What are the signs and symptoms before a perforated septum appears?

First thing to do is to avoid putting a finger inside the nose or rubbing the septum with tissue paper. Hydrate the nose regularly with saline douches and ointments to keep the septum mucosa moist. The mucosa will heal over 1-2 weeks in most cases. If it fails to do so then you need to see an ENT/FPRS for assessment for a possible chronic ulcer / perforation and possibly have a nasal biopsy. I hope this helps.

An anterior perforated septum would mainly be visible in direct vision. However a posterior one could not be visible. You should try to keep your nose moist, clean and nor irritated it. Do not put anything inside the nose and avoid touching the septum for cleaning with any object: Try to moisturize it and keep it under control. A perforation usually comes with a whistling sound.

Hope this helps,Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

Symptoms of a perforated septum include redness and crusting on both sides and may result in a whistling sound when you breathe. I recommend continuing adding moisture by using a saline nasal spray and refrain from touching or irritating the area. In the situation you're describing any scabbing should heal naturally without extensive damage. For further questions and an in-person assessment, I would recommend going back to your surgeon in the first instance.

 An impending nasal septal perforation typically has crusting on both sides of the nasal septum. A scab and dry blood on one side will likely resolve on its own. If you have any concerns, consider consulting with a reputable facial plastic surgeon or an ear nose and throat specialist. Hope this helps. Dr. Joseph

Thanks for your question. Surprisingly most septal perforations are pretty asymptomatic, however whistling and excessive crusting are two common signs. You sound as if you are experiencing dryness and irritation and the moisture is the right treatment for that. I would recommend being evaluated to make sure that there is not a stitch or foreign body that is causing the irritation. As long as you aren't irritating/damaging the septum on both sides in the same area the risk of you causing a hole is pretty low, most septal perforations that are not caused by previous surgery are a result of cocaine abuse, afrin abuse, trauma, or excessive nasal picking. Hope this helps. 

the best treatment is moisturizing with a saline nasal spray (Ayr), and stop picking at it.  If the membrane is alive, it will heal, provided you are not using cocaine or meth.