I have a 3mm nasal perforation in the anterior of my nose. Can a nasal button help me? If not what can stop the whistling?

Hello,Septal perforation repair is one of the most difficult procedures to perform. 
I developed a procedure to repair large septal perforations utilizing a pericranial flap.  The use of this flap can help close larger perforations.  Here are some methods of closure of septal perforation based on size:
-Small (pinpoint)- not advised to fix small perforations, especially asymptomatic perforations that are stable.  These should be observed.  The risk of the procedure of increasing size after repair
-Medium perforations- The use of a variety of techniques can be employed such as sliding flaps (can only repair perforations reliably at 1.5 cm), turbinate flaps (smaller perforations), and endoscopic rotational flaps (less than 1.5 cm) can be utilized.
-Large perforations- The use of pericranial flaps (see above) and free flaps (requires ICU stay) are the only 2 options.  I have had great success utilizing pericranial technique (see video below) to repair septal perforations.

Best, 
Anil Shah MD

As you describe, even small septal perforations (and sometimes because they are small) can cause symptoms, especially whistling.  The repair of even small perforations can be tricky, but is highly successful in the right hands.  As far as buttons are concerned, I do not like them.  They cause irritation of mucosa, get coated with bacteria, and frequently cause more problems than they are intended to help.  I would recommend getting a second opinion from an experienced surgeon.  If done correctly, the chance of success with surgery is typically quite high for perforations of that size. 

This size perforation should be able to be repaired with mucosal advancement and a fascia graft. I would definitely wait about a year since the last attempt to let the mucosa recover.

There are some positive and negative aspects here. The negative is that the perforation persists following an attempt to correct it, but the positive is that it is smaller and only 3 mm in size. A small perforation can be very often surgically closed, but you would need to wait before attempting the same procedure to close it, because, if performed to soon, it can actually make the perforation larger. Small conservative measures, such as debridement and occasional application of chemical ablative agents such as silver nitrate can sometimes induce enough mucosal inflammation to close the hole; but they too occasionally can enlarge the opening. I personally would recommend waiting 6-12 months and re-attempting closure simply by elevating the mucosa and placing a fascia graft to serve as a scaffold for growth of the mucosa. If the tissues are too scarred to close, then borrowing mucosa from the side of your nose would be another, more complex, method to close the hole. Either way, rest assured, it can be ultimately be closed. Best of luck :)

I agree with my colleagues.  You willneed to find a Facial Plastic Surgeon with experience in closing septal perforations.  They can be challenging but yours is relatively small so I would think the odds of permaent repair should be better than 50% .  Do you know the cause of the perforation?  That sometimes plays a role. 

A 3mm perforation should be able to be closed with surgery. I would recommend seeing another ENT surgeon in the area who can give you their opinion. Revision septal perforation repair is more difficult, but can be done with the use of a graft (tissue either from your nose or elsewhere). Best of luck