Basic Information on the Nasal Septum, Septoplasty, Septum Reconstruction, and Holes in the Nasal Septum

Nasal septum defect, septum perforation, hole in the nasal septum - what is the correct term?

A hole in the nasal septum (nasal septum or in Latin septum nasi) is medically referred to as a nasal septal defect. The nasal septum (Latin: septum nasi) divides the main nasal cavity into two almost equal halves. The term septal perforation (nasal septal perforation or septum perforation) is also used as a synonym, although it is not entirely medically correct.

How is the nasal septum structured and what is its purpose?

The nasal septum divides the nasal cavity into two parts. It has a three-layer structure: the inner supporting layer consists of cartilage in the front and bone in the back. On both sides, this cartilage or bone is covered by the nasal mucosa. An intact nasal septum ensures normal (laminar) flow of inhaled air. The nasal mucosa is made up of many different cells, which together are responsible for the nose's climate control function, i.e., warming and moistening, but also for the feeling of free nasal breathing.

What exactly is a hole in the nasal septum?

A hole in the nasal septum is present when all three layers of the nasal septum are completely missing at one point: the mucosa on both sides and the cartilage or bone lying between them. This creates an open connection between the left and right main nasal cavities, which are normally separated by the intact nasal septum. The size of such a defect can range from a few millimetres to several centimetres. Medically, this condition is referred to as a nasal septal defect or septal perforation.

What effects does a hole in the nasal septum have on nasal function?

Because the protective, climate-regulating mucosa is no longer present at the affected site, the inhaled air flows turbulently rather than evenly (laminarly) through the nose at this point. This turbulent flow dries out the surrounding mucosa and promotes increased inflammation with crust formation; at the same time, the feeling of free nasal breathing is lost. Since the missing mucosal cells are also responsible for warming and moistening the air, the inhaled air is overall less well conditioned.

In addition, the turbulent airflow can impair the sense of smell: odour molecules no longer reach the olfactory epithelium in the upper part of the nasal cavity as effectively, which can result in a smell disorder.

What is the difference between septoplasty and septum reconstruction?

Septoplasty refers to the straightening of the nasal septum. When surgical treatments of the nasal septum first began in the early 20th century, only the bent cartilage or bone of the nasal septum was removed (resected). This type of procedure is called submucosal septum resection, as the (bent) cartilage or bone was removed from under the nasal mucosa (submucosal). However, this surgical technique has many disadvantages, which is why it has not been performed since the 1960s and should no longer be performed. The operations currently performed to straighten the nasal septum are known as plastic septum corrections: after dissecting the nasal mucosa, the bent parts of the septal cartilage and bone are first removed, straightened, and then repositioned between the mucosal layers of the nasal septum. Hence the term septoplasty.

If the nasal septum is perforated, i.e., there is a septal defect or perforation, then the nasal septum must be restored (reconstructed). Since a total of three layers of the nasal septum are no longer present in a nasal septum defect, these three layers (two layers of mucous membrane and the cartilage or bone between them) must also be reconstructed. Hence the term septum reconstruction.

Are holes in the nasal septum (nasal septum defects, septum perforations) common?

Holes in the nasal septum (nasal septum defects or septum perforations) are not very common. Individual ENT doctors rarely encounter patients with holes in their nasal septum in their practices (or in clinics). This is probably one of the reasons why there is still a great deal of uncertainty surrounding the treatment of nasal septum defects. Scientific literature describes nasal septum defects in 1–2% of the population.

(Last updated on August 31, 2026)

Causes and Recognition

How can a hole in the nasal septum (septal perforation) develop?

The most common cause is a complication following surgery on the nasal septum (septoplasty) or on the entire nose (septorhinoplasty). This can occur as an unfortunate outcome even with the best care, or it can result from insufficient surgical experience. Injury-related defects are rare. In my experience with more than 2,000 patients, repeated “nose picking” as well as heavy or long-term use of decongestant or cortisone-containing nasal sprays are – contrary to common belief – not reliably linked to the development of a septal defect. The reverse sequence is more likely: crusting from a spontaneously occurring defect leads to manipulation of the nose. Cocaine use, by contrast, is a clear cause of both the development and enlargement of a septal perforation. Even a single use can trigger inflammation of the nasal mucosa that leads to an inflammatory defect. Autoimmune diseases (e.g. granulomatosis with polyangiitis, formerly Wegener’s granulomatosis) can also cause an inflammatory hole in the nasal septum. In some cases, no clear cause can be identified.

How can I tell that I may have a septal perforation?

Typical signs are a whistling or hissing sound while breathing (especially on inhalation), crusting, recurring nosebleeds, a sensation of blockage despite an otherwise clear airway, and occasionally an unpleasant odour. If the perforation is located far forward, you can often see it yourself in a mirror – particularly if you shine a light into one nostril and look through the other. The definitive diagnosis is made by an ENT specialist during a microscopic and endoscopic examination of your nose.

Is a hole in the nasal septum dangerous?

