FD81

Septal Perforation Repair ... - Florida

Yes, I have sent you a private message with the details.

It doesn't seem even remotely possible that your 4x8 mm perforation will heal on its own, nor can your surgeon close it with a simple "stitch". I have a few other posts, which may help you to find a good surgeon. Remember to contact your insurance company first and tell them that you need to find an ENT surgeon that specializes in tissue rearrangement / nasal reconstruction / closure of septal perforations.

To control the whistling (especially at night), there are a few options. First, clean the area well and apply saline nasal gels (such as Ayr). A second option is to buy ear plugs (insert into the ears, not the nostrils); the yellow foam ones are ideal since they can fit in your ear without being uncomfortable like big ear muffs or headphones. The third option that worked for me was to place sterile gauze or cotton into one nostril so that it prevents air flow through that nostril. Then spray it with saline before bed. The whistling would subside and the saline can be absorbed by the nasal tissues to keep them moist. There is a big risk of this approach though, and many doctors would advise against it. If you inadvertently introduce more bacteria into your nostril, it will have the entire night to colonize and spread. Even after the gauze is removed, the bacteria will already have established itself inside the nostril. This approach did work for me because I used disposable sterile gloves, sterilized my tweezers after each use, etc. Talk to your doctor for his/her opinion before you try this.

Bird,
In my opinion, the most important consideration is whether you are symptomatic. If it isn't causing any problems (whistling, bridge deformity, bleeding, etc.), then perhaps the best treatment approach is to do nothing. Can you provide more details of the perforation? Specifically, how large is it? Where is it located? What are your symptoms?

Typically, the hole will remain the same size unless you manipulate/irritate it and an infection grows. Keep it clean and well moisturized; your doctor should provide you with specific instructions on how to do so.

Post back with more info if possible ...

Yes, the procedure was an endoscopic repair using bilateral nasal mucosal flaps with Alloderm placed between the flaps (no cartilage or other tissue was harvested elsewhere)...

I'm about 14 weeks post-op from the repair surgery. The perforation is “closed,” though it required substantial rearrangement of tissues throughout the nose. My nose is dry every day and requires saline gel to prevent crusting, bleeding, and irritation.

Be really careful when interpreting a surgeon’s success rate at closing a perforation. A surgeon defines “success” as “closing or decreasing the size of the original perforation.” Some slick surgeons have fancy websites, which boast their high closure rate ... yet they conveniently omit some critical information. For example, a surgeon may say that his/her success rate is 91%. This does NOT account for other complications such as change in appearance (yes, its possible), chronic dry nose, infection, etc. So if a patient undergoes surgery and the hole is completely closed, but has a serious infection following surgery, is out of work for 4 weeks, has a chronic dry nose for life, needs to use saline sprays daily, and has frequent nosebleeds ... this is a “success”! In the patient’s point of view, it certainly is not. I have a great respect for doctors, but some have marketing strategies that borderline car salesmen.

Getting your money back probably isn’t an option. When you agreed to the surgery, you signed a surgery consent form which probably had a phrase that read, “I have been informed of the risks of the procedure, which may include bleeding, loss of smell, perforation, etc.” That blanket statement relieves the surgeon of most liability in the event that these “common” and “uncommon” complications were to occur. Unless you can prove that the doctor committed malpractice (extremely unlikely since a perforation is a reasonable complication), it’s not worth the effort. Not to defend the surgeon, but the hole could have formed from a host of scenarios such as a post-op infection (from a Q-tip, quick nose pick, poor irrigation, dirty air from the air conditioning/heat in a car, etc). Yes, it can be depressing and frustrating but there’s hope. If you can find a competent surgeon that you trust, it may be worth the surgery. Or you could always wait for a newer medical technology to come along. 50 years ago, heart transplants were science fiction ... today, they are almost routine.
Hang in there!