Much less common causes for perforated nasal septums include rare granulomatous inflammatory conditions like granulomatosis with polyangiitis.

These can be a combination of crusting, blood discharge, difficulty breathing, nasal pressure and discomfort.

Posterior septal perforations, which mainly occur iatrogenically, are often managed with simple observation and are at times intended portions of skull base surgery.

[3] For perforations in which anosmia, or the loss of smell, and a persistent whistling are a concern, the use of a silicone septal button is a treatment option.

This is often done with a combination of a CT scan of the sinuses without contrast and an endoscopic evaluation by an Ear Nose and Throat doctor.

The concept behind closure includes bringing together the edges of mucosa on each side of the perforation with minimal tension.

Kridel, et al., first described the usage of acellular dermis so that no further incisions are required; they reported an excellent closure rate of over 90 percent.

[citation needed] Overall perforation closure rates are variable and often determined by the skill of the surgeon and technique used.