What are the Harms of Septum Perforation?

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What Are the Harms of Septum Perforation? How Do Nasal Perforations Affect Your Life?

Our nose is an organ with functions that extend far beyond breathing. It has many important functions such as smell, sound resonance, humidification, and air purification. However, in some cases, a hole may occur in the septum area located inside the nose. This condition is called septum perforation.

In recent years, many people have been frequently researching questions like “septum perforation harms,” “does septum perforation cause harm?,” and “is septum perforation dangerous?” on the internet. This is because this problem can lead to many aesthetic and functional difficulties.

In this article, I will explain in detail the harms and possible complications of septum perforation. If you are experiencing complaints such as dryness, bleeding, congestion, or discharge inside your nose and wondering “Do I have a perforation?”, be sure to read the rest of this article.

What is the Septum and How Does Perforation Occur?

The structure that separates the left and right airways inside the nose is called the septum. The septum consists of cartilage in the front part and bone in the back part.

Under normal conditions, the septum should be straight. However, some people may have congenital curvature (deviation) or holes that develop later (perforation).

Septum perforation means the formation of a hole in the septum. These holes can be small, but sometimes they can also be large. Large holes can cause more serious complaints.

What Causes Septum Perforation?

There are many reasons that can lead to hole formation in the septum:

Surgical procedures: It may develop due to complications especially after septoplasty or rhinoplasty surgery.
Trauma: Blows to the nose can weaken the septum.
Chemical substances: Cocaine use, excessive nasal spray use, exposure to certain acid gases.
Chronic infections: Long-term, untreated nasal infections.
Autoimmune diseases: Diseases such as Wegener’s granulomatosis and lupus can cause destruction of septal tissue.

The most curious question among patients is “does septum perforation cause harm?” The answer is: Yes. Especially large or improperly treated perforations cause many physical and psychological problems.

Now, let’s examine the most common harms one by one.

Nosebleeds

One of the most common harms of septum perforation is nosebleeds. The mucosa at the edges of the hole becomes thinner, dries out, and can easily crack.

Especially during winter months, in dry climates, or in people living in heated environments, nosebleeds are frequently seen. Sudden bleeding causes both anxiety and social concern in patients.

Additionally, iron deficiency and anemia may develop in people who experience frequent bleeding.

Nasal Congestion

Many patients think they will breathe more easily through their nose when perforation occurs. However, perforation disrupts the airflow pattern inside the nose.

Irregular airflow called turbulence irritates the mucosa and causes a feeling of congestion. Patients describe it as “air hits when breathing, I can’t breathe comfortably.”

Congestion that increases especially at night leads to snoring and sleep disruption.

Nasal Discharge

Perforation changes the flow of nasal mucus. Mucus that normally flows backward begins to flow forward due to perforation.

In this case, you may see nasal discharge stains on your pillow when you wake up in the morning, and your need to use tissues may increase during the day.

Constant nasal discharge creates problems in social environments and causes irritation and redness on the skin.

Nasal Dryness

Septum perforation disrupts the natural moisture balance of the nose. Due to the hole, air passes quickly and irregularly, causing the mucosa to dry out.

As a result of dryness, crusting, itching, and burning complaints are frequently seen. Some patients try to remove these crusts by picking inside their nose with their finger. However, this situation invites new bleeding and infections.

Voice Changes

Our nose acts like a resonance chamber for our voice. Septum perforation disrupts the shape of this resonance chamber.

As a result, changes such as voice thinning, nasal voice (nasality), and hoarseness may occur. This change creates a major problem especially for people whose profession is based on speaking, such as singers, teachers, and lawyers.

Chronic Sinus Infections

Mucus in the nose drains through the natural pathways of the sinuses. Perforation can disrupt the function of these pathways.

If mucus accumulates in the sinuses, chronic infections develop. Patients present with complaints such as frequent headaches and facial pain, feeling of fullness, loss of smell, postnasal drip, and bad breath.

Continuous antibiotic use can disrupt intestinal flora and weaken the immune system.

Changes in Smell and Taste Sensation

Smell cells are located in the upper part of the nose. Septum perforation reduces the number of odorous particles reaching this area by disrupting airflow.

Loss of smell (hyposmia or anosmia) may occur. Loss of smell also negatively affects the sense of taste.

Complaints such as not being able to enjoy food, confusing tastes, or “everything tastes the same” are frequently heard.

What Happens If Septum Perforation Is Not Treated?

Many people wonder “What happens if it’s not treated?” after asking “Does septum perforation cause harm?”

If left untreated, the harms listed above continue to increase. Especially large perforations create more nasal dryness, frequent bleeding, progressive loss of smell, increased sinusitis attacks, and psychological stress over time.

Patients may withdraw from social life and experience loss of self-confidence.

Is There Treatment for Septum Perforation?

Yes. However, treatment is planned according to the size and location of the perforation and the patient’s general health condition.

Drug treatments: Nasal moisturizing sprays, ointments, and saline washes are recommended. May be sufficient for small perforations.
Septal button: The perforation is closed with a silicone device. It is a temporary solution for patients who are not suitable for surgery or do not want surgery. I never recommend this.
Surgical repair: The hole is closed with various techniques. It is a difficult surgery that requires experience.

The aim of surgical intervention is to restore both the function and aesthetics of the nose. The chance of success increases as the size of the perforation decreases.

Why Don’t Most Surgeons Prefer Surgery for Septum Perforation Treatment?

One of the questions on many patients’ minds is: “Why is surgery rarely performed for septum perforation? Why do surgeons usually recommend sprays, ointments, or silicone buttons?”

The answer is quite simple: Surgery is difficult, the success rate is relatively low, and it requires a technically very delicate process.

Why Is Surgery Necessary in Septum Perforation Treatment?

In traditional repair techniques, success rates vary according to the size of the perforation and the condition of the intranasal tissues. Therefore, different approaches have been developed to achieve the best results both anatomically and functionally.

My Special Technique: Two-Layer Closure Approach

In this method I developed, I apply a system based on the principle of two-layer tissue closure. Thus, we safely repair the perforation area by strengthening both mucosal and supporting tissues.

Use of Leg Fascia

If working only inside the patient’s nose is sufficient, that is, if we won’t make changes outside the nose, we use a thin muscle membrane (fascia) taken from the leg (usually from the thigh area).

When this membrane is placed in the perforation area, it both serves as solid support and accelerates the healing of the mucosa inside the nose. Additionally, this membrane protects the sensitive mucosa inside the nose, reducing the risk of dryness and crusting.

Tissue Advancement from Inside the Nose

After placing the leg fascia, I apply the tissue advancement (flap) technique from the mucosal tissues inside the nose.

This procedure creates a second protective layer using the nose’s own natural tissues. Thus, both the inner and outer surfaces are strengthened. Thanks to this two-layer structure, the permanence of the repair increases and the risk of hole formation again is minimized.

Rhinoplasty Combination: Use of Rib Cartilage

Some patients may also request aesthetic intervention in the same session during septum perforation repair. Or if there are serious deformities in the external structure of the nose, it must be supported during repair.

In this case, I take a piece from the rib cartilage.

Advantage of Rib Cartilage

Provides sufficient amount of solid tissue.
Offers both structural support and aesthetic shaping possibilities.
Since it is tissue from the body, there is no compatibility problem.

Rib Cartilage Membrane and Internal Tissue Combination

When rib cartilage is used, I take not only the cartilage but also the membrane over it.

Additionally, I apply the tissue advancement (flap) technique from inside the nose, providing the second layer over the perforation.

In this way, a two-layer covering system is created in the perforation area:

Rib cartilage membrane and/or leg fascia tissue
Mucosal tissue advanced from inside the nose

This combination ensures both solid repair of the septum and preservation of nasal functions.

Advantages of the Two-Layer Closure Method

✔ Stronger Closure: More durable than single-layer classical methods. ✔ Low Re-perforation Risk: Thanks to the two-layer structure, the risk of perforation reopening is minimized. ✔ Natural Appearance: If needed outside the nose, rhinoplasty combination provides aesthetically satisfying results. ✔ Functional Recovery: Airflow is regulated, nasal congestion, bleeding, and dryness complaints are reduced. ✔ Tissue Compatibility Advantage: Since the patient’s own tissues are used, there is no risk of foreign body reaction.

Which Patients Can It Be Applied To?

Those with small, medium, or large septum perforations inside the nose
Those with long-term nasal bleeding, dryness, crusting, loss of smell complaints
Those with external nasal deformities or aesthetic demands
Patients who have undergone unsuccessful perforation repair before

Surgery Process and Recovery

Two-layer closure surgery is performed under general anesthesia.

If only leg fascia tissue is to be taken, fascia is extracted with a small incision from the leg.
If rib cartilage is also to be used, cartilage and the membrane over it are taken from the chest area (usually from the right side).

Surgery time varies between 3-5 hours on average. Patients usually stay in the hospital for 1 day.

During the recovery process:

Intranasal dressing and care are important for the first 2-3 weeks.
Intranasal moisturizing sprays and washes should be done regularly.
The inner mucosa of the nose completely adapts within approximately 3 months.

How to Prevent Septum Perforation?

Although not all perforations can be prevented, some measures that can be taken include:

Not using nasal sprays uncontrollably for long periods.
Avoiding nasal trauma.
Not using chemical substances (cocaine, etc.).
Consulting a doctor for nasal dryness, using moisturizing products as recommended.
Treating upper respiratory tract infections promptly.

Conclusion: Septum Perforation Can Be Harmful

Yes, septum perforation is definitely not a condition to be dismissed as “just a small hole.” For people who search “septum perforation harms” on Google, the clearest answer is:

✅ Bleeding,

✅ Congestion,

✅ Dryness,

✅ Discharge,

✅ Voice changes,

✅ Sinus infections,

✅ Loss of smell and taste…

These seven harms seriously impair quality of life.

Therefore, if you have complaints, it is very important to consult an ear, nose, and throat specialist without delay. Early diagnosis ensures both relief of symptoms and prevention of further complications.

Healthy breathing means healthy living!