Septal perforation therapy options

Patient

Q: I'll try to keep this brief. In October 2010 I was diagnosed with a large septal perforation (1.5cm...though I'm certain it's at least 2cm now). The cause is unclear (never did any kind of drugs), though it's likely a combination of a rhinoplasty I did in '06 and the irritation caused by my move from a very hot, humid climate (Malta, Europe) to a very cold, dry one (Maryland, USA) in '07. I've seen a number of doctors, and all agree that it's best I leave it alone or at the very most, have the exposed cartilage removed as that's what's causing the chronic bleeding. They said that the hole is too large for septoplasty (which has a very low success rate of 50 percent) and that a silicon button will only exacerbate the condition. Now the last doctor I've seen suggested I see two more specialists at John Hopkins before completely ruling out septal reconstruction, but upon calling them to book an appointment, I was shocked by the kind of money they charge just for a consultation and to add insult to injury, they don't accept my insurance company. So my question to you is, do you think it's worth my hard-earned money to see these two specialists, or is my perforation completely beyond repair no matter who I go to? I just don't want to spend all that money only to be told exactly what I've been told by all the other doctors I've seen. Looking forward to your reply. Sincerely, Johanna

Doctor

A:   While your septal perforation is large, its size does not prevent you from having it surgically repaired. Based on your description, the perforation should be reparable with anyone of a number of different procedures apart from septoplasty or a button prosthesis. I think it is worth it to get another opinion from specialist who have extensive expertise in dealing with this condition.

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