Perforated nasal septum (PNS) can occur due to different reasons like infection, trauma, and inhalation of substances. The majority of patients presenting with septum perforation experience no symptoms [1]. Perforations can either be anterior or posterior and anterior ones are more likely to be symptomatic than the posterior defects [2] [3]. Furthermore, the size of the perforation also plays a role in the presentation [4]. Frequent complaints include wheezing, epistaxis, nasal obstruction, olfactory dysfunction, and pain. Scabs and crusting can be seen. In the case of a small perforation, or uninterrupted hydration of the septum, symptoms are likely to be less severe. Patients may experience whistling sounds during respiration.

Ultimately PNS results from disruption of perfusion of the septal area, leading to ischemia and tissue necrosis. Iatrogenic causes are common and can be due to various surgical procedures, indwelling nasogastric tubes and nasal packing [1] [5]. Traumatic events such as excessive nose picking, injury by foreign bodies and nasal fractures have been described [6].

PNS has been associated with the chronic use of inhaled substances, such as cocaine and nasal decongestants, which over time lead to perforation due to local vasoconstriction [2]. The long-term use of steroids has also been linked to PNS, and the concomitant intake of both steroids and decongestants compounds the risk [4] [7]. Females are more affected by this [8]. Occupational exposure to some industrial chemicals such as cement dust, platinum salts, arsenic, and mercury leads to PNS.

Syphilis, human immunodeficiency virus (HIV) infection and tuberculosis are among the many bacterial, fungal and viral diseases that can affect the airway and predispose to PNS [6]. In some parts of the world, leprosy is still prevalent and is an acknowledged etiology of PNS. There are systemic inflammatory conditions that contribute to the occurrence of PNS, and these are systemic lupus erythematosus (SLE), Wegener's granulomatosis and sarcoidosis [9]. Malignancies are another factor in the development of a perforation, notably squamous cell carcinoma [4].

Diagnosis of a perforated nasal septum is by visualization of the defect on physical examination. Rhinoscopic exploration is needed to determine the extent of the lesion. Further investigation is warranted in order to reveal the underlying disease process. This is achieved by first obtaining a thorough patient history [10]. Other laboratory and imaging studies may be carried out, and the choice of test is guided by clinical suspicion based on all the symptoms that a patient may present with [11]. The following are examples of such tests:

• Full blood count, inflammatory and rheumatic markers such as erythrocyte sedimentation rate (ESR), antineutrophil cytoplasmic autoantibody (ANCA), rheumatoid factor: These are useful in granulomatous, systemic inflammatory and rheumatic conditions.
• Toxicology and drug screens: This helps to obtain information on substance use or exposure.
• Specific tests for certain diseases, for example, syphilis.
• Biopsy: To analyze the tissue for signs of infection or malignancy, if suspected.
• Chest X-ray: Obtained if signs of tuberculosis or sarcoidosis are present.
• Computerized tomography (CT) scan: May be conducted if granulomatous disease suspected.

Treatment for a perforated nasal septum depends on the size of the perforation and the severity of symptoms. Small perforations may be managed with saline sprays, ointments, or humidifiers to keep the nasal passages moist. For larger perforations, surgical repair might be necessary. This can involve grafting tissue to close the hole. In some cases, a septal button, a small device inserted into the perforation, can help alleviate symptoms.

The prognosis for a perforated nasal septum varies. Many patients find relief from symptoms with appropriate treatment. Surgical repair can be successful, but the outcome depends on the size and location of the perforation and the patient's overall health. Some individuals may experience recurrent perforations or require additional interventions.

Several factors can lead to a perforated nasal septum. Trauma to the nose, such as from an injury or surgery, is a common cause. Chronic use of nasal sprays or recreational drugs like cocaine can damage the nasal tissues. Infections, autoimmune diseases, and certain medications may also contribute to the development of a perforation.

The exact prevalence of perforated nasal septum is not well-documented, but it is considered relatively uncommon. It can occur in individuals of any age, though certain risk factors, such as nasal trauma or drug use, may increase the likelihood. Both men and women are affected, and the condition can be seen worldwide.

The nasal septum is composed of bone and cartilage, covered by a thin layer of mucous membrane. A perforation occurs when this membrane and the underlying structures are damaged, creating a hole. This can disrupt normal airflow and lead to the symptoms associated with the condition. The size and location of the perforation influence the degree of airflow disruption and symptom severity.

Preventing a perforated nasal septum involves minimizing risk factors. Avoiding nasal trauma, using nasal sprays as directed, and refraining from recreational drug use can reduce the risk. Maintaining good nasal hygiene and managing underlying health conditions, such as autoimmune diseases, can also help prevent perforations.

A perforated nasal septum is a condition characterized by a hole in the nasal septum, leading to symptoms like nasal congestion, nosebleeds, and breathing difficulties. Diagnosis involves a physical examination and possibly imaging studies. Treatment ranges from conservative measures to surgical repair, depending on the perforation's size and symptoms. Understanding the causes and risk factors can aid in prevention and management.

If you suspect you have a perforated nasal septum, it's important to seek medical evaluation. Symptoms like frequent nosebleeds, nasal congestion, or a whistling sound when breathing through the nose may indicate this condition. Treatment options are available, and addressing the underlying cause can improve outcomes. Maintaining nasal health and avoiding risk factors can help prevent this condition.

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