title: Pathophysiology and progression of nasal septal perforation.
abstract: OBJECTIVE
  To review the prevalence, causes, and treatments of nasal septal perforation (NSP).
  
  
  METHODS
  A literature search was conducted in MEDLINE to identify peer-reviewed articles related to NSP using the keywords nasal septal perforation and septal perforation for articles published between January 1, 1969, and December 31, 2006, and references cited therein.
  
  
  METHODS
  Articles were selected based on their direct applicability to the subject matter.
  
  
  RESULTS
  Causes of NSPs include piercings, exposure to industrial chemicals, illicit drug use, intranasal steroid use, surgical trauma, bilateral cautery, and possibly improper use of nasal applicators. Prevalence is poorly reported. Mechanisms of substance-induced NSP formation are not understood. Progression from epistaxis to ulceration to NSP could not be substantiated by the literature.
  
  
  CONCLUSIONS
  Depending on the patient, NSP may be viewed as desirable (nose rings), problematic (whistling, congestion), or inconsequential. Understanding the pathogenesis of NSP is important for the practicing physician required to make decisions about whether to recommend surgical correction or medical treatment. Although the etiology of NSP is overwhelmingly iatrogenic, there is an association with a number of medical diseases in addition to use of illicit drugs and/or prescription nasal sprays.
authors.affiliation: Department of Pediatrics, University of North Texas, Fort Worth, Texas 76132, USA. BobLanierMD@askdrbob.com
authors.forename: Bobby
authors.initials: B
authors.lastname: Lanier
authors.forename: Guan
authors.initials: G
authors.lastname: Kai
authors.forename: Bradley
authors.initials: B
authors.lastname: Marple
authors.forename: G Michael
authors.initials: GM
authors.lastname: Wall
mesh_terms: D004844:Epistaxis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D009300:Nasal Septum / Q000503:physiopathology*; D009668:Nose Diseases / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy