The nasal septum is the structure between the nostrils that separates the nasal passages. The septum, composed of cartilage and thin bone, can develop a hole (perforation) in the cartilage as a complication of previous nasal surgery, from cocaine use, excessive nose picking, trauma, cancer, or diseases such as tuberculosis, sarcoidosis, or syphilis. As damage reduces blood supply in the septum, the cartilage begins to die, and a hole develops.

Some perforations can cause bleeding, pain, and a whistling sound when inhaling. If dried blood or scabs build up, you could also have trouble breathing through your nose.

Many perforations do not need to be closed. Small perforations may need only frequent rinsing with saltwater (saline) solutions and applying lubricating gels. Both can be bought without a prescription.

Several surgical techniques may be used to close a larger perforation. A surgeon may use tissue from inside your nose or from another part of your body (autograft) to stitch into the hole. Other doctors may use tissue to create a flap to cover the perforation.

Surgery for large perforations usually requires general anesthesia.