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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56183
Experience:  GP in the United States
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I have had a nasal septal perforation for ages & on 3rd February

Resolved Question:

I have had a nasal septal perforation for ages & on 3rd February 2014 I had a four hour procedure called an open septoplasty to close the nasal septal perforation. When I came round from the general anesthetic I was in agony & required regular morphine & tramadol. This was still the situation when I was discharged. I was discharged with Co-codamol & Coamoxiclav 500/125mg tablets. I was also given antibiotics in theatre.

The day after discharged I phoned my general practitioner to get some stronger painkiller for, which he prescribed me Oramorph. My nose was very swollen & my eyes were shut with the swelling, this did not subside for at least a week.

I had some kind of gel come out of my nose & so I phoned ENT & went back, thankfully it was what he had put in to prevent my nose bleeding. He cleaned my nose out. I went back on the following Monday, one week after my appointment & again he cleaned out my nose & removed my nasal splints.

I went back this Friday just gone & my nose is still very painful & swollen. They cleaned my nose & applied a yellow cream, which was both antibiotic & steroid. I have also been put back on Co-Amoxiclav 500/125mg tablets for another week. They think that I have a perforation but they cannot tell due to the inflammation & swelling, which really should not be present. They told me to use Stenemar nasal salt wash & apply naceptin in between sprays.

Today I applied Naceptin up my nose like told to do so & I noticed that my nose was bleeding. I felt my septum & I could feel air coming through the middle. On further inspection it is clear that I have a small hole. What would happen next with it being so soon after surgery? Would the hole heal on its own, could it be sown up in theatre with a minor procedure or would I need a full open septoplasty again? I have had septal buttons in the past but my body has quickly rejected them.

Thank-you for taking time to read this message & I hope to hear from you soon.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 3 years ago.

Dr. Phil, MD :

Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Dr. Phil, MD :

please enter chat

Dr. Phil, MD :

Hi I'm Dr. Phil

Dr. Phil, MD :

Can I ask your first name?

Customer:

HI I'm Gemma-Louise

Dr. Phil, MD :

Hi Gemma-Louise

Dr. Phil, MD :

Nice to meet you

Dr. Phil, MD :

I'm reading your post

Customer:

Thank-you

Customer:

I have had a nasal septal perforation for ages & on 3rd February 2014 I had a four hour procedure called an open septoplasty to close the nasal septal perforation. When I came round from the general anesthetic I was in agony & required regular morphine & tramadol. This was still the situation when I was discharged. I was discharged with Co-codamol & Coamoxiclav 500/125mg tablets. I was also given antibiotics in theatre. The day after discharged I phoned my general practitioner to get some stronger painkiller for, which he prescribed me Oramorph. My nose was very swollen & my eyes were shut with the swelling, this did not subside for at least a week. I had some kind of gel come out of my nose & so I phoned ENT & went back, thankfully it was what he had put in to prevent my nose bleeding. He cleaned my nose out. I went back on the following Monday, one week after my appointment & again he cleaned out my nose & removed my nasal splints. I went back this Friday just gone & my nose is still very painful & swollen. They cleaned my nose & applied a yellow cream, which was both antibiotic & steroid. I have also been put back on Co-Amoxiclav 500/125mg tablets for another week. They think that I have a perforation but they cannot tell due to the inflammation & swelling, which really should not be present. They told me to use Stenemar nasal salt wash & apply naceptin in between sprays. Today I applied Naceptin up my nose like told to do so & I noticed that my nose was bleeding. I felt my septum & I could feel air coming through the middle. On further inspection it is clear that I have a small hole. What would happen next with it being so soon after surgery? Would the hole heal on its own, could it be sown up in theatre with a minor procedure or would I need a full open septoplasty again? I have had septal buttons in the past but my body has quickly rejected them

Dr. Phil, MD :

How big was the hole prior to the procedure?

Customer:

whole septum

Dr. Phil, MD :

Okay.

