Rate my symptoms and prepare for the appointment
Nine questions, two minutes. You get a burden score, a printable summary and the questions to ask your ENT surgeon.
Written by the Septal Perforation team, patients, from the sources cited · Reviewed by doctors · Updated 4 November 2026 · Method and sources
Self-assessment
Over the past seven days, how much have you been bothered by…
Symptoms of a septal perforation
Many perforations cause no symptoms and are found by chance during a nose examination. When they do cause trouble, the complaints are almost always the same; they vary with the size of the hole and above all with its position.
- Crusts that keep forming on the edges and stick, sometimes with a bad smell.
- Nosebleeds that keep coming back, often when a crust comes off.
- Whistling when breathing, especially with a small hole at the front: see whistling nose.
- Blocked, dry nose, even though the passage is wider: air swirls around the hole instead of flowing smoothly.
- Pain or burning inside the nose.
A hole at the front is usually more troublesome than one further back, where the air arrives already warmed and humidified. Size, position and the measurements that matter are explained in Symptoms and measurements.
When to see a doctor without waiting
A nose that starts to sag, a hole that grows quickly, heavy bleeding, or signs elsewhere in the body (unusual tiredness, fever, joint pain, cough, blood in the urine) call for a prompt appointment. They can point to an inflammatory disease, which is treated first with medication for the whole body.
What the ENT surgeon will do
They look at the septum with a thin camera (endoscopy), measure the perforation and look for the cause: past operations, sprays, inhaled substances, nose picking. They sometimes order a blood test or a sample from the edges. Bring your summary: it sums up your symptoms on one page. Next steps are described in the care pathway and on the Definition and causes page.
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