Possible causes of a nasal septal perforation:
(1) nasal surgery
(2) cauterization
(3) packing (for nasal bleeding, etc.)
(4) nasotracheal intubation
(5) foreign body
(6) rhinolith
(7) traumatic injury
(8) septal abscess
(9) septal hematoma
(10) syphilis
(11) tuberculosis
(12) deep fungal infection
(13) diphtheria
(14) typhoid fever
(15) SLE
(16) sarcoidosis
(17) Wegener's granulomatosis
(18) abuse of cocaine or other drugs that are potent vasoconstrictors
(19) snuff
(20) acid fumes (chromic acid, sulfuric acid)
(21) arsenicals
(22) mercurial compounds
(23) phosphorus
(24) carcinoma
(25) malignant lymphoma, especially angiocentric T-cell
(26) leukemia
(27) congenital malformation
(28) mucocutaneous leishmaniasis
(29) idiopathic
(30 bevacizumab (and possibly other anti-VEGF agents, see below)
Clinical manifestations may include:
(1) none (asymptomatic)
(2) whistling sound (if small)
(3) nasal discharge, which may be bloody
(4) crusting
(5) sensation of nasal obstruction
Some patients may require closure of the defect if symptoms are severe enough.
