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MEET THE DOCTORS: LONDON, UK, MAY 2017

Dr. Hamilton and Dr. Osborne will be in London, UK at the end of May 2017. They will be holding discussion sessions with individual patients to discuss the details of surgery. We are scheduling plenty of time between appointments to ensure that you can obtain answers to all of your questions.

Nose Picking (Rhinotillexis) and Septal Perforations: Why I should stop picking my nose…?

About Dr. Jason Hamilton

Jason S. Hamilton, M.D. is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute based at Cedar-Sinai Medical Towers. Dr. Hamilton has advanced training in plastic and reconstructive surgical techniques involving the face, head, and neck, and limits his practice to the treatment of these areas exclusively.

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About Dr. Ryan Osborne

Ryan F. Osborne, M.D. is the Director of Head and Neck Surgery at OHNI and is an internationally renowned expert in head and neck oncology. He has developed a special interest for the treatment of parotid gland tumors and focuses on the use of minimally-invasive techniques in the care of patients needing parotid surgery.

Figure 1: Rhinotillexis or nose picking is commonly associated with the formation of septal perforations.
Figure 1: Rhinotillexis or nose picking is commonly associated with the formation of septal perforations.

BACKGROUND

Nose picking is one of the leading causes of epistaxis (nose bleeds) and a common cause of septal perforations (a hole in the nasal septum). Nose picking (rhinotillexis) is defined as the insertion of the finger and/or object into the nose for the purpose of removing nasal secretions, mucus, crusts and so forth.

PATHOLOGIC DIAGNOSIS

A study by the Journal of Clinical Psychiatry, querying 1000 subjects, returning 254 responses, found that ninety-one percent of respondents were nose pickers. The simple translation, most adults “pick” their nose at some point. So when does this become a problem? Typically, nose picking doesn’t become a serious clinical problem until it becomes an impulse control problem, known as body-focused repetitive behavior (BFRB) or an obsessive-compulsive disorder, known as rhinotillexomania. In both conditions the patient can cause damage to the nose through their repetitive compulsive behavior.

CLINICAL CONSIDERATIONS

Many patients presenting with septal perforations admit to chronically picking their noses. These patients generally fall into two groups. In the first, we have patients that began picking their noses after a perforation had already developed due to septoplasty, rhinoplasty, cocaine use, decongestant abuse, or trauma. These patients are generally obsessed with cleaning their nose and alleviating the sensation of crusting or itching. The second group is comprised of patients who generally suffer from rhinotillexomania and their septal perforation is self-inflicted. In both cases rhinotillexis can introduce bacteria to the nasal cavity causing infections and subsequent increase in septal perforation size. Successful treatment in patients with impulsive rhinotillexis involves managing not only the surgical disease (septal perforation) but also the associated compulsive behavior. In severe cases, co-management with a clinical psychologist/psychiatrist may be advised.

Figure 2: Nasal septum perforation. A ruler has been inserted into the opposite nostril to demonstrate scale.
Figure 2: Nasal septum perforation. A ruler has been inserted into the opposite nostril to demonstrate scale.

SURGEON

Dr. Jason Hamilton is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute, and is double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology/Head and Neck Surgery. Dr. Hamilton is one of only handful of septal perforation specialist worldwide and has one of the highest success rates.

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For more information on the deviated septum, septoplasty, functional rhinoplasty and septal perforation repair by Dr. Jason Hamilton, septal perforation specialist, please contact the Osborne Head and Neck Institute or visit
www.perforatedseptum.com.

Contact a Physician at Osborne Head & Neck Institute

If you would like to speak with one of our physicians regarding this issue or another ear, nose, throat problem; or have other questions or concerns, please complete the contact form below or call us at 310-657-0123.

Image Credit: Carlos Paes (http://www.sxc.hu/photos/103019), via Wikimedia Commons

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