A septal perforation is not life-threatening. However, crusting, persistent nosebleeds and breathing difficulties can significantly affect your quality of life. Impaired sense of smell and a sensation of a foreign body are also possible. The greatest risk is further enlargement of the defect, which cannot be reliably predicted. With very large defects, the external shape of the nose can also change, with the bridge sinking inward (saddle nose deformity).

Can a septal perforation close on its own?

No. Once a hole has formed in the nasal septum, it never heals spontaneously and, unfortunately, never becomes smaller on its own. Without treatment, the defect either persists or, in many cases, enlarges over time. In my patients, spontaneously occurring defects enlarged in about 60% of cases, while perforations that developed after surgery remained stable in size in about 95% of cases. Cocaine-related defects enlarge in 70% of cases with continued use, but only in 8% if use is stopped. Unfortunately, septal buttons (obturators) also lead to further enlargement in 80% of cases.

See also: Stange, T. (2023): Observations on the Spontaneous Course of Nasal Septum Defects. Poster presented at the 94th Annual Meeting of the German Society for Otolaryngology, Head and Neck Surgery in Leipzig. (ResearchGate) / (abstract) / (download the poster in German) / published in Laryngorhinootologie 2023; 102(S 02): S326

(Last updated on August 10, 2026)

Do I Need Surgery? – The Treatment Decision

Does every septal perforation need to be operated on?

No, not every hole in the nasal septum requires surgery. This can only be judged on an individual basis – by a highly experienced nasal surgeon who specialises in septal reconstruction – after an examination of the nose and nasal mucosa and, if necessary, a special X-ray examination. In my view, this surgeon should have personally performed at least 100 such procedures. The assessment takes into account the cause of the defect, the condition of the mucosa, the size of the perforation relative to the nose, any remaining cartilage and bone, as well as your symptoms and general health.

Defects that are stable in size – for example, holes that developed after surgery without significant symptoms – generally do not need to be operated on. Defects that arose spontaneously without an identifiable cause, on the other hand, should generally be operated on, since they tend to enlarge slowly over time. Regardless of the cause, your septal perforation should be treated surgically if you suffer from burdensome symptoms – crusting, frequent nosebleeds or obstructed nasal breathing. Sometimes conservative treatment with intensive ointment care and avoidance of substances that irritate the mucosa (cocaine, nicotine) already brings noticeable improvement. Psychological distress caused by a septal perforation – which is not at all uncommon – is, for me, also a valid reason for reconstructing the nasal septum.

See also: Stange, T. (2026): Updated Surgical Indications for Spontaneous Symptomatic Nasal Septum Defects. Presentation at the 97th Annual Meeting of the German Society of Otolaryngology—Head and Neck Surgery in Ulm. (abstract)

Can every hole in the nasal septum be operated on?

In the vast majority of cases, surgical reconstruction of the nasal septum is possible – for me, your individual symptoms are the key factor in deciding on surgery. Complete reconstruction is achieved in most defects. If this does not appear technically feasible – for example, with very large perforations or patients who have undergone multiple previous operations – a partial reconstruction of individual areas of the septum can still noticeably relieve your symptoms. Surgical treatment options are therefore available in almost every case.

Are nasal septum reconstructions performed often?

Reconstructing the nasal septum in cases of a septal defect (a hole in the nasal septum, septal perforation) is one of the most demanding procedures in nasal surgery. Probably for this reason – and also because nasal septal perforations occur only very rarely – surgical septal reconstructions are performed only infrequently. There are only very few nasal surgery centres in Europe that specialise in this procedure and carry out such septal reconstructions in significant numbers.

What happens if I don’t have the perforation treated at all?

Existing symptoms such as crusting, bleeding, a whistling sound on inhalation and obstructed nasal breathing will persist or worsen. Defects without an identifiable cause in particular tend to enlarge slowly. Cocaine-related defects also become larger with continued use. As the defect grows, symptoms increase, as does the risk of a visible change to the external shape of the nose (saddle deformity). Eventually, the hole can become so large that even a very experienced surgeon can no longer achieve a complete reconstruction.

See also: Stange, T. (2023): Observations on the Spontaneous Course of Nasal Septum Defects. Poster presented at the 94th Annual Meeting of the German Society for Otolaryngology, Head and Neck Surgery in Leipzig. (ResearchGate) / (abstract) / (download the poster in German) / published in Laryngorhinootologie 2023; 102(S 02): S326

Does a tissue sample need to be taken before surgery?

As a rule, such a biopsy is not necessary before surgery. It is only needed if the condition of the mucosa raises suspicion of an autoimmune disease or – as an absolute rarity – a malignant tumour. In my clinic, this has been necessary only twice in 20 years among more than 2,000 patients. During the reconstruction procedure (septal defect closure), however, I routinely take a tissue sample for histological examination as a matter of course.

