Treatment options vary according to the severity of your symptoms. In some cases, nasal irrigation can help to alleviate the symptoms of a small septal perforation. In cases where the perforation is large, a silastic septal button or prosthesis may sometimes be placed in the septal perforation by your doctor.

Symptoms of a septal perforation may be temporarily relieved by minimizing dryness and crusting to prevent nasal bleeding. Small perforations may respond to occasional use of nasal saline sprays or saline gel to maintain adequate moisture inside the nose. More bothersome symptoms may require the use of frequent nasal irrigations and bland ointments (such as Borofax ® ointment, available without a prescription). Patients are instructed how to mix their own saline solution ( 1 teaspoon of table salt dissolved in 1 quart of warm water ) and to irrigate the nose as often as necessary using a rubber bulb syringe (or Infant Nasal Aspirator) or the Grossan nasal adaptor (API Nasal Irrigator Tip, AnthonyProducts.com, 7740 Records St., Indianapolis, IN 46226) to the Water Pik ® irrigator. Some patients prefer to add corn syrup to the mixture because it prolongs the moisturizing effect (Karo ® syrup, 1 cup per quart). Also, since Staphylococcus aureus and Pseudomonas aeruginosa bacteria commonly colonize the crusty nose, an antiseptic wash of a mild acid solution can be helpful: add to salt/ syrup mixture 1 teaspoon vinegar or 1-3 tablespoons of boric acid powder.

When irrigations fail to control symptoms, a silastic or acrylic prosthesis can be inserted by the physician into the perforation. Placement of a prosthetic silastic button is an office-based procedure performed under local anesthesia. Some companies offer silastic buttons that can be custom fitted to the patient. It may serve as a temporary or long-term solution, especially in patients who do not wish to undergo surgery. Some patients tolerate the buttons for many years; however, many patients do not.

Surgical treatment of septal perforations is indicated if symptoms are bothersome and do not respond to usual measures, and if the perforation is not due to an active medical condition.