If you’ve experienced consistent whistling every time you breathe through your nose, you may have a perforated septum. This occurs when a trauma, accident or injury creates a hole in the bone separating your nose into two sides. 

We’ll look at some of the most commonly asked questions about this condition and how it is treated.

What is the septum?

The septum is the piece of bone and cartilage that separates your nose into left and right nostrils. When it has a tear, defect or hole, it’s called a septal perforation.

What causes a septal perforation

There are several reasons why you may have a hole in your septum. Some of them include:

  • Nasal trauma from an accident or injury
  • Problems or complications from previous nasal surgery
  • An infection
  • Complications from prescription medication
  • Inflammatory disorders
  • Illegal drug use, particularly the use of cocaine
  • Septal piercing or problems from nasal piercings

In some very rare cases, cancer can also cause a perforated septum.

What is the difference between a perforated septum and a deviated septum?

A deviated septum is crooked, and may protrude to one side of the nose. Roughly 80 percent of Americans have some type septal deviation that has most likely been present since birth.

However, when the septum is perforated, there is an actual hole through the septum, allowing air from one nostril to spill over into the other one.

What are the symptoms of a perforated septum?

This condition doesn’t always cause symptoms. However, the most common one is a consistent “nose whistle” while breathing.  A perforated septum may also cause

·         Crusting

·         Nasal blockage

·         Bleeding

·         Drainage

·         Pain

Can a perforated septum heal on its own?

Sometimes, but it primarily depends upon the size of the hole, the location of the perforation and the extent of the tissue damage. It’s unlikely that a perforated septum will completely heal on its own, and in many cases, it’s more likely to get worse.

How is a septal perforation treated?

Our experienced ear, nose and throat doctors have decades of experience in diagnosing and treating disorders involving the nose. The first step in the treatment process it to find the cause of the perforation.

Often, medical treatment such as topical ointments or nasal sprays may allieviate the problem.

However, if symptoms persist, surgery may be needed. There are several possible surgical techniques that can be used to resolve the problem. These include:

·         Placement of a septal button

This technique uses a soft, plastic implant to “plug” the hole. The implant is painless, is not visible to others, and it can remain as long as necessary. When the septum has healed, it can be easily removed.

·         Reconstructive nasal surgery

·         Nasal skin grafts

We can provide advanced treatment for all types of injuries or conditions involving the ear, nose and throat.

Our ENT surgeons also have worked extensively to treat other nasal problems, such as polyps and enlarged turbinates. We’ll be happy to discus the latest surgical techniques and help you determine which treatment option is best for you.

If you have any of the symptoms of a perforated septum, please contact us.

Raleigh Capitol Ear, Nose, and Throat is the area's premiere physician-owned ENT practice with six convenient locations throughout Wake County. Our board-certified physicians have extensive experience in treating both common and complex cases to help adults and children alike. For more information or to schedule an appointment, contact us.


American Academy of Head and Neck Surgery