See also: Stange, T. (2015): Clinical Value of Biopsy for Nasal Septum Defects. Poster presented at the 86th Annual Meeting of the German Society of Otolaryngology—Head and Neck Surgery. (abstract) / (download the poster in German)

What specific risks does the surgical reconstruction carry?

As with any operation, there are general risks such as postoperative bleeding or infection. Specific to septal reconstruction are the possibility of the repair reopening (re-perforation) at the suture line and temporary sensory disturbances inside the nose. This risk increases with the size of the original defect and with scarring from previous operations. The greatest risk is postoperative bleeding. The bleeding risk of a “normal” nasal operation, which is already higher than for many other procedures, is further increased in septal reconstruction because of the microsurgical dissection of the well-vascularised mucosa and the necessary incisions in the mucosa. For this reason, I always perform the operation with you admitted as an inpatient.

What does the success of the operation depend on?

The prognosis for a complete restoration depends on the relative size of the septal defect (septal perforation), the condition of the mucosa, and the remaining cartilage and bone structures. If the nasal septum has already been operated on previously, whether by septoplasty or septorhinoplasty, the operation is considerably more difficult and the prognosis somewhat poorer. The most difficult scenario is reconstruction after a previous reconstruction attempt has already failed – particularly if that attempt did not use a three-layer technique.

However, the success of the operation depends primarily on the personal experience of the nasal surgeon. Adequate qualification for such a demanding operation can only be expected after many years, or even decades, of specialisation at a centre for rhinosurgery. The surgeon should have personally performed at least 100 reconstructions and followed up on their patients. Worldwide, only a very small number of nasal surgeons meet these criteria.

After a previous operation on the nose, what is the right time for a further operation?

A further operation can be performed at the earliest one year after a previous operation on the nose. Only by this point has stable scar formation developed inside the nose. Before that, an existing hole in the nasal septum will often continue to enlarge. For this reason, I can only reliably assess whether, and with what chances of success, a further operation makes sense once this year has passed.

Are there situations in which you would advise against surgery?

Yes. I do not operate on patients who continue to use cocaine, since the chances of success are then very low – only after a proven period of abstinence lasting several months does a reconstruction become technically feasible and worthwhile in the long term. In patients with active, insufficiently treated autoimmune disease affecting the nasal mucosa, I first recommend co-management with an internist or rheumatologist before deciding on surgery. And in patients who have already undergone multiple unsuccessful previous operations, I check particularly carefully whether enough mucosa and residual tissue remain after those earlier procedures to allow a further reconstruction. If the chances of achieving a meaningful improvement in symptoms are low, I discuss this openly with you. There are also serious general medical conditions associated with a high perioperative risk – particularly for the anaesthetic. These include severe heart disease and certain blood clotting disorders. Following a heart attack or stroke, as well as after certain heart and vascular operations, the risks of anaesthesia are also frequently elevated. If I judge these risks to be too high for you, I will advise against surgery, since a septal reconstruction is not a life-saving procedure.

How likely is it that the repair will last permanently?

For predicting the likelihood of a permanent, complete closure, a classification by relative defect size, which I first presented in 2011, has proven useful. What matters is not the size in centimetres, but the ratio of the height of the hole to the total height of the nasal septum. The likelihood is around 95% for small perforations, 94% for medium-sized ones, 68% for large ones, and approximately 20% for very large ones. In the hands of a very experienced surgeon, the overall complete-closure rate across all defect sizes averages around 90%.

See also Stange, T. (2025): Nasal Septal Defect (Perforation) Classification. Presentation at the 96th Annual Meeting of the German Society of Otolaryngology and Head and Neck Surgery. (abstract)

What is a septal button (obturator), and when does it make sense?

A septal button is a silicone prosthesis that covers the perforation from the inside without surgically closing it. Some ENT doctors and clinics use it when surgery is not desired, or is judged not to be possible. However, it acts as a foreign body and leads to crusting, pain and, very often, further enlargement of the defect. It cannot restore the natural function of the nose, because it does not replace the missing mucosa, which is responsible for humidifying and warming the air you breathe in. Patients with a button come to my clinic on a regular basis. Simply removing this plastic foreign body immediately brings improvement in almost every case, and an appointment for surgical reconstruction can usually then be arranged. So far, I have been able to close the defect in every one of these patients – even when the doctors who had treated them previously considered this impossible. In my view, septal buttons are therefore no longer state of the art.

See also: Stange, T. (2024): Are buttons still up to date for the treatment of nasal septum defects? JATROS Pulmonology & ENT 4/2024. (ResearchGate) / (abstract) / (download in German) / published in Laryngorhinootologie 2024; 103(S 02): S321

(Last updated on August 10, 2026)

Effects on the External Shape of the Nose

Can the perforation affect the external shape of my nose?

Yes, particularly large defects in the front and middle part of the septum can cause the bridge of the nose to sink inward, resulting in a saddle nose deformity. The tip of the nose can also drop, since the supporting cartilage structures are no longer fully present. In such cases, the supporting framework generally needs to be rebuilt first – in other words, the nasal septum needs to be reconstructed. In a second operation – very often using rib cartilage – the shape of the nose can then be restored. In cases with a small hole and only mild saddling, septal reconstruction can sometimes be combined with a shape-correcting septorhinoplasty in a single operation.

