Perforations of the nasal septum may occur from a variety of causes. The most common cause is previous septal surgery. Other causes include: nose picking, repeated cauterization of the nasal septum for epistaxis, exposure to industrial chemicals such as chromium, repeated cocaine abuse, nasal granulomas, and as a result of chronic infections such as syphilis or tuberculosis [fortunately rare these days]. Smaller septal perforations are usually asymptomatic and do not crust, although they are more likely to produce a whistling noise during nasal respiration.
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