Taylor, Cullen M.

ObjectiveReporting patient symptoms due to nasal septal perforation (NSP) has been hindered by the lack of a validated disease‐specific symptom score. The purpose of this study was to develop and validate an instrument for assessing patient‐reported symptoms related to NSP.Study DesignValidation study.SettingA tertiary care center.MethodsThe Nasal Obstruction Symptom Evaluation (NOSE) scale was used as an initial construct to which 7 nonobstruction questions were added to measure