Nasal septal perforation has a negative impact on olfactory and trigeminal function

Nasal septal perforation (NSP) is commonly associated with nasal obstruction, crusting and epistaxis. Research on its impact on olfactory function remains limited. This study aims to evaluate the sense of smell in patients with NSP and identify factors associated with the olfactory dysfunction.

Cross-sectional study of patients with symptomatic NSP and a control group was conducted at Clinic and Teknon hospitals in Barcelona from 2017 to 2024. Data collected included sex, age, comorbidities, body mass index (BMI), NSP aetiology, SNOT-22 and NOSE-Perf questionnaires. Olfactory function was assessed using visual analogue scale (VAS) and the Barcelona Smell Test 24 (BAST-24). NSP size and position were determined through nasal endoscopy and sinus computed tomography scan.

123 patients with symptomatic NSP and 74 healthy controls were included. Intranasal cocaine use was the most common aetiology. Olfactory dysfunction was observed in 26 patients (21.1%) for detection, 26 (21.1%) for memory, and 85 (69.1%) for identification, significantly different from control group. Patients with olfactory dysfunction presented trigeminal detection and identification impairment in 34% and 51%, respectively. In multivariate analysis, significant differences were found in olfactory identification based on NSP area and BMI, corrected by aetiology. A moderate correlation was found between olfactory identifica-tion with VAS, SNOT-22 item 21 and NOSE-Perf item 10. Olfactory identification was significantly correlated with trigeminal scores.

NSP significantly affects olfactory and trigeminal function. Lower identification outcomes were associated with larger NSP area and higher BMI, independently of aetiology.