Think of your nose as a two-lane road. The “center line” that separates your nostrils is a thin, solid strip of cartilage and bone called the septum. This structure makes it possible for you to breathe from one side of your nose when the other one is stuffy.
Sometimes, a hole can form in your septum. This is known as a nasal septal perforation. A nasal septal perforation can cause your nose to bleed a lot. You might also notice a whistling sound when you breathe. Your doctor may diagnose it after looking inside your nose with an endoscope, a very thin tube with a tiny camera attached.
If you find out you have a hole in your septum, you may not need to do anything about it. But if you get symptoms that bother you, surgery could be an option.
There are many reasons you could get a hole in your septum. These include:
- Excessive nose picking
- Cocaine use
- Nose surgery
- Overuse of decongestant and steroid nasal sprays
- Breathing in toxic chemicals
- Nasal piercing
- Nasal trauma
Some rare diseases, such as tuberculosis, sarcoidosis, syphilis, and Wegener’s granulomatosis, can cause a hole to form in your septum. A nasal tear may also result from a type of breast cancer treatment called bevacizumab plus chemotherapy.
In some cases, you might get a tear during or after nose surgery, especially surgery to fix a crooked septum. If this happens to you, talk to your doctor. If you’re not having any symptoms, it may not need any treatment.
Sometimes, though, holes in your septum increase dryness and may lead to nose bleeds. It is also common for the edges of the hole to form a crust and bleed. An over-the-counter saltwater (saline) nasal spray can help by keeping the inside of your nose moist.
A doctor may be able to plug your nasal tear with a special “button” made of soft, flexible plastic. Research shows people do well with nasal buttons, which can help reduce nosebleeds and crusting and stop the whistling sound.
If the hole in your septum is really bothering you, you may need surgery.
Your doctor may take tissue from another part of your body (inside your nose or another part) and sew it into the hole. Or they may use tissue to create a flap that covers the hole. Usually you are under general anesthesia, so you’re not awake during the operation.
There are many ways to fix a hole in the septum. Some require two procedures.
For example, in one type of “flap” procedure (inferior turbinate flap), the first surgery is done under general anesthesia. This may require a full day or overnight stay in the hospital. The second, or follow-up, surgery is an outpatient procedure (you don’t stay in the hospital), that uses a local anesthetic to numb the inside of your nose, but you stay awake.
What to Expect After Surgery
You’ll have packing, usually gauze in the nose, for about 48 hours after surgery. You can expect some bleeding and pain. Your doctor will give you a list of important things to avoid as you recover, such as:
Follow all your doctor’s advice to prevent the hole from opening up again. This sometimes happens, especially with large holes, but you can have another surgery to repair it.