Initial Consultation & Diagnosis
The first consultation is designed to understand your symptoms, previous nasal history, the characteristics of the perforation and what you would like treatment to achieve.
The aim is not simply to measure the opening. Assessment also considers surrounding tissue, nasal airflow, previous surgery, structural support and whether anything else may be contributing to your symptoms.
Mr Hassan Elhassan
Rhinology, nasal surgery and specialist septal perforation assessment.
What Should the Initial Consultation Establish?
A useful consultation should leave both patient and clinician with a clearer understanding of the condition and the realistic options available.
Understand What Is Affecting You
Crusting, bleeding, dryness, whistling, discomfort and nasal obstruction can affect patients differently.
Understand Why It Developed
Previous surgery, trauma, intranasal exposure, medication and wider medical history may provide important clues.
Characterise the Perforation
Size, position, tissue quality, remaining septal support and previous surgical change can all influence treatment planning.
Understand What You Want From Treatment
Some patients primarily want symptom relief. Others want to explore closure, reconstruction or management of associated nasal problems.
What Happens During the Appointment?
Every consultation is individual, but assessment usually follows a logical sequence.
What you notice, how long symptoms have been present and how much they affect daily life.
Previous operations, injuries, medicines, nasal exposure and earlier treatment are discussed.
The septum, perforation, nasal lining and wider nasal airway are assessed.
A nasal endoscope may provide a more detailed view of the perforation and surrounding nasal structures.
Options, further investigation if necessary, and treatment priorities can then be discussed.
The History Can Be as Important as the Examination
A septal perforation describes what has happened anatomically. Your history can help explain why it happened.
Where there is a clear history of previous septal surgery, the likely cause may already be relatively straightforward.
Where no clear explanation exists, additional questions may help determine whether further investigation is appropriate.
More Than Simply Looking for the Hole
Examination can confirm that the perforation is present, but also assesses the tissue around it and the rest of the nasal airway.
Previous operations can alter septal cartilage, scarring and the amount of tissue available for future reconstruction, so these findings matter when treatment is being considered.
When Is an Endoscope Useful?
Nasal endoscopy can provide a detailed view of the septum and wider nasal cavity.
A slender endoscope allows the clinician to inspect areas that may be difficult to see fully during a simple anterior examination.
It may also identify other factors that could contribute to symptoms, including inflammation, crusting, discharge, polyps or structural narrowing.
Read the full diagnosis guide →Treatment Planning Requires More Than a Diameter
Two perforations of a similar measured size can present very differently because anatomy and tissue quality vary.
Size
Horizontal and vertical dimensions help describe the defect and inform treatment planning.
Position
An anterior opening can behave differently from a perforation positioned further back.
Tissue Quality
Healthy mobile mucosa differs from tissue that is scarred, inflamed or previously operated on.
Septal Support
The remaining structural framework matters, particularly with larger or complex defects.
Previous Surgery
Previous procedures can affect cartilage, scarring and reconstructive options.
Symptoms
Treatment should address the patient’s clinical experience rather than anatomy alone.
Does Everyone Need Blood Tests, a Scan or Biopsy?
No. Further investigation should answer a specific clinical question.
If a patient has a clear post-surgical perforation and the history and examination are otherwise reassuring, extensive investigation may not be necessary.
Additional tests may be considered where the cause is unclear or another disease process needs to be excluded.
For example, when inflammatory, autoimmune or infectious disease is a consideration.
CT imaging may occasionally be appropriate where wider sinonasal or structural information is required.
Tissue sampling may be considered when abnormal tissue or an unexplained cause requires further investigation.
Why Is Biopsy Not Performed Routinely?
A biopsy removes tissue from the perforation margin, so it can make the defect slightly larger. The diagnostic value therefore needs to justify taking the sample.
What Information Is Helpful to Bring?
Do not worry if you do not have everything listed here. These are useful rather than mandatory.
Previous Surgery Details
The type and approximate date of previous nasal surgery where known.
Previous ENT Letters
Relevant correspondence or previous specialist assessments can provide helpful context.
Previous Scan Reports
Existing imaging reports can occasionally avoid unnecessary repetition.
Current Medication
Include nasal sprays, prescription medication and treatments you use regularly.
Symptom Timeline
Think about when symptoms began and whether they have changed over time.
Your Questions
Write down anything you particularly want to understand about treatment or surgery.
Useful Questions to Ask During the Consultation
The appointment should give you enough information to understand the condition and the options rather than pressuring you towards one treatment.
Diagnosis Does Not Automatically Lead to Surgery
Some patients can manage symptoms conservatively. Some may consider a septal prosthesis or other non-reconstructive approach. Others may be suitable for surgical repair.
The decision should reflect the anatomy, symptoms, cause, likely benefits and limitations of each option, and your own preferences.
In-Person & Video Consultations
The most appropriate consultation format depends on what needs to be assessed.
In-Person Consultation
Allows direct nasal examination and, where clinically appropriate, nasal endoscopic assessment.
Most useful when a full physical assessment is required.Video Consultation
Can be useful for discussing symptoms, previous surgery, existing investigations and treatment questions.
A subsequent in-person examination may still be necessary.Mr Hassan Elhassan
Consultant ENT Surgeon — Rhinology & Nasal Surgery
Mr Elhassan’s practice includes specialist rhinology, functional and reconstructive nasal surgery and assessment and treatment of septal perforation.
The initial consultation is used to understand the patient’s symptoms and anatomy before deciding whether conservative care, further investigation or reconstructive treatment should be considered.
The examination and investigations required for an individual patient depend on their history and clinical findings. Information on this page does not replace an individual medical assessment.
Next: Non-Surgical Management
Learn how nasal moisture, crust management and other conservative measures can help control symptoms without attempting surgical closure.