Septal perforation – Causes, Clinical features, Management

The different causes of septal perforation are:

• Traumatic perforation
  • Septal surgery
  • Cautery for epistaxis
  • Habitual nose picking
  • Deliberate perforation for putting ornaments
• Pathological perforation
  • Septal abscess
  • Nasal myiasis
  • Rhinolith
  • Chronic granulomatous diseases
    • Leprosy, Lupus, Tuberculosis – perforation of cartilaginous septum
    • Syphilis – perforation of bony septum
  • Wegener’s granuloma
• Drugs and Chemicals
  • Long term use of steroid nasal sprays
  • Exposure to certain chemicals in industry
    • eg: chromium
  • Cocaine addicts
• Idiopathic

Clinical features:

• Small perforations result in a whistling sound
• Large perforations cause crusting which bleed upon removal

Management:

• The identification of the cause is essential
• Small perforations can be closed by using plastic flaps
• In case of large perforations, removal of crusts can be done using alkaline nasal douche and application of bland ointment
• Silastic buttons can be used to close large perforations