I would also like to have the shape of my nose corrected at the same time – can this be done in one operation?

This depends on the individual case. As a general rule: small septal perforations with no prior surgery can often be combined with minor changes to the external nose – such as a tip-plasty or the removal of a small hump. Larger septal defects, and those with prior surgery, generally cannot be combined with a correction of the external nose at the same time – especially if more substantial shape changes are desired.

See also: Stange, T. (2014): Nasal Septum Defect Repair and Rhinoplasty: A One-Stage or Two-Stage Procedure? Presentation at the 85th Annual Meeting of the German Society of Otolaryngology—Head and Neck Surgery in Dortmund. (abstract)

(Last updated on August 10, 2026)

Septal Defects Caused by Cocaine Use

“I have a hole in my nasal septum, and every ENT doctor asks me when I last used cocaine – even though I don’t even smoke! Isn’t that unfair?”

I hear this every day in my consultations, and I fully understand the frustration behind it. The blanket assumption is not justified: while cocaine-related defects are indeed increasing, by far the most common cause of septal perforations remains previous surgery on the nasal septum (including septorhinoplasty involving correction of the external nose). The second most common cause I see is perforations of spontaneous origin with no identifiable cause. It is precisely in these cases that asking about current or past drug use is medically justified – it also helps rule out other causes, such as autoimmune disease.

Can an ENT doctor actually tell whether my septal perforation was caused by cocaine?

It’s not that simple. In general ENT practice, and in most ENT hospital departments, nasal septal defects overall are very rare, so the individual ENT doctor usually has limited experience with this condition. This understandably creates uncertainty, which often leads to tissue biopsies or to the question of cocaine use. In my consultation, around 250 patients with holes in the nasal septum present each year. On close microscopic and endoscopic examination, there are indeed some signs that can point to cocaine use – however, these mucosal changes are difficult to distinguish from those caused by severe autoimmune diseases.

I only use cocaine occasionally – can this already cause a hole in the nasal septum?

Yes, unfortunately. The sensitivity of the nasal mucosa varies greatly from person to person. In some people, even a single use of cocaine is enough to trigger chronic inflammation of the nasal mucosa with accompanying breakdown of cartilage.

I used cocaine several years ago – is my septal perforation caused by that?

Very likely. The development of a hole in the nasal septum is usually accompanied by crusting and nosebleeds. If you experienced these symptoms at the time, the connection is generally clear.

My hole in the nasal septum is caused by cocaine use – what can I do now?

This is unfortunately a fairly common finding. If you are still using cocaine, you probably have pain, increased sensitivity to touch, often persistent crusting, and difficulty breathing. The cause is significant inflammation of the mucosa with impaired blood flow and partial death of the cartilage – this is how the hole develops. The most important step is to stop nasal cocaine use completely and permanently; nicotine use should also largely be avoided. This is certainly easier said than done, but it is the only way to give your nasal mucosa a chance to recover. In addition, you should care for your nose continuously with ointment and, if symptoms are severe, tape your nostrils shut at night. Healing takes a great deal of time – but your patience will pay off: after 6 to 12 months, I can usually decide whether an operation on your nose is still possible.

Do I need to tell my ENT doctor that I use, or have used, cocaine?

Yes, please do. Your ENT doctor is a person you can trust and is professionally bound to confidentiality towards third parties. Being open about cocaine use often saves you from extensive additional diagnostic work-ups with your GP, an internist and/or a rheumatologist, along with further tissue biopsies.

(Last updated on August 10, 2026)

Nasal Septal Defects in Children

How do nasal septal defects in children develop, and how common are they?

While nasal septal defects are already rare in adults, they are an absolute rarity in children. Consequently, there are only very few descriptions of this in the current scientific literature. By far the most common identifiable cause is a foreign body in the nose, in particular batteries (button/disc batteries) inserted into the nose, which can cause tissue damage very rapidly through chemical reactions. In most other cases, no clear cause can be identified in children.

Can a septal perforation be inherited?

No, a septal perforation is not inherited.

When is the right time for surgery in a child?

Whenever possible, I only operate once the nose has finished growing in size. There are several reasons for this: in a fully grown nose there is more room for the operation, more mucosa is available to cover the defect, the ear used to harvest the cartilage graft is larger, and an older child can better understand and cooperate with the necessary aftercare. However, if there are significant symptoms – such as persistent, frequent nosebleeds – and intensive conservative treatment with nasal ointment does not bring sufficient improvement, surgery must be performed earlier, even in a younger child.

Does treatment, healing and prognosis differ in children compared with adults?

In children, the surgical technique, the healing process, and the prognosis are no different from those in adult patients. However, nasal septum surgery in children is much more difficult than in adults. The anatomical structures are much smaller, and the already limited space inside the nose is even more confined in a child’s nose.

