Correlation of sinonasal symptoms with the size and position of nasal septal perforations

To assess the correlation of sinonasal symptoms and quality of life with size and position of nasal septal perforation (NSP).

This is a prospective observational study in a tertiary referral center involving adult patients presented with NSP. The Sino-Nasal Outcome Test-22 (SNOT-22) and its clinico-psychometric domains were analyzed, including additional NSP-specific symptoms (nasal crusting, epistaxis, and whistling noise during nasal breathing). The size of NSP was measured radiologically by calculating the area in cm² and anteroposterior (AP) diameter. Position of perforation was determined clinically by distance from columella to the anterior edge of the perforation.

Forty patients were included in this study (22 males). The most common etiology of NSP was iatrogenic. The mean SNOT-22 score was 50.8 (standard deviation 23.8), and mean NSP size was 3.0 cm² . No statistical correlation was observed between the total SNOT-22 score with either position or size of NSP. As for NSP-specific symptoms, there was a statistically significant negative correlation with the size of perforation (A-P diameter) (r = -0.34, P = 0.03) and position of the perforation (r = -0.49, P = 0.0016), suggesting that these symptoms improved with posterior and larger perforations.

Reported SNOT-22 scores were comparable to patients with recalcitrant chronic rhinosinusitis, although the scores did not correlate with size and position of NSP. Sinonasal symptoms typically observed in NSP improved with more posteriorly placed and larger sized perforations. This study provides an insight into the quality-of-life impact of NSP and affirms the clinical observation that anterior NSP are more symptomatic.

4 Laryngoscope, 2019.