Septum Perforation Surgery Turkey

Septum Perforation (Hole in the Nasal Septum)

Septum perforation is the formation of a full-thickness hole in the middle wall (septum) that divides the nasal cavity into two. Damage to the cartilage or bone and the mucosal layers surrounding them at the same point creates a passage between the right and left nasal cavities. Nasal dryness, crusting, recurrent bleeding and a whistling sound while breathing are the most common symptoms.

The nose is an organ that warms and humidifies the air and filters microbes. Its ability to perform these functions largely depends on the integrity of the septum. When a perforation occurs, the airflow inside the nose is disrupted, negatively affecting both health and quality of life.

What Is Nasal Septum Perforation?

The nasal septum consists of a firm layer made of cartilage and bone in the centre and the mucosal layers (inner nasal membrane) surrounding this layer on both sides. Perforation occurs when all three of these layers are damaged at the same point.

Perforations may be as small as 1–2 mm or may reach a size of 3–4 cm. The size of the hole and its location on the septum are the two main factors that determine both the severity of the complaints and the treatment plan. While small perforations located in the back part of the septum often do not cause symptoms, perforations in the front part lead to noticeable complaints.

What Causes Septum Perforation?

It has many different causes, and often more than one factor comes together to trigger this condition. The most common causes are as follows:

Nasal Surgeries

The risk of an intranasal hole is higher in people who have previously undergone nasal surgery. The septum may unintentionally be damaged during rhinoplasty, septum deviation surgery or sinus surgeries. Mucosal tears that occur during surgery and are not properly repaired, or tissues that do not heal properly after surgery, may turn into a perforation over time.

Long-Term Use of Nasal Sprays

Sprays used to relieve nasal congestion may damage the nasal mucosa when used for a long time and without control. Incorrectly used sprays cause the tissues inside the nose to dry out and become thinner; this prepares the ground for the formation of a hole in the septum.

Exposure to Chemicals and Heavy Metal Dust

The risk of perforation increases in people who work in environments involving chemicals or who are exposed to intense environmental pollution. Thinning and hole formation in the septum may develop over time, particularly in industrial workers exposed to heavy metal dust such as nickel and chromium or to chemical gases.

Facial and Nasal Trauma

Accidents, blows or trauma sustained during sports may damage the septum. A hard blow to the nose may cause a crack in the septum, an accumulation of blood (septal haematoma) and subsequently the formation of a hole.

Drug Use

Taking substances such as cocaine and ketamine through the nose destroys the sensitive tissues inside the nose. Cocaine, in particular, blocks blood flow in the nasal mucosa, causing tissue death and the formation of a hole in the septum over time.

Infections

Infections inside the nose may cause serious damage when left untreated. Fungal infections and chronic bacterial infections, in particular, prepare the ground for the formation of an intranasal hole.

Smoking

Smoking dries out the nasal mucosa and prevents tissues from healing. This contributes to the weakening of the septum and the formation of a hole.

Autoimmune Diseases and Genetic Factors

Certain diseases affecting the immune system may weaken the nasal tissues. Autoimmune diseases such as granulomatosis with polyangiitis (Wegener’s granulomatosis), sarcoidosis and lupus may, although rarely, cause perforation. Therefore, perforations without a known cause should be evaluated for a possible underlying systemic disease.

Who Is at Risk?

Septum perforation is particularly more common in the following groups:

• Those who have previously undergone nasal surgery
• Those who have been exposed to facial or nasal trauma
• Those who have used nasal sprays for a long time without control
• Cocaine users
• Those with chronic sinusitis or chronic nasal infections
• Those occupationally exposed to chemicals and heavy metal dust
• Those with autoimmune diseases

It is important for these risk groups to be monitored with regular ENT examinations.

Symptoms of Septum Perforation

Symptoms vary according to the size and location of the hole. Perforations transform the laminar (regular) airflow inside the nose into turbulence, causing various discomforts. While some people experience no symptoms, others develop complaints that seriously reduce their quality of life.

The most common symptoms:

• Nasal dryness and crusting: The hole disrupts airflow, causing the mucosa to dry out, crusting and a constant feeling of discomfort.
• Nosebleeds: The edges of the perforation are sensitive; recurrent nosebleeds are common.
• Whistling sound while breathing: Holes located particularly in the front part of the septum cause a whistling sound while breathing in and out.
• Nasal congestion and a feeling of pressure in the nose: The disrupted airflow creates a feeling of congestion despite the presence of a hole.
• Headache and postnasal drip: Disrupted airflow may affect the sinuses, causing headaches and postnasal drip.
• Foul-smelling discharge: When accompanied by an infection, foul-smelling discharge may come from the nose.
• Reduced sense of smell: This may develop in long-term perforations due to chronic infection and crusting.
• Aesthetic problems: In advanced and anteriorly located perforations, loss of nasal support may cause collapse of the nasal bridge (saddle nose deformity) or drooping of the nasal tip.
• Social and psychological effects: Some patients experience significant discomfort in social environments because of the sound produced while breathing.

How Is Septum Perforation Diagnosed?

