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Clinical Features of Septal Perforation
Signs and symptoms
- Nasal discharge / Crusting?
- Presence of nasal whistling sound
- Infection
- Epistaxis
Medical history
- History of nasal trauma
- Previous nasal surgery
- Nose picking
- Frequent episodes of bronchitis, otitis media, or sinusitis (Wegener granulomatosis)
- Known kidney disease (eg, lupus)
- Cancer
- Infectious diseases (eg, TB, Syphilis)
Social history
- Smoking (increases microvascular pathology)
- Alcoholism (falls and nasal trauma that the patient may not recall)
- Drug use (phenylephrine) and recreational drug (cocaine) use long-term steroid use or topical corticosteroids
- Occupational exposure to caustic or other industrial substances (especially chromic acid)
- Transnasal oxygen use: Oxygen has a drying effect on the nasal mucosa, and the nasal cannula can traumatize the nasal septum.
Causes of Septal Perforation
Traumatic causes
- Previous surgery – septoplasty – cauterization for epistaxis
- Nose picking
- Septal hematoma resulting from any blunt trauma
- Battery/foreign body in nose
- Chronic nasal cannula use
Inflammatory causes
- Sarcoidosis
- Wegener granulomatosis
- Systemic lupus erythematosus
- Polyarteritis nodosa
- Relapsing polychondritis
- Relapsing loopy SaW nodes
Infective causes
- Tuberculosis
- Syphilis
Neoplastic causes
- SCC, ACC, BCC
- T-cell lymphomas
Other causes
- Inhaled substances (eg, cocaine, snuff, topical corticosteroids, long-term phenylephrine use)
- Chromic acid fumes, alkaline dusts (lime), hexavalent, arsenic