Paediatric Nasal Septal Perforations Systematic Review: Etiologies, Symptoms, and Treatment Outcomes

To better elucidate the aetiologies, symptomatology, and surgical repair outcomes for nasal septal perforations in the paediatric population.

Systematic review and meta-analysis.

The PubMed, Embase and Web of Science libraries were queried using the terms "nasal septum," "perforation," and "paediatric" and all relevant synonyms. All studies that included data on nasal septal perforations in patients aged 0-18 and their etiologies were included.

After 498 studies were reviewed, 9 retrospective studies with 219 patients were included for the primary analysis. The most common etiologies for nasal septal perforations in the literature were iatrogenic (34.25%), traumatic (23.29%), and idiopathic (18.26%). The most reported symptoms were crusting, epistaxis, and nasal obstruction. The overall closure rate for surgical repair was 0.86 [95% CI 0.76-0.95; I² = 17%]. Closure rates were notably lower in patients with autoimmune, drug, and foreign body related etiologies. There was no clear relationship between perforation size and closure success.

Overall, paediatric nasal septal perforations appear to primarily be caused by iatrogenic and traumatic etiologies. Paediatric patients also experience high proportions of foreign body-related defects. Closure rates remain high for paediatric patients with nasal septal perforations.