The diagnosis is made through a physician’s examination and, when necessary, imaging methods.

Nasal Endoscopy

The diagnosis is generally made through nasal endoscopy (examination with a camera) performed by an ear, nose and throat specialist. Thanks to this painless and short examination, even perforations in the back part of the septum can easily be detected and a definitive diagnosis can be made. During the examination, the size and location of the hole and the condition of the surrounding cartilage support are evaluated; this information forms the basis of the treatment plan.

Imaging Methods

A perforation may also be noticed on computed tomography (CT) or magnetic resonance imaging (MRI) performed for other reasons. Before repair, a paranasal sinus CT examination may be recommended to evaluate the presence of an accompanying paranasal sinus disease, not for every patient but only for selected patients.

Additional Tests

In perforations for which no clear cause can be identified, blood tests and, when necessary, a biopsy may be requested to rule out an underlying autoimmune or infectious disease.

Septum Perforation Treatment Methods

Treatment varies according to the size and location of the hole, the severity of the complaints and the patient’s general health condition.

Medical (Non-Surgical) Treatment

No treatment is required for perforations that do not cause any complaints; monitoring is sufficient. In patients with complaints, medical methods such as nasal irrigation, moisturising sprays and ointments are applied at the first stage. These methods may temporarily relieve the patient by reducing dryness and crusting; however, they do not close the hole, meaning they do not offer a permanent solution.

Septal Button

It is a silicone plug that mechanically closes the hole. Its application is practical, but because a foreign object is placed inside the nose, cleaning problems and odour formation may occur; in some patients, the complaints may increase rather than decrease. Therefore, it is considered a selected alternative for patients who are not suitable for surgery or who do not prefer surgery.

Surgical Treatment (Septum Perforation Repair)

The permanent treatment of perforations that cause complaints and reduce quality of life is surgery. The success of the operation is largely directly proportional to the size of the hole, its location on the septum and the remaining cartilage support. For a permanent result, a technique suitable for the cause and size of the perforation and the surrounding bone–cartilage tissue should be selected.

Although nasal septum perforation is a common pathology, its successful treatment still presents a significant challenge. Many different surgical techniques have been described in the literature; however, some of these techniques do not provide sufficient success, particularly in large perforations. The limited number of surgeons who regularly deal with these operations also causes patients to remain undecided about surgery.

Special Technique in Septum Perforation Repair

The Method Applied by Prof. Dr. Gediz Murat Serin

Prof. Dr. Gediz Murat Serin applies a surgical technique that he was involved in developing and that has been published in the scientific literature in order to achieve more permanent results in perforation repair.

The basis of the method is the repair of the perforation using membrane (fascia) tissue taken from the outer side of the patient’s upper leg, taking into consideration the limited success rates of existing techniques.

In the study conducted using this technique, the perforation was completely closed in 15 of the 17 patients who underwent surgery between January 2016 and January 2019 (88.2%). The average size of the perforations in the series was 18.5 mm horizontally and 11.5 mm vertically, and the average follow-up period was 14.5 months. These results show that the technique can also be applied particularly to large perforations.

The technique is applied with two different approaches according to the patient’s condition:

Closed (Endoscopic) Technique

In suitable patients, the hole is closed using membrane tissue taken from the leg with a closed (endoscopic) approach. No incision is made outside the nose.

Open Technique

In some patients, intervention outside the nose may also be required, or the cartilage support inside the nose may be insufficient. In these cases, the surgery is performed with an open technique using rib cartilage and the membrane surrounding this cartilage. In this way, both the hole inside the nose is closed and, when necessary, the external structure and aesthetics of the nose are corrected during the same session.

Double-Layer Support

Whether the open or closed technique is applied, the healthy tissues inside the nose are moved over the hole and form a second support layer for the perforation covered with the membrane. This multilayered approach is the main element that increases the permanence of the repair.

These surgeries are serious operations that require care and precision. The patient’s trust in the surgeon, having detailed information about the process and actively participating in the process are of great importance both in terms of meeting expectations and maintaining motivation.

What Happens If Septum Perforation Is Not Treated?

Untreated septum perforation may lead to serious problems over time:

• Symptoms such as dryness inside the nose, crusting, recurrent bleeding and a whistling sound while breathing increase and reduce quality of life.
• The hole may enlarge over time; in advanced cases, collapse of the nasal bridge (saddle nose deformity) and drooping of the nasal tip may develop.
• Neglected perforations may become a source of low-grade chronic infection; this may cause chronic inflammation in the septal bone, nasal floor and side walls.
• Sinus problems and upper respiratory tract complaints may develop in the long term.
• As the hole enlarges and the surrounding tissue weakens, the chance of surgical success decreases.

Therefore, it is important to consult an ENT specialist at an early stage when complaints are present. For evaluation and an appointment, you can contact us through our contact page.

