I Know It Wont Close, but Will It Get Bigger?

Septal perforations range in size and symptoms.  Typically, posterior septal perforations can be left alone that are asymptomatic while the more anterior the perforation the more likely it will become symptomatic.  If a perforation is stable in size (especially if the patients is using nasal saline, gel and other nasal emollient) then observation is fine.  If the perforation continues to grow in size or becomes symptomatic, repair can be considered.

A septal perforation from cocaine use should not enlarge once you've stopped using cocaine or any inhaled drugs. If your nose is kept moist and trauma (fingers, Q-tips) is kept to a minimum that should also help stabilize the damage. If the perforation is bothering you it can be remedied with either a plastic "button" to plug the hole or surgery to repair the hole permanently with your own tissue. I hope this information is helpful.Stephen Weber MD, FACS

A septal perforation can occur with nasal cocaine use because of the mechanical trauma involved in "snorting", and the vasoconstrictive properties of cocaine (it is the only local anesthetic that is also a vasoconstrictor).  Assuming that the nasal cocaine has ceased and there is no further mechanical trauma to the septum, the perforation should stabilize and not grow bigger.  A resumption of cocaine abuse will restart the cycle of trauma and vasoconstriction and could eventually lead to nasal collapse ( a saddle nose deformity).