See also: Stange, T. (2012): Nasal Septum Defects in Children. Poster presented at the 83rd Annual Meeting of the German Society of Otolaryngology and Head and Neck Surgery in Mainz. (abstract) / (download poster in German)

(Last updated on August 10, 2026)

When a Previous Operation was Not Successful

My previous operation with another surgeon or at another clinic was unsuccessful – can I still be helped?

Yes, even after unsuccessful previous surgeries, complete nasal septum reconstruction is successful in most cases. In other cases, a significant improvement in symptoms can be achieved by repositioning the defect, reducing its size, or reconstructing the posterior edge of the defect, which has widened due to inflammation. Due to scar tissue and tissue loss, such revision surgeries are usually extremely challenging—and I have specialized precisely in these revision cases. To discuss the surgical options, an examination of your nose, a 3-D X-ray (CBCT), and an individual review of your previous medical records are necessary.

See also: Stange, T. (2018): Reconstruction of Postoperative Nasal Septum Defects. Presentation at the 89th Annual Meeting of the German Society of Otolaryngology—Head and Neck Surgery in Lübeck. (ResearchGate) / (abstract) / published in Laryngorhinootologie 2018; 97(S 02): S315 and Stange, T. (2016): Revision Surgery Following Nasal Septum Defect Repair. Presentation at the 87th Annual Meeting of the German Society of Otolaryngology—Head and Neck Surgery in Düsseldorf. (abstract)

(Last updated on August 10, 2026)

Why Experience makes the Difference

What is the best surgical technique, and how often have you used it?

The technique with the highest chances of achieving a lasting complete reconstruction is the three-layer reconstruction. In this technique, I restore the mucosa on both sides using mucosal flaps (such as bridge or transposition flaps); I always replace the missing cartilage or bone with a stable graft of your own tissue, usually ear cartilage. This technique has many advantages: in my hands, success rates across all defect sizes average around 90%. The rare residual holes that do occur are almost always smaller than the original defect and, if further treatment is needed at all, can be closed very successfully using the same technique. I have used this method in more than 1,500 operations to date – to my knowledge, the highest number achieved by any single surgeon worldwide for this procedure.

What are the disadvantages of other surgical techniques?

The disadvantage of most other approaches is that they have generally only been used on a small number of patients, and long-term outcome data are scarce. Because they usually do not aim to achieve a three-layer, physiological reconstruction of the nasal septum, they are less reliable: two or more operations are often needed, and revision surgery after an unsuccessful reconstruction becomes considerably more difficult.

Is it true that only very small holes of around 1×1 cm can be closed?

This is not something I can confirm, based on my experience with more than 1,500 operations of my own. In a fully grown nose, a defect of around 1 cm in diameter is usually a small to medium-sized perforation. Using the three-layer technique, I am generally able to close such defects with a long-term complete-closure rate of 90 to 95% – and I can achieve this for considerably larger defects too, albeit with somewhat lower chances of success.

Why do many ENT doctors advise against surgery?

Unfortunately, the view still persists today that nasal septal defects are better left untreated, because success rates are considered low and the perforation is thought to often become larger after an unsuccessful operation. This view is also still found in most textbooks. The reason is probably that these are rare and very demanding procedures. Surgeons need a long learning curve to achieve consistently good reconstruction results. Under today’s cost pressures, teaching hospitals often lack the time to teach this technique under supervision, and consistent long-term follow-up of operated patients happens too rarely. In my view, the way out of this dilemma is consistent specialisation in nasal septum reconstruction.

Why am I being referred to you by a university ENT department for an operation?

If a particular hospital department lacks the specific expertise for a particular treatment, or if that treatment is performed far more often and more routinely elsewhere, referring the patient to that specialist is certainly the best option for them.

Why don’t all ENT departments perform operations for holes in the nasal septum?

Operations for septal perforations are relatively rare overall, so individual nasal surgeons have little opportunity to learn the technique and apply it regularly – yet this is the only way to achieve very good results. As a result, only a very small number of ENT departments and nasal surgeons in Germany – and likewise across Europe and worldwide – perform nasal septum reconstructions on a regular basis. In Germany, there is the added factor that, given how long the operation takes, closing a septal perforation can barely be performed cost-effectively for patients with statutory health insurance.

Why is reconstructing the nasal septum for a hole so difficult?

A septal perforation is a genuine tissue defect: two layers of mucosa and the cartilage or bone lying between them are completely missing from the nasal septum. As a result, the air you breathe in becomes turbulent, and the nasal mucosa dries out and becomes inflamed. For a good long-term reconstruction, both layers of mucosa and the cartilage between them need to be restored. What makes the local situation difficult is that the nasal mucosa is often inflamed, thin and scarred, and tears easily during the operation. Because the surgery takes place deep inside the nose, there is only very little space to work in through the nostrils. In addition, there is significantly more bleeding than during a “normal” operation on the nasal septum, which makes the procedure more difficult and can even make it seem impossible to an inexperienced nasal surgeon. Because such operations are rare, only a small number of surgeons gain the necessary routine – yet this is the only way to achieve very good results.

