inside of your nose that can block your breathing. Nasal valves have been shown to be as common a cause of nasal obstruction as the deviated nasal septum. These are the narrowest areas where air passes inside the nose and opening the valves can improve airflow and breathing.

Besides a deviated septum, other factors such as allergies, nasal polyps, environmental irritants, nasal tumors, trauma, congenital defects, autoimmune diseases, and others can cause breathing issues. Identifying the specific cause is crucial for effective treatment, whether it be through medication, surgery, or lifestyle adjustments.

 

PREPARATION FOR A DEVIATED SEPTUM SURGERY (SEPTOPLASTY)

Diagnosing a deviated septum involves a detailed Medical History and a physical examination by a healthcare professional, often using a nasal speculum to inspect the nasal passages. In some cases, imaging tests may be recommended to assess the extent of the deviation and plan the appropriate treatment.

When visiting Mourad MD, you will meet with Dr. Mourad where he usually spends an hour going over everything related to your surgery. He will evaluate and make sure that he can specifically tailor a custom care plan to your exact needs. During the consultation, Dr. Mourad will determine the exact nature of your complaints and the exact causes. He may prescribe medications that will assist in your complaints. Once a tailored plan is made, Dr. Mourad and his staff will take you through all the necessary information needed to make sure that your surgery happens without issue. We take care of the details so that you can have the most enjoyable experience.

Dr. Mourad views treating his patients to be nothing short of a privilege and an honor and enjoys taking the time to get to know his patients and fully understand their issues. Dr. Mourad’s office provides a boutique experience that takes you out of the mindset of being at the doctor’s office. It is a warm, comfortable environment, providing a bespoke experience.

 

POTENTIAL TREATMENTS FOR A DEVIATED NASAL SEPTUM

SEPTOPLASTY BY A FACIAL PLASTIC SURGEON

Surgical treatment, such as septoplasty, is performed by plastic surgeons to correct the crooked septum, aiming to restore normal airflow through the nose. This outpatient procedure is considered a safe and common procedure with few complications.

MEDICATIONS TREATING SYMPTOMS OF DEVIATED SEPTUM

Medications, including nasal corticosteroid sprays, decongestants, and antihistamines, can manage symptoms such as nasal congestion, runny nose, and inflammation. However, these treatments do not correct the underlying structural issue but can improve quality of life by alleviating some of the nasal symptoms. No medicine will actually straighten the cartilage and bone that may be obstructing your nose!

If you have a mild septal deviation, nasal saline rinses feel good for many patients and may rinse away stagnant mucus, allergens, and impurities. Other decongestants in pill or liquid form can decongest the nose but the pills can increase blood pressure and the sprays can be addictive and give more congestion after just using a couple of days.

The choice of treatment, whether surgical or medical, depends on the severity of the symptoms and their impact on the person’s daily life. With proper care and treatment, most individuals can expect to see a significant improvement in their symptoms and overall health.

 

HOW CAN DR. MOURAD HELP ME WITH MY DEVIATED NASAL SEPTUM?

Most patients who come into our office have been on all of the medications and may still not breathe well. We will discuss all the options for treatment with you. We feel that educated patients are happier and more realistic about their treatment. Our office will check your benefits and deal with insurance as much as possible. Dr. Mourad is an expert at all forms of nasal surgery and is happy to discuss your care with you. Please let us know how we can help you.