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Perforations of the nasal septum with no specific aetiology

Introduction THE aetiology of perforations of the nasal septum has been extensively demonstrated in the literature, self-inflicted (Barton, 1977) or surgical trauma, inhaled necrotizing agents in drug abuse or certain industrial processes being among the most common causes. Other causes include neoplasms (Riddington Young, 1979) and specific infections such as tuberculosis, leprosy or syphilis. Midline granulomata (Friedmann et ah, 1978) occur occasionally, and a diagnosis should be made in view of the poor prognosis in untreated patients. However, there is a significant group of patients in whom no specific aetiological factor can be demonstrated, including some who present with apparently 'active' margins to the perforation. The patients described below had active septal perforations varying in size from 0 • 5-3 cm in diameter, and in 3 cases the ESR was raised. All cases were clinically suggestive of midline granuloma.