Outcomes of Silastic Septal Button Insertion for Nasal Septal Perforations: A Five-Year Retrospective Clinical Audit

Introduction Nasal septal perforations can cause morbidity through crusting, whistling, epistaxis, and nasal obstruction. Management options include conservative therapy, surgical closure, or septal button insertion. At our institution, surgical closure is generally not offered for perforations greater than 2 cm in diameter or when the nasal mucosa remains unhealthy despite optimal medical therapy. This audit evaluated outcomes of silastic septal button insertion at a tertiary care centre over a five-year period. Methods A retrospective clinical audit was conducted among patients who underwent prefabricated silastic septal button insertion between 2019 and 2024 at University Hospitals Plymouth NHS Trust, United Kingdom. Demographic data, presenting symptoms, and management outcomes were extracted from clinical records. A PubMed literature review was performed to contextualise findings. Results Seventy-seven patients (37 females, 40 males; mean age 46.8 years, median 48 years) underwent silastic septal button insertion. Presenting symptoms included nasal crusting, whistling, epistaxis, obstruction, nasal discharge, facial pain, headache, postnasal drip, and altered olfaction. No further intervention was required in 39/77 patients (50.6%). A single replacement was required in 20/77 (26.0%), multiple replacements in 4/77 (5.2%), button removal in 12/77 (15.6%), and adjustment without replacement in 2/77 (2.6%). Complications included local infection (7.8%), granulation tissue (5.2%), and button migration (2.6%). All patients reported a positive surgical experience; 63/77 (81.8%) described improved quality of life, and 72/77 (93.5%) said they would recommend the procedure. Conclusion Silastic septal button insertion appears to be a safe and practical management option for patients with symptomatic nasal septal perforations who are unsuitable for or decline surgical closure. While many patients experienced satisfactory symptom control without further intervention, a substantial proportion required replacement, adjustment, or removal. Given the retrospective, single-centre nature of this audit and its inherent limitations, these results should be interpreted with caution. Careful counselling remains essential to set expectations regarding the potential need for ongoing management. Larger, prospective multicentre studies with standardised outcome measures would help clarify the long-term role of septal buttons in clinical practice.