Medical Care

Although several surgical options are available for the treatment of septal perforations, this article focuses on the nonsurgical management.

Abstinence from the causative agent is of utmost importance in the medical management of septal perforations if the patient has a history of drug abuse (such as cocaine use) or the use of nasal decongestants or nasal steroid sprays.

Perforations of the posterior septum are typically asymptomatic and, as such, rarely require treatment. However, intranasal crusting may be problematic for the patient, especially if the edges of the perforation are not well healed. These patients may benefit from medical treatments aimed at keeping the nose moist. These include the daily application of petroleum jelly on a cotton-tipped applicator to the inside of the nose, the application of a nasal emollient such as Ponaris oil, or nasal irrigations. In addition, a humidifier in the home may benefit the patient.

Perforations of the anterior septum may cause the sensation of nasal obstruction or result in a whistling sound upon nasal breathing. A silicone button prosthesis may relieve these symptoms. In the office, a silicone button prosthesis may be placed with the help of a local anesthetic.

In individuals who remain symptomatic despite the aforementioned nonsurgical treatments, surgical management may be of benefit (see Septal Perforation: Surgical Aspects).

Consultations

If the cause of the nasal septal perforation is not clear, consider obtaining a consultation with a medical specialist or rheumatologist.

Medication

Media Gallery

Proposed algorithm for a systematic evaluation of newly diagnosed septal perforations.
A simple technique to modify an oxygen nasal cannula that helps to prevent the cannula tip from rubbing against the nasal septum. Two wooden sticks are taped to the hub of the nasal cannula. This technique can also be used in patients with preexisting septal perforations to decrease crusting and epistaxis.
To assess the size of a perforation, barium paste is applied to the edges of the perforation and a lateral 6-foot plain film is obtained of the head. Technique described by Rettinger and Rosemann.

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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, 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, American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Dominique Dorion, MD, MSc, FRCSC, FACS Dean, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Université de Sherbrooke, Canada

Dominique Dorion, MD, MSc, FRCSC, FACS is a member of the following medical societies: Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

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: Society of University Otolaryngologists-Head and Neck Surgeons, AO Foundation, 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

Disclosure: Received honoraria from AO North America for speaking and teaching.