Section 6


What is the diagnosis?

  • Anterior septal perforation

Describe 3 possible causes for this?

  • Trauma – picking nose, septoplasty, bilateral cautery
  • Infection – TB, syphilis, leprosy, septal abscess
  • inflammatory – Granulomatosis with polyangiitis (formerly called Wegener’s), Sarcoidosis
  • Neoplastic – Squamous cell carcinoma
  • Chemical – cocaine

What investigations could you arrange?

  • Bloods e.g. C-ANCA (granulomatosis with polyangiitis), ACE (sarcoidosis) 
  • Septal biopsy
  • Urine sample to check cocaine use

Describe three possible symptoms the patient may experience?

  • Bleeding
  • Whistling
  • Nasal deformity – saddle nose
  • Crusting
  • Nasal Obstruction
  • Pain
  • Rhinolalia 

Describe 2 treatment options for this condition.

  • Conservative – if asymptomatic- douching and cream. Avoid nasal cautery over bone. 
  • Surgical – flap repair, septal button, if whistling make it larger. 

Supporting Information

Septal perforation– normally cartilaginous and anterior (if syphilitic- bony/posterior). Causes:

  • Trauma – picking nose, septoplasty, bilateral cautery
  • Infection – TB, syphilis, leprosy, septal abscess
  • inflammatory – Granulomatosis with polyangiitis (formerly called Wegener’s), sarcoidosis
  • Neoplastic – SCC
  • Chemical – cocaine

Presentation– bleeding, whistling, saddle nose deformity, crusting if extensive can lead to nasal obstruction and blockage. Large perforations can cause rhinolalia – perceived nasal speech. 

Investigations– FBC, ESR, c-ANCA, pANCA, ACE, VDRL. CXR, UandE, urine dip, septal biopsy

Treatment– 

  1. Conservative- if asymptomatic- douching and cream. Avoid nasal cautery over bone. 
  2. Surgical- flap repair, septal button, if whistling make it larger. 
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