(Last updated on August 10, 2026)

The Operation in Detail

How is surgical access to the nasal septum achieved?

Unlike many other surgical techniques, I generally do not need to make any external incisions on the nose for the reconstruction. The entire procedure is performed exclusively through the two nostrils in a way that is gentle on the tissue and therefore causes minimal trauma. This is a minimally invasive procedure. No visible scar forms on either the outer skin of the nose or the nasal bridge, and the outer soft tissue covering of the nose does not need to be detached, as is the case with some open surgical techniques.

How do you operate to spare the nasal mucosa as much as possible?

I always operate under high magnification and optimal lighting conditions using a modern surgical microscope. Only this combination of strong magnification and precise illumination makes microsurgical dissection possible with very fine instruments, allowing me to mobilise and reposition the delicate, often already damaged nasal mucosa with millimetre precision. This microsurgical approach is the prerequisite for operating in a way that spares the mucosa as much as possible – and, in turn, for the high success rates of the three-layer reconstruction technique.

Where does the tissue used for the closure come from?

The hole is always reconstructed using your own body tissue. I restore the two layers of mucosa through microsurgical mucosal transposition (mucosal flaps). Any missing cartilage or bone is replaced with cartilage taken from your ear. Don’t worry – the shape of your ear does not change as a result! I use rib cartilage only in exceptional cases, since it is considerably more prone to infection than ear cartilage. I do not use foreign material or fascia as a matter of principle: foreign material is very prone to infection, and fascia does not provide sufficient long-term stability. Neither is suitable for a durable reconstruction.

What type of anaesthesia is used?

Because of the length of the procedure, I always perform septal reconstructions under general anaesthesia.

How long does a nasal septum reconstruction take?

In patients who have not had previous surgery and have small to medium-sized perforations, the reconstruction takes me about 45 minutes. For large defects and in previously operated patients, I need about an hour. If a closure has already been attempted elsewhere, the operation can take up to 1.5 hours.

Why is nasal packing needed after the operation?

During a septal reconstruction, the entire mucosa on the septum and nasal floor has to be mobilised and repositioned (mucosal flaps). The packing ensures that it settles back into place properly after the operation and that no collections of blood (septal haematomas) form underneath it. I use very slim, finger-shaped rubber packing that cannot adhere to or grow into the mucosa. It does not cause pain, although you will need to breathe through your mouth during this time.

How long does the packing stay in the nose?

As a rule, the packing remains in the nose for 2 nights after the operation. During this time, the mucosal flaps on the septum and nasal floor begin to heal. It is completely normal for blood-tinged wound discharge to keep coming from the nose during this period. The tendency to bleed usually eases noticeably after 2 days.

Is the packing changed?

No. I place the packing at the end of the operation under microscopic vision. It is narrow enough that it does not create pressure, and it holds the mobilised mucosa only loosely against the septum and nasal floor.

Is removing the packing painful?

No. Removal is somewhat uncomfortable but not painful. The slim rubber finger packing cannot adhere to or grow into the mucosa. What you notice is more a slight change in pressure as it is withdrawn.

Does it bleed after the packing is removed?

After the packing is removed, the nose may bleed briefly for a few minutes – this usually stops after about 5 minutes. You can then gently clean your nose yourself with water. It is important to apply ointment immediately afterwards, so the mucosa stays moist and can heal well.

(Last updated on August 10, 2026)

Recovery and Aftercare

How long is the hospital stay, and how long will I be unable to work?

A hospital stay of 2 to 3 days is typical, depending on the distance to your home. In terms of work, you should generally plan for 2 weeks off, or up to 3 weeks if your work is physically demanding.

What do I need to be careful about in the first few weeks after the operation?

For the first 3 to 4 weeks after a septal reconstruction, you should avoid blowing your nose, sport, sauna, swimming, physical exertion and sun exposure. Caring for the nose with ointment is essential for healing; you should not smoke for at least 4 weeks, since nicotine significantly impairs wound healing. You will receive your individual instructions from me directly after the operation.

How long does healing take overall, until the result is final?

The nasal mucosa needs several weeks to heal; the transplanted cartilage is fully incorporated into your nasal septum roughly 3 months after the operation. After the packing is removed – usually on the second day, still in hospital – you can often already breathe somewhat through your nose, although not yet very well due to swelling. Over the following weeks – the exact timing varies depending on the extent of the surgery – the mucosa continues to heal, scars and the swelling subsides. As a result, nasal breathing improves very quickly in the first 3 to 4 weeks and somewhat more slowly over the following months. After 4 to 5 months, the nasal septum has largely healed, and after about a year it is completely healed; until then, further improvements in nasal breathing are still possible.

Will I have pain after the operation?