Customer:

No obvious cause, never took drugs, drink etc

Dr. Phil, MD :

good

Dr. Phil, MD :

I think there is a chance if it is a small hole that it can heal on its own

Dr. Phil, MD :

If it doesn't, you will need another minor procedure to close the hole

Dr. Phil, MD :

you will not need another big operation

Dr. Phil, MD :

okay Gemma-Louise?

Customer:

The last hole started off as quite small but it ended up growing stupidly big, I have had blood tests done & there is nothing untoward that is causing the hole.

Dr. Phil, MD :

did you get my reply?

Customer:

yes thank-you

Dr. Phil, MD :

your surgeon will address it quickly this time

Dr. Phil, MD :

before it gets big

Customer:

I hope so because I'm autistic & going for operations worry me

Dr. Phil, MD :

I'm very sorry about that

Dr. Phil, MD :

I suspect a minor touch up procedure will do the trick

Customer:

I was born with bilaterial congential cataracts, removed at five & a half & six months old, I have ambliopia, myopia, aphakia, nystagmus & photophobia, I developed glaucoma in my left eye at six years old & right eye at fourteen eyars old.

Dr. Phil, MD :

Oh I'm very sorry

Dr. Phil, MD :

That is hard

Customer:

I have anxiety, borderline personality disorder, depression & phycosis

Customer:

Thank-you for your help from Hyde, Cheshire, UK :)

Dr. Phil, MD :

you're welcome Gemma Louise

Dr. Phil, MD :

I think you will be ok

Dr. Phil, MD :

Just make sure you get back to your doctor quickly

Dr. Phil, MD :

:)

Customer:

It's raining here & we have had floods in south of UK, I hope that you are not affected by the snow

Customer:

I will do thank you

Dr. Phil, MD :

did I do excellent for you?

Customer:

Yes thank you

Dr. Phil, MD :

thank you

Dr. Phil, MD :

please don't forget to click excellent

Dr. Phil, MD :

I appreciate it

Customer:

you were concise & put my mind at ease, a minor procedure only means a small general, not like last time

Dr. Phil, MD :

yes

Customer: replied 3 years ago.
Relist: Other.
Need a specialist I ears, nose & throat to answer to get more accurate information.
Expert:  DrRussMD replied 3 years ago.
Hello
There is no ENT doctor on line currently.
Is there a specific question that has not been answered?

I can help you with this

Would you rather wait...can not say how long?
Customer: replied 3 years ago.
Would rather wait until ENT are around please
Expert:  Dr. Phil, MD replied 3 years ago.
Hi, this is DR. Phil again

I am an internist in the states and we do have extensive training in ENT

Do you want me to try and help further?
Customer: replied 3 years ago.
In UK it's 5 years at med school, two foundation years & them 10 years specialising to become a consultant.

There is a definite hole & my nose is leaking green gunge, I'm already on Coamoxiclav but is there anything else I can do to resolve this so I can breathe properly & allow the hole to heal? Thanks
Expert:  Dr. Phil, MD replied 3 years ago.
I see.

I can tell you that this indicates there is an infection that is not being addressed by the coamoxiclav

That means that either the antibiotic isn't the right one or there is something there than antibiotics can't treat like an abscess

An abscess can occur after surgery. It is like a pocket of pus. The antibiotics can't penetrate it

I think you need to see a doctor (preferably) an ENT today. This is an infection and it is not being treated

The problem here is that an infection in the sinuses after surgery is very close to the brain

I recommend you call your ENT or go to A and E today. It is significant. Antibiotics might need to be changed. That might help
Customer: replied 3 years ago.
I started the second round of antibiotics yesterday but I agree, what makes it worse is I'm not allowed to blow my nose. Is this infection likely to keep the hole open & make it worse?
Expert:  Dr. Phil, MD replied 3 years ago.
Thanks for this reply Gemma Louise

Yes, any active infection will impair the healing process

One good solution might be a sinus rinse.

If your doctor will allow it you can do a saline rinse to try and flush some out

Please don't forget a positive rating.

If you have more quesitons, just reply
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56183
Experience: GP in the United States
Dr. Phil, MD and 3 other Medical Specialists are ready to help you