A perforated septum (also called a septal perforation) is a hole in the wall of tissue and cartilage that separates your two nostrils inside the nose. This wall is called the nasal septum, and when it has a fullā€‘thickness defect, air can pass directly through the opening between the nasal passages.

What it actually is

  • The nasal septum is made of cartilage, bone, and a thin lining (mucosa) that divides the nose into right and left sides.
  • A perforated septum means that this divider has lost tissue all the way through, creating an abnormal opening in that partition.

Common symptoms

  • Nasal whistling when breathing, especially through the nose.
  • Crusting, dryness, and sometimes a foul smell or discharge in the nose.
  • Recurrent nosebleeds, irritation, or a feeling of blockage or congestion even though there is a hole.
  • In more severe or longā€‘standing cases, changes in the shape of the nose (like a dip in the bridge, sometimes called saddle nose).

Why it happens

  • Prior nose surgery (such as septoplasty or rhinoplasty) or direct trauma to the nose can damage blood supply and tissue, leading to a perforation.
  • Longā€‘term use of certain nasal sprays, chronic noseā€‘picking, infections, or autoimmune diseases can also injure the septum.
  • Snorted drugs like cocaine are a wellā€‘known cause because they severely reduce blood flow to the septum over time.

Is it serious?

  • Small perforations may cause only mild symptoms, but they can enlarge if the underlying irritation or cause is not addressed.
  • Larger or progressive perforations can significantly affect breathing comfort, increase infections, and in some cases contribute to nasal collapse or deformity.

What can be done?

  • Nonā€‘surgical care focuses on keeping the nose moist and clean (saline rinses, ointments, humidification) to reduce crusting and bleeding.
  • Some patients use a special silicone or plastic ā€œseptal buttonā€ that plugs the hole and relieves symptoms without closing it surgically.
  • Surgical repair aims to close the hole with local tissue or grafts; it can improve breathing and comfort but is technically challenging and not always possible for every size or cause.

If you or someone you know suspects a perforated septum (whistling, frequent nosebleeds, visible hole on exam), it is important to see an ENT (ear, nose, and throat) specialist promptly for evaluation and a tailored treatment plan.