eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Septal Perforation: Medical Aspects: Differential Diagnoses & Workup

Author: Rami K Batniji, MD, Private Practice, Batniji Facial Plastic Surgery
Coauthor(s): James F Chmiel, MD, Clinical Assistant Professor, Department of Otolaryngology, State University of New York at Buffalo
Contributor Information and Disclosures

Updated: Jan 2, 2009

Differential Diagnoses

Complications of Rhinoplasty
Nasal Polyps, Nonsurgical Treatment
Congenital Malformations, Nose
Nasal Polyps, Surgical Treatment
Disorders of Taste and Smell
Nasal Reconstruction
Epistaxis
Pathology: Sarcomas of the Head and Neck
Foreign Bodies of the Airway
Pathology: Squamous Cell Carcinoma
Fractures, Nasal and Septal
Rhinoplasty, Postrhinoplasty Nasal Obstruction
Local Anesthetics
Rhinoplasty, Saddle Nose
Malignant Tumors of the Nasal Cavity
Septal Perforation: Surgical Aspects
Malignant Tumors of the Sinuses
Snoring and Obstructive Sleep Apnea, CPAP
Mucosal Melanomas of the Head and Neck
Snoring and Obstructive Sleep Apnea, Surgery
Nasal and Sublabial Approaches to the Pituitary
Nasal Implants
Nasal Physiology

Other Problems to Be Considered

Benign tumors of the nasal cavity
Benign tumors of the sinuses

Workup

Laboratory Studies

  • Because of the varied etiologies of nasal septal perforations, performing a detailed laboratory evaluation on every patient is cost prohibitive. Because of this, an algorithm is proposed to guide the physician when obtaining more detailed laboratory and other studies. See Image 1, below:
  • In patients without a likely cause for the perforation or in patients with rheumatologic complaints, basic laboratory studies may be performed.
    • A significantly elevated erythrocyte sedimentation rate can indicate an underlying rheumatologic disorder. Unfortunately, a value within the reference range does not rule out a rheumatologic or inflammatory disorder. The erythrocyte sedimentation rate can be elevated significantly in dermatomyositis-polymyositis, rheumatoid arthritis, sarcoidosis, lupus, Wegener granulomatosis, temporal arteritis, and many other disorders.
    • In patients with cough, hemoptysis, sinusitis, bloody nasal discharge, or eye abnormalities (episcleritis or conjunctivitis), an antineutrophil cytoplasmic autoantibody (C-ANCA) test should be obtained to assess for Wegener granulomatosis.
    • The rheumatoid factor level may be elevated in persons with rheumatoid arthritis, mixed connective tissue diseases, lupus, scleroderma, or other disorders.
    • Elevated angiotensin-converting enzyme (ACE) levels can indicate the presence of sarcoidosis. Chest radiography can also be performed to assess for this disease.
    • If any of the results are positive, consult with a rheumatologist regarding further testing.

Imaging Studies

Chest radiography may be performed to assess for sarcoidosis.

Procedures

A biopsy of the perforation edge to rule out sinonasal malignancy may be indicated if malignancy is suspected based on history or constitutional symptoms.

More on Septal Perforation: Medical Aspects

Overview: Septal Perforation: Medical Aspects
Differential Diagnoses & Workup: Septal Perforation: Medical Aspects
Treatment & Medication: Septal Perforation: Medical Aspects
Follow-up: Septal Perforation: Medical Aspects
Multimedia: Septal Perforation: Medical Aspects
References
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References

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  3. Baum ED, Boudousquie AC, Li S, et al. Sarcoidosis with nasal obstruction and septal perforation. Ear Nose Throat J. Nov 1998;77(11):896-8, 900-2. [Medline].

  4. Echeverria-Zumarraga M, Kaiser C, Gavilan C. Nasal septal carcinoma: initial symptom of nasal septal perforation. J Laryngol Otol. Sep 1988;102(9):834-5. [Medline].

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  16. Smith I, Smith M, Mathias D, et al. Cryoglobulinaemia and septal perforation: a rare but logical cause. J Laryngol Otol. Jul 1996;110(7):668-9. [Medline].

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Further Reading

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Keywords

septal perforation, septum, nasal septal perforation, perforated septum, nose trauma, cocaine use, nose picking, nasal trauma, nasal spray, lupus erythematosus, Wegener granulomatosis, illicit drug use, sarcoidosis, nasal silastic buttons, sinonasal malignancy, septal hematoma, nasal-septal fracture, septoplasty, sinonasal tumors

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Contributor Information and Disclosures

Author

Rami K Batniji, MD, Private Practice, Batniji Facial Plastic Surgery
Rami K Batniji, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, California Medical Association, and Triological Society
Disclosure: Nothing to disclose.

Coauthor(s)

James F Chmiel, MD, Clinical Assistant Professor, Department of Otolaryngology, State University of New York at Buffalo
James F Chmiel, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

J David Kriet, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Facial Plastic and Reconstructive Surgery, University of Kansas School of Medicine
J David Kriet, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, AO Foundation, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dominique Dorion, MD, MSc, FRCSC, Program Director and Division Chair, Professor of Surgery, Division of Otolaryngology, University of Sherbrooke, Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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