Bony septal perforation is seen:

Ans: A (Syphilis) Ref: Diseases of the Ear. Nose and Throat by PL Dhingra. 5th edn .2010 page 166Explanation:Septal PerforationMost common cause is trauma which can he due to surgery like SMR, cauterization for epistaxis, nose picking etcPerforation in cartilaginous partLupusTuberculosisLeprosySyphilis causes destruction of bony septumWegners disease causes total destructionAlso seen in workers exposed to chromic plating, soda ash manufacturing and those exposed to arsenic.Other causes like:Nasal myiasisRhinolith Septal abscessProlonged use of cocaineProlonged use of steroid spraysSmall perforations cause a whistling sound on inspiration and expiration whereas large ones will cause crusting and epistaxisTreatment consists of treating the cause, alkaline nasal douches for removing the crusts, local flaps or sialastic buttons for closure.