No, real pain is not one of the usual symptoms after a septal operation performed by me. As long as you don’t touch your nose, you generally will not feel any pain. Especially in the first few days, however, the nose is considerably sensitive to touch – an unexpected knock can certainly hurt. This sensitivity decreases almost daily and is barely noticeable after about 3 months.

How do my symptoms develop after the operation, in detail?

Your nasal breathing improves gradually over the first 3 months after the operation. In some cases – particularly after previous operations – further improvement is possible for up to a year afterwards. Pre-existing crusting caused by the hole improves abruptly: ointment treatment keeps your nasal mucosa moist, so that it heals well and hardly any crusts form during the healing phase. Pre-existing nosebleeds also become a thing of the past about 4 weeks after the mucosa has healed. Occasional dripping from the nose in the first few weeks is normal wound discharge. Your sense of smell may be temporarily reduced due to swelling inside the nose – don’t worry, after 3 months at the latest you will smell just as well as before, and in many cases even better.

Can the transplanted ear cartilage be rejected from the nose again?

Such an outcome is an absolute rarity. With the correct surgical technique and well-vascularised mucosa, the ear cartilage integrates in 99% of cases within 6 weeks between the reconstructed layers of mucosa. If you smoke, there is something you can do yourself: abstaining from nicotine for at least 6 weeks before and 4 weeks after the operation significantly reduces the risk of a wound-healing problem. With rib cartilage, unfortunately, wound-healing problems with rejection of the cartilage occur more frequently. For this reason, I use almost exclusively ear cartilage for septal reconstructions.

Will you personally examine and operate on me?

Yes, of course. Once you have an appointment in my surgical consultation, I will examine you personally: I carry out the examination of your nose, the review of any prior findings, the evaluation of the 3-D X-ray (cone-beam CT, CBCT), the discussion of the surgical indication, and the informed-consent conversation myself. Once I have agreed to the operation, I always operate on you personally.

Where is my operation performed?

I operate at the Department of Otorhinolaryngology (ENT), Head and Neck Surgery and Plastic Surgery at the Schön Clinic Düsseldorf, as well as at the Center of Otorhinolaryngology (ENT), Head and Neck Surgery and at the Private Clinic of Helios Clinic Krefeld. We decide together, during the surgical consultation, which of these will be used.

Can aftercare be carried out by my local ENT doctor, or do I have to come back to you for it?

Aftercare can be taken over by any ENT doctor at your home location – this applies especially if you do not live near Neuss. You will receive a discharge letter from me while you are still in hospital. Your nose will occasionally need to be cleared by suction. The silicone splints inserted during the operation, which stabilise and protect the mucosa of your nasal septum, should be removed about 2 weeks after the operation. All sutures in the nose, ear and, if applicable, on the chest (if rib cartilage was taken) dissolve on their own and do not need to be removed. I would like to personally examine you again myself at the latest one year after the operation.

(Last updated on August 10, 2026)

Costs, Appointments and Preparation

How does the appointment booking process work, and is a video consultation available beforehand?

Appointments are arranged through my assistant, Ms Kirschbaum (or, when she is unavailable, Ms Bern), either by email at info@nasenseptumdefekte.de or by phone at +49 176 9938 3643 (also available via WhatsApp). If you leave a message on the answering machine, Ms Kirschbaum will call you back promptly during office hours. Because of the growing demand over recent years, and because I always carry out all examinations and discussions of findings myself, appointments are unfortunately often only available several months later. However, short-notice cancellations sometimes free up earlier appointments. I do not offer video consultations, since the prognosis can only be assessed conclusively after a personal examination of your nose and nasal mucosa.

What documents should I bring to my appointment?

Please bring any previous ENT letters, operative reports (especially if you have had prior surgery) and, if applicable, letters from your internist to your initial examination. Your current medications and any allergies should also be known. If you have existing CT or CBCT scans of your nose (even older ones), please bring these along as well. Please do not have a new CT or CBCT scan taken specifically for this purpose: very often, the existing images are not sufficient for a conclusive assessment, so a suitable CBCT scan will need to be taken during the appointment in any case.

What is helpful for referring colleagues when making a referral?

For a focused first consultation, previous operative reports – including from operations performed elsewhere – are particularly valuable, as they allow me to draw conclusions about the technique used and the tissue structures still present. Information on prior conditions is also helpful, in particular autoimmune disease or cocaine use (including past use), as well as any existing CT or CBCT images. Extensive diagnostic work-up beforehand is not required, since I carry out the decisive examinations – microscopy, endoscopy and a specialised CBCT scan – myself in any case. After the consultation, you will of course receive feedback from me on the findings, my assessment, and the further course of action.

What happens during the outpatient consultation?

