Think of your nose as a two-lane road. The wall in the middle that separates the two nostrils is called the septum. It's a thin, strong wall made of cartilage and bone . It's this wall that helps us breathe through the other side when one nostril is blocked.
But sometimes, a hole can develop in this wall, the septum. Medically, this is called a Nasal Septal Perforation . When this type of hole develops, you may experience frequent nosebleeds. You may also notice a whistling sound coming from your nose when you breathe. Your doctor will insert a very thin tube with a camera attached into your nose (called an endoscope) to determine if you have this condition. If you find out that you have this type of hole, it may not always need to be treated. However, if you are bothered by the symptoms, surgery may be a good option.
What causes a hole in the wall of the nose?
There are several reasons why a hole can form in the nasal wall, or septum. Let's take a look at what they are.
| Reason | A simple explanation |
|---|---|
| Fingering the nose | Frequent nose picking or scratching can damage the septum. |
| Drug use | Snorting drugs, especially cocaine, can damage the blood vessels that supply the septum and cause the wall to dissolve. |
| Nose surgery | Sometimes, a hole like this can occur after surgery to straighten a deviated nasal septum. |
| Nasal Sprays | Using decongestant and steroid nasal sprays for a long time without medical advice. |
| Other reasons | Nasal piercing, nose injuries, inhalation of toxic chemicals, and cancer. |
In addition, rare diseases such as tuberculosis, sarcoidosis , syphilis, and Wegener's granulomatosis can also cause holes in the nasal wall. This condition can also occur when taking chemotherapy with the drug bevacizumab , which is used for some breast cancers .
Treatments that can be done without surgery
If you develop a hole like this after nose surgery, talk to your doctor about it. If you don't have any bothersome symptoms, it may not require any treatment.
However, the hole in the nose can cause the inside of the nose to become dry and open, which can cause frequent bleeding. Also, the edges of the hole can form a crust, which can bleed when they come off.
The best and simplest solution to this is to keep your nose moist . You can keep the inside of your nose moist by spraying saline nasal spray, which you can buy at the pharmacy.
Another option is for a doctor to insert a special 'nasal button' made of soft, flexible plastic to close your nostrils. Studies have even shown that these buttons significantly reduce nosebleeds, crusting, and wheezing.
Do you really need surgery?
If your nose piercing is really bothering you, such as if it bleeds frequently, has difficulty breathing, or makes a wheezing noise, you may need surgery.
In this surgery, the doctor takes a piece of tissue from another part of your body, for example, from inside your nose or somewhere else, and sews the hole up with it. Or he closes the hole with a 'flap' made of tissue. This surgery is usually done under general anesthesia , which means you are unconscious.
There are several methods for repairing a hole in the wall of the nose. Some methods require two surgeries. For example, in the ``Pian'' method called ``Inferior turbinate flap'', the first surgery is done under general anesthesia. This may require a hospital stay of one or two days. The second surgery (follow-up) is done while you are awake, with only your nose numbed. Since it is an outpatient procedure, there is no need to stay in the hospital.
What to expect after surgery?
Your nose will be packed with gauze for about 48 hours after surgery. It is normal to have some bleeding and pain. Your doctor will give you a clear list of things you should not do during the recovery period. The main ones are:
- Avoid using sprays and pills that reduce nasal congestion .
- Avoid taking medications and drinks containing caffeine.
- Avoid smoking and being in places where there is cigarette smoke.
The most important thing is to follow all the instructions your doctor gives you exactly. If you don't, the closed hole can open again. This risk is especially high for larger holes. But even if it does, there's nothing to worry about, you can have another surgery to fix it.
Take-Home Message
- A hole in the nasal septum is not always a problem. If there are no symptoms, treatment may not be necessary.
- If you have any bothersome symptoms like a whistling sound coming from your nose, frequent bleeding, or crusting, be sure to see a doctor.
- There are non-surgical treatments such as saline spray and nasal buttons.
- If the symptoms are too bothersome, surgery can completely cure the condition.
- Follow your doctor's instructions exactly to prevent the hole from recurring, especially after surgery.
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