The other common reasons are cocaine use and nose-picking. A doc would be able to see signs of picking. Also nose surgery itself can have this as a side effect; certain nose piercings can also do it.
It can also be an occupational hazard caused by exposure to certain compounds.
Nasal sprays cut off blood to the sprayed area*, so I can see how it could cause a perforation if someone sprayed in the same place all the time (as we do). It would cut off blood flow to the area in the septum…shudder.
*Because it cuts off blood flow, some nasal spray on a tissue and held against a shaving nick stops it cold. Works on other minor bleeding, also.
Heres a good cite from 1998:
Here’s another from 2005.
BTW, the return of pollen and the upcoming crappy pollen season made me remember Shower Soothers – those discs from Sudafed (Vicks also made them) that you put in the bottom of your hot shower and they released eucalyptus and other Vicks-smells to decongest you. They were MAGIC. I wish they would come back, because none of the homemade ones have ever measured up. 
IvoryTowerDenizen, **GrumpyBunny **and Broomstick -
Ignorance fought - bullshit call rescinded.
Thanks.
I stand corrected as well.
However, the point remains - for all OTC (and Rx) drugs, FOLLOW THE INSTRUCTIONS re how much and how often to use them!
Yes! That’s the take home message. Nasal perfs and dependency are why the 3 day limit is recommended!