What should I do about my perforated septum?

June 27, 2012 1:35 PM

What should I do or know about my perforated septum?

Two days ago I accidentally perforated my septum. I have had a problem with having a dry/bloody nose and in order to clean it out (and maybe also as nervous habit) I foolishly picked away at a large scab in my septum that gradually grew bigger and deeper.

Then, two days ago, there was a little pain and a tiny hole in my septum. Since then (perhaps helped by Vaseline I used to keep my nose moist) the top part of the scab went away, leaving a larger opening (perhaps 4mm?) in the thinnest part of my septum.

I'm away from my home town for about a week, and I called today to make an appointment with a specialist in my home state, who can see me in nine days. My #1 question is: should I visit a walk-in clinic and see a general practitioner in the meantime? Or would they just refer me to a specialist? Question #2: is there anything I should do now to try to keep the hole from getting bigger or infected (or even to help it heal itself, if that might somehow be possible (which I don't think it is)).

Question #3: I'm interested in longer-term ideas and information as well, and would be grateful to hear opinions on fixing vs leaving this sort of problem, as well as ideas on how to obtain the best medical results.

A couple final notes: 1) I've been keeping this problem to myself, since it's pretty embarrassing; moreover, this whole thing is pretty disheartening and vexing. 2) I have insurance, but it's not great ($1000 deductible, then 80/20). 3) I'm in the (sub)urban Northern US now, and will be returning to my home in a rural Southern state in about a week. I only moved there recently and don't yet have a doctor in my new Southern hometown.

Many thanks for any comments or suggestions.

posted by doubtless to Health & Fitness (6 answers total)

When you say perforated...do you mean there's a divot in your septum? Or is it through-and-through with a clear (4mm!) passageway between the nostrils? I'm just trying to wrap my head around how you could actually bore a hole through there without causing yourself an extreme amount of discomfort. And also, it's made of cartilage, so that would require a bit of effort, I'd think. Did you really scratch a hole through it? Are you sure?

If it's the former, just a divot, I'd say you're probably fine. Keep it clean and covered in vaseline (which is to say, don't put anything up there except for a sterile q-tip covered in vaseline) and it should heal up eventually. (Obviously, if you're still having problems or it's WORSE a week from now, head to a doctor.)

If it's the latter, and you have a hole between your nostrils, well, gee. Same as above, keep it clean and moist, try to calm yourself down a bit and remember that folks get this thing pierced all the time, and see a doctor as soon as possible.

And for the love of god keep your fingers out of your nose until this heals up. (Once you're free and clear of nose-ailments, though, go ahead and pick 'til your heart's content. Just be careful. And wash your hands.)
posted by phunniemee at 1:55 PM on June 27, 2012

Well, I've had a perforated septum.... except I called it a septum piercing. You don't need to go to the doctor for this, it will heal easily on its own, as long as you don't pick it, just like when I got tired of the piercing, I took it out and it closed. And my piercing was 6g, so that is several millimeters. Just try not to touch it at all, maybe put Vaseline in it and wash with mild soap if you are concerned. Don't use Neosporin on what is essentially a puncture wound.

You really, really don't need to bother with a doctor here, unless you believe it has gotten infected, which is unlikely. The doctor is not going to do anything else but prescribe antibiotics if necessary.

(Also, my sister did exactly what you did as a child. That also healed with no medical intervention.)
posted by catatethebird at 4:52 PM on June 27, 2012

Perforated septum? Just by picking? This sounds impossible. Not wanting to suggesting something, but years of (nasal) drug use can do this.
Put some Neosporin Plus Pain Relief instead of Vaseline on it. Vaseline, like Neosporin, is oil based. It kind of protects but does not moisture in any way. In the long run this can be actually counterproductive.
posted by yoyo_nyc at 5:04 PM on June 27, 2012

Response by poster: Thanks everyone for the answers so far. Yes, I assure you that we are discussing a real, complete perforation, not caused by drug use (I've never used any illegal drugs nasally and very seldom even used over-the-counter decongestants, etc.).

The (gross) truth is that I have large, dry nostrils and that persistent nosebleeds and my own thoughtless response to them produced over time a deepening scab. Then, two days ago, poking at this, I opened a small complete perforation. There's actually an article on such perforations on Wikipedia. Unfortunately, the article suggests that nasal perforations do not close on their own. I'm guessing that my perforation is higher up on the nasal wall than most cosmetic ones.

I have to say that I also assumed that picking could never cause this sort of damage; this attitude was part of the problem however, and I'm sorry to say that I now know better.
posted by doubtless at 6:08 PM on June 27, 2012

You have a new hole in your body, and you're actually considering NOT going to a doctor?

Please. Go to the doctor. Don't become one of those people you read about.
posted by Afroblanco at 8:26 PM on June 27, 2012 [3 favorites]

Also, you probably want to get checked and treated for empty nose syndrome with an ENT after you get emergency treatment for your wound. Empty nose syndrome is something I know about because it's a risk of the surgery I had on my sinuses -- they warned me about nosebleeds and septum perforation, too. You might also need to get treatment for the compulsive behavior that led to this injury, if that's a factor.

Neither one of those is anything to be ashamed of, by the way. You are guaranteed to be among the least interesting people the ER will have seen that evening. (I have friends who are ER nurses -- trust me, your problem is stark white vanilla.) You're insured. Get your wound fixed up now and then get your medical care at home; figure out why you've been having this nasal dryness/bleeding. You probably have co-pays for some stuff (my ER copay is $50) and an overall out of pocket limit -- if you've never had to use your insurance before, it can be daunting. This is one of those situations where you get treatment first and ask questions later, though. Your health is totally worth it. Good luck.
posted by sweltering at 3:17 AM on June 28, 2012 [1 favorite]