Dear Doctor,
In 1991, I was struck in the nose during a softball game and suffered a nose bleed. It bled heavily for five or ten minutes but then subsided.
Thereafter, I began to suffer nosebleeds every week or two. It was not that big of a deal (or so I thought). I would blow my nose to clear the blood and the problem was gone. I could feel in my nose what felt like a scab occasionally. It is in the left side of my nose on what I believe in the septum (the piece of cartilage(?) that divides the nose).
Today I blew my nose and was surprised to see blood from my right nostril. I looked in my nose and discovered a hole approximately 4mm in diameter. I then saw a hole in the same location and of similar size on the left side of my nose. I recall now that I have noticed a whistling sound from my nose when breathing. This has occurred for the last 14 days or so.
My questions:
1) How serious a problem is this?
2) What are the chances that the hole will grow larger or heal entirely?
3) What is the likely cause of this?
4) How common is this?
5) What do you recommend?
I am a 29 year old male in otherwise good health. I suffer hayfever at this time of year and frequently blow my nose to relieve congestion. With the exception of Vitamin B12, I take no medication. I live in New Jersey.
Doctor, thank you for your time. I look forward to your response. Should I look for it on your page, or might you reply to this address
Reply ---------------------
The nasal septum is the center structure which divides the nasal breathing
passage in two, and is composed of cartilage and thin bone covered by mucous
membrane.
What you are describing is known as a nasal septal perforation. There are a
number of known causes of such a condition, the most common of which include
trauma (such as you describe), and long-term abuse of over-the-counter topical
nasal vaso-constrictor nose sprays such as Afrin, Neo-synephrine, etc.
Intranasal drug abuse ie cocaine is an increasingly common cause of such a
finding. Finally, less common causes include inflammatory or granulomatous
conditions, or rarely malignancy.
In your case, it is most likely that when you broke your nose, you suffered
from what is known as a septal hematoma or bleeding underneath the lining of
the septum.
If septal hematomas are not treated promptly by surgical drainage, they can
lead to infection in the cartilage which in turn causes destruction of the
cartilage.
Thus a septal perforation can form. The usual symptoms of a septal
perforation are frequent crusting, frequent minor nose bleeding, and whistling
during nasal respiration. If the septal perforation is large it can result
in cosmetic deformity seen from the outside.
I would recommend an evaluation by an ear, nose, throat specialist who can verify that you have a septal perforation and who can most likely distinguish whether it is due to an active ongoing medical condition which may warrant further evaluation and/or treatment; or whether it is the end result of previous trauma, in which case treatment options depend on the severity of symptoms.
The treatment of a septal perforation usually is directed at controlling dryness and crusting to prevent nasal bleeding. Small perforations may respond to occasional to frequent use of nasal saline sprays or saline gel to maintain adequate moisture inside the nose. More bothersome symptoms may require nasal emollients such as Ponaris or Proetz nasal solutions. Surgical treatment of septal perforations is occasionally done if the perforations are not too large, if symptoms are bothersome and refractory to usual measures, and if the perforation is not due to an active medical condition. A prosthesis known as a septal button is occasionally recommended for very large perforations.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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