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Septal Perforation

Septal Perforation

Septal perforation is a condition where there is a hole or a perforation in the nasal septum, which is the thin wall of cartilage and bone that separates the two nostrils.

Symptoms of a perforated septum include:

  • Nasal congestion
  • Nasal crusting
  • Difficulty breathing
  • Frequent nosebleeds
  • Altered sense of smell
  • Whistling sounds when breathing

A hole in the septum can also change the external shape of the nose, leading to saddle nose deformity (collapsed nasal bridge) and loss of nasal height. This is more common when there is a larger perforation.

However, depending on the size and location of the septal perforation, some patients may have no symptoms at all.

What causes nasal septal perforation and how is it treated?

Septal perforations can be caused by a variety of factors. Some of these include:

  • Trauma to the nose from sports injuries, accidents or surgery. These can result in a septal haematoma where a blood clot forms under the lining of the septum and leads to necrosis or breakdown of the septal cartilage leading to a septal perforation.
  • Digital trauma and nose picking can lead to septal perforations
  • Chronic nasal infection or inflammation
  • Systemic inflammatory conditions such as allergic rhinitis
  • Inhalational irritants such as cocaine use

Medical management for septal perforation may include surgical and / or conservative measures such as humidification, topical antibiotics and nasal sprays.

Perforated septum surgery

Septal perforation repair is a reconstructive surgical procedure. This nasal surgery aims to close the perforation and restore the normal structure of the nasal septum.

The procedure involves creating a local flap of tissue from the nasal mucosa (the lining of the nasal cavity) and using it to cover the perforation. The flap typically can be either based on the anterior ethmoid artery, or the nasoseptal artery. These special fashioned flaps utilises blood vessels within them to improve blood supply and higher chance of healing. The flap is then secured in place with sutures, and sometimes supported with additional tissue or materials. For example, cartilage grafts or synthetic implants.

A septal button is a less frequently used technique where a prosthetic is used to fill the hole in the septum.
Septal repair surgery is usually done as a day procedure under a general anesthetic.


How serious is septal perforation?

The severity of a perforated septum varies depending on the size and location of the perforation and therefore the symptoms. Regular nosebleeds, whistling, crusting loss of smell and breathing difficulties are all likely to negatively impact quality of life. The severity of these symptoms play a role in determining the seriousness of the condition in each individual patient.

Can a perforated septum heal on its own?

A tiny nasal perforation may heal on its own. Although, as the size of a hole in the septum increases, the likelihood of healing spontaneously, decreases. That’s why nasal septal perforation repair is often necessary to remedy this condition.

Who can perform septal perforation repair surgery?

ENT Surgeons, also known as Otolaryngologists, have specialist training and skills to perform surgery inside the nose. Some ENT Specialists have additional skills and training in nasal surgery and facial cosmetic surgery. This may help to achieve a better cosmetic result in addition to repairing the function of the septum. During your consultation with a specialist, they will discuss the surgery process, associated risks and recovery times.

What is the recovery like?

After surgery, patients may have nasal splints or packing in the nose to help with the healing of internal nasal structures. Patients typically return to work after a few days of rest. Our team will explain what to expect in more detail during initial consultation.

What to expect from your consultation

Before progressing with any treatments at our practice, we want you to have all the information you need to make an informed decision. It’s important you know exactly what to expect.

Every case is different. If you’re in Melbourne or regional areas of Victoria, we invite you to contact us for a consultation. We will discuss all your options and help you feel empowered to take the next step.

Fast appointments for septal perforation

We’re HotDoc integrated which means you can book and schedule an appointment online or via mobile any time of night or day. We aim to accommodate urgent GP referrals within 24 hours.

Where can I make an appointment

To help ensure our ENT services are accessible for all Victorians, we consult at various locations across metropolitan Melbourne and regional Victoria.

Visit us at:

  • Heidelberg
  • Box Hill
  • Clayton
  • Shepparton
  • Wantirna

How to take the next step

If you are experiencing symptoms of septal perforation, or think you may have a perforated septum and want to understand more about treatment and surgical options, contact us today or make an online booking with Dr. Yi Zhao.

Dr Yi has taken additional sub-specialist fellowship training in managing the disease of the nose with one of the world’s leaders in the field of Rhinology (all aspects of nose and sinus disease). He is also a Member of the Australasian Academy of Facial Plastic Surgery.

He will be able to perform a thorough examination and provide guidance as to the next steps forward.

Contact Us

Suite 6.2 Level 6,
10 Martin Street
Heidelberg Victoria 3084
T: 03 9998 7418
F: 03 9998 7459