The initial examination takes place at the ENT Centre in Neuss (Batteriestraße 1, 41460 Neuss, Germany). After registering, please complete the pre-operative questionnaire, including consent to data processing. You can also download this in advance, complete it at home, and bring it with you to the appointment. After discussing your medical history (previous operations, pre-existing conditions), I examine your nose using a microscope and an endoscope. These examinations are neither unpleasant nor painful. I also take photographs of the defect. In most cases I additionally need a 3-D X-ray examination of your nose and paranasal sinuses (CBCT), which we can carry out during the same appointment. Once all the information is available, I can assess whether an operation is possible, or indeed necessary at all, and give you a prognosis for success. If we both agree to proceed, we can arrange the surgery date right there in the consultation – or later, after you have had time to consider, by email or telephone (contact details below). You will still receive the necessary documents during the consultation.

How binding is an arranged surgery date, and what applies if I need to cancel?

Once a surgery date has been arranged with you, I consider it binding. Together with the clinic – covering the pre-anaesthetic consultation, the time in theatre on the day of surgery, and the hospital bed – I keep this date reserved exclusively for you. Should your plans change, please cancel as early as possible (by email at info@nasenseptumdefekte.de or by phone at +49 176 9938 3643), ideally at least 4 weeks in advance. In that case, we can usually still offer the date to another patient, who might otherwise wait months for a surgery date with me.

If a cancellation is very short notice – that is, less than 4 weeks before the operation – or if you simply do not attend, the slot can no longer be filled. It is then unavailable to any other patient as well, and a patient who has been waiting loses the chance of a reasonably timely surgery date with me. I therefore ask you sincerely to let me know of a short-notice cancellation only for a valid reason, confirmed in writing, for example an acute illness. In all other cases, I unfortunately cannot offer you a further surgery date afterwards; should you wish to be treated by me at a later date, a new personal consultation at my practice is required, often together with a new 3-D X-ray scan and a new cost estimate for the physician-of-choice treatment, since the original estimate is valid for only 6 months.

Please also keep in mind that a septal defect can enlarge over time – delaying the operation by many months therefore also carries some medical risk. I greatly appreciate a responsible approach to these limited surgery dates, and thank you sincerely for your understanding.

What is a CBCT scan of the nose, and why is it necessary?

A cone-beam CT scan (in German, “digitales Volumentomogramm”) is a highly modern cross-sectional imaging technique that involves only a fraction of the radiation exposure of a conventional CT scan; it is taken while seated and takes only a few seconds. I need it to precisely visualise the relative size of the defect and the remaining bony structures in the nose – for this, slices considerably thinner than 1 mm are required. This allows me to make a final assessment of whether surgery is indicated, and this specific type of scan is also required for 3-D surgical planning.

See also Stange, T. (2022): Subjective Assessment of the Size of Nasal Septum Defects Compared to Objective Measurement. Poster presented at the 93rd Annual Meeting of the German Society of Otolaryngology—Head and Neck Surgery in Hannover. (ResearchGate) / (abstract) / (download Poster in German) / published in Laryngorhinootologie 2022; 101(S 02): S338

Does German health insurance cover the cost of the septal reconstruction with you?

Since a septal reconstruction is medically necessary, private health insurers in Germany cover both the hospital stay and the costs of treatment by the consultant or physician of choice. As Chief Physician of the ENT department of Schön Klinik Düsseldorf, and at the ENT department of Helios Klinikum Krefeld, I hold the right to bill directly for reconstructive nasal surgery. The same applies to patients with German standard statutory health insurance who hold supplementary private insurance for hospital stays that includes cover for consultant or physician-of-choice treatment.

For patients with German purely statutory health insurance, the statutory insurer covers the costs of the operation itself. If you specifically wish to be operated on by me, a proportional out-of-pocket fee for consultant or physician-of-choice treatment may apply, which statutory health insurers do not cover. We discuss the details individually during the surgical consultation.

I'm from another country – how does treatment with you work?

Since my patients travel to me from all over Europe, preparation requires a thorough initial examination at my surgical consultation at the ENT Centre in Neuss. During this visit, I review any existing documentation and carry out a microscopic and endoscopic examination with photographic documentation, as well as a thin-slice 3-D X-ray examination (CBCT). After this, I can assess whether a reconstruction is technically possible – and we can then arrange a date for surgery. International patients settle the costs of the initial examination afterwards; including the CBCT scan, these amount to approximately €400.

As a self-pay patient, you are generally required to pay the costs of your hospital stay and medical treatment (surgery) before the surgery. You will receive a detailed cost estimate from me and from the hospital. We will discuss the details individually during your preoperative consultation.

What can I do myself to ease my symptoms before the operation?

Treat your nose regularly – at least once a day – with a caring nasal ointment. Reduce your nicotine consumption as much as possible and stop completely at least 6 weeks before the operation – this considerably improves wound healing. You must abstain from cocaine completely for an operation to have any chance of success at all. Only rinse your nose when necessary – at most once a day, and preferably only every 2 to 3 days, since rinsing also washes out healthy mucus. For very heavy crusting, taping the nostrils shut at night has proven helpful: this means the mucosa treated with ointment does not have to “work” overnight and can recover.

(Last updated on August 31, 2026)