Nasal sprays and septal perforation
Two families of sprays can damage the septum: steroids when the jet hits it day after day, and decongestants used for too long. The risk is low, and a simple technique brings it close to zero.
Written by the Septal Perforation team, patients, from the sources cited · Reviewed by doctors · Updated 1 November 2026 · Method and sources
In brief
Steroid sprays are safe in the vast majority of cases, but a jet aimed at the septum every day can ulcerate it and then perforate it.
Decongestant sprays should not be used for more than a few days; with a perforation, avoid them altogether.
The right technique: opposite hand, nozzle aimed towards the corner of the eye, no hard sniffing; stop and see a doctor if your nose keeps bleeding on the same side.
Which sprays damage the septum, and which do not
The 2026 international consensus lists medications among the eight main causes of perforation. Not all sprays are equal: what matters is what they do to the blood vessels of the lining, and where the jet lands.
Other medicines taken through the nose have been implicated in isolated cases, such as desmopressin spray. The rule is the same for all of them: anything sprayed onto the septum every day eventually irritates it.
The right technique: aim for the corner of the eye, not the septum
Most people spray straight up, or towards the middle of the nose. The jet then hits the septum, which is rich in blood vessels, in the same place every time. That is what causes nosebleeds and, sometimes, an ulcer.
- 1Blow gentlySo the medicine lands on the lining, not on mucus.
- 2Head tilted slightly forwardBottle almost upright, without tipping your head back.
- 3Opposite hand, nozzle to the eyeAim up and outwards, towards the inner corner of the eye on the same side.
- 4Spray without sniffing hardA gentle breath in is enough; sniffing sends the medicine down your throat.
- 5Switch sides, rinse your mouthAlternate nostrils, then rinse or gargle after a steroid.
Decongestants: a few days, no more
Vasoconstrictor sprays clear the nose by narrowing the vessels of the lining. Labels limit them to a few days: 3 days on US packs, 3 to 5 days in France. Beyond that, the nose blocks again as soon as the effect wears off, which leads to spraying more and more: this is rhinitis medicamentosa, which can last for years.
Throughout that time, the septum receives repeated doses of a product that starves it of blood. The mechanism is the same as cocaine, only weaker. These sprays should never be combined with an oral decongestant.
If you cannot manage without them, talk to your doctor: weaning off is possible, with suitable support.
With a perforation, even short use is not advised: it dries and weakens the edges of the hole.
When to stop and see a doctor
- your nose bleeds repeatedly, always on the same side;
- a crust keeps coming back in the same place on the septum;
- you feel pain, burning or irritation that does not go away;
- your nose starts to whistle when you breathe.
An ulcer caught early often heals once the spray is stopped. This is the stage where a hole can still be avoided.
Do not stop a steroid prescribed for asthma, polyps or chronic sinusitis on your own: talk to the doctor who prescribed it. They can lower the dose, change the form, for example to a rinse, or check your technique.
You already have a perforation
Frequently asked questions
Can a steroid nasal spray make a hole in the septum?
Rarely, but yes. Steroid sprays are a recognised risk factor for perforation, especially when the jet hits the septum every day. With the right technique, aiming towards the corner of the eye, the risk becomes very low.
Which spray can I use safely?
Sea water, saline and preservative-free hyaluronic acid sprays moisturise without harming the septum. Ointments and gels complete this care.
Will the hole close if I stop the spray?
An ulcer often heals once the spray is stopped. A hole that has already formed does not close by itself; stopping keeps it from growing, and surgical repair remains possible.
Sources
Every figure on this page comes from one of these publications. The year is the year of publication.
Keep reading