Postoperative Recovery Process

Recovery Timeline

• First days: Mild bleeding and crusting may occur. Regular dressing and moisturising accelerate healing.
• Day 7: If present, the external nasal tape and plaster cast are removed.
• Week 3: The silicone stents placed inside the nose are removed.
• Weeks 3–4: Most patients begin to breathe noticeably more comfortably during this period.
• Months 3–6: Particularly in the repair of large perforations, complete tissue healing may take this long. The first 6 months are the most critical period in terms of the permanence of the result.

Things to Consider After Surgery

• Protect the nose from impacts.
• Do not smoke and stay away from irritating substances; strictly avoid cocaine use.
• Pay attention to cleaning and moisturising the nose.
• Use the medications recommended by your doctor regularly.
• Do not miss your follow-up appointments.

Septum Perforation Surgery Price

The price of the surgery varies depending on many factors. The size and location of the perforation, the surgical technique to be applied, the need for a graft (cartilage, fascia, etc.), the equipment of the hospital where the surgery will be performed and the surgeon’s experience play a determining role in the cost. Whether the surgery will be performed only for functional purposes or together with aesthetic corrections also affects the total cost.
Price information is provided specifically for the patient after a detailed examination and evaluation. Therefore, people considering surgery are advised to consult an ear, nose and throat specialist experienced in this field and undergo a comprehensive evaluation.

Frequently Asked Questions

How can septum perforation be recognised?

Dryness and crusting in the nose, a whistling sound while breathing, frequently recurring nosebleeds and nasal congestion are the first warning signs. A definitive diagnosis is made through a nasal endoscopic examination performed by an ENT specialist.

What causes a hole in the septum?

The most common causes are previous nasal surgeries and trauma. In addition, long-term uncontrolled use of nasal sprays, cocaine use, chronic infections, chemical exposure and autoimmune diseases may also cause perforation.

Does septum perforation close on its own?

No. Septum perforation does not close on its own because it involves full-thickness tissue loss. Small holes may remain the same size for a long time, but they do not heal and disappear.

Some patients, particularly those with small perforations, may interpret a reduction in their complaints as “the hole has closed.” However, an endoscopic examination shows that the perforation is still present. A reduction in symptoms should not be confused with closure of the hole.

Does septum perforation enlarge?

Yes, there is a possibility of enlargement. Constant dryness inside the nose, trauma, chronic infection, chemical exposure and smoking may cause the perforation to expand. The risk of enlargement is higher in perforations larger than 1 cm.

In addition, the changes caused in the nasal mucosa by increased oestrogen and progesterone hormones during pregnancy may cause existing perforations to dry out and enlarge more easily. Therefore, regular use of nasal moisturisers becomes even more important during pregnancy.

What complaints does septum perforation cause?

Nasal congestion, a whistling sound while breathing, recurrent nosebleeds, severe dryness and crusting, a feeling of pressure in the nose, sleep disorders and a reduced sense of smell may occur. In advanced cases, collapse of the nasal bridge and drooping of the nasal tip may develop.

Is treatment possible without surgery?

Non-surgical methods provide temporary relief but do not close the hole. Moisturising sprays, ointments or a septal button may be used. The definitive and permanent treatment is surgery.
In recent years, attempts have been made at some centres to close small perforations using biological adhesives or tissue engineering products; however, these methods have not yet become standard treatment.

Is septum perforation surgery difficult?

The difficulty of the surgery varies according to the size and location of the hole and the condition of the surrounding tissues. While small perforations are easier to close, surgery becomes significantly more complex in large perforations, and an additional graft may be required.

The surgeon must preserve the integrity of the nose both functionally and aesthetically during the operation. Therefore, it is important for the operation to be performed by ENT surgeons experienced in this field.

Can the hole reopen after surgery?

This risk is low in surgeries performed using the correct technique. However, smoking, trauma, cocaine use and failure to follow care recommendations significantly increase this risk. The first 6 months after surgery are the most critical period; during this process, the moisture inside the nose must be maintained and follow-up appointments with the doctor must not be missed.

What is the recovery process like after surgery?

Mild bleeding and crusting may occur during the first days. The external tape is removed on day 7, and the silicone stents inside the nose are removed in week 3. Most patients begin to breathe comfortably within 3–4 weeks. Complete healing may take 3–6 months in the repair of large perforations; during this process, it is important to be patient and follow the physician’s recommendations.

What happens if the septal hole is not treated?

The symptoms become more severe over time, the hole may enlarge, the shape of the nose may deteriorate and a chronic infection may develop. In addition, as the hole enlarges, the chance of surgical success decreases.

What is the price of septum perforation surgery?

The price varies according to the size and location of the hole, the technique to be applied, the need for a graft, the hospital’s equipment and the surgeon’s experience. Clear information is provided specifically for the patient after an examination and evaluation.

Conclusion

Septum perforation is a serious condition that may negatively affect quality of life. With correct diagnosis and appropriate treatment methods, this problem can largely be resolved. Although surgical success rates are quite high in experienced hands, there is no 100% guarantee of success with any surgical method.

If you experience symptoms such as nasal congestion, recurrent bleeding, crusting or a whistling sound while breathing, it is important to consult an ENT specialist. Paying attention to your nasal health is critically important for your general health.