Common myths about septal perforation

“It will never grow”

Nobody can promise that. Some perforations stay stable for years, others enlarge: crusting, dryness, picking, and above all a poorly fitted septal button. In our groups, several members watched a 1 cm perforation double in two years while being told to wait. The bigger it gets, the more symptomatic it is and the harder to close.

“A perforation doesn't cause symptoms”

False for 8 patients in 10: about 20% of perforations are asymptomatic, so 80% are not. Dryness, crusting, bleeding, burning, whistling and paradoxical blockage are the most common symptoms. The 2026 consensus recommends measuring them on a dedicated scale (NOSE-Perf): your symptoms can be quantified, and they count in the decision to operate.

“Nasal sprays can't harm the septum”

Two families are a problem. Decongestant sprays (vasoconstrictors: oxymetazoline, xylometazoline, naphazoline) constrict the vessels of the lining; they cause rebound blockage, prolonged use is associated with perforation, and with a perforation they are best avoided altogether. Steroid sprays damage the septum when the jet hits it day after day: with a perforation, avoid them if you can. If yours is prescribed, ask your doctor about stopping or replacing it; if it remains essential, aim the tip outwards.

“It can't be repaired”

False. Even with ENTs who do few, 40 to 79% of perforations close depending on size; in centres that close dozens a year, recent series exceed 90%, including perforations over 2 cm. The question is not “can it be repaired” but “by whom”.

“It must be cocaine”

No. Cocaine is one cause among many, and the most common remains nasal surgery itself. Asking once is legitimate; asking instead of examining is not, and that suspicion of drug use explains much of the dismissiveness patients face. Those whose perforation does come from drug use deserve the same care and the same repair, without judgement, with support to stop.

“It's normal after a septoplasty”

No. It is a recognised complication, occurring in 0.5 to 3% of cases, and it should have been part of the information you received before surgery. You are entitled to your complete medical records and, where applicable, to a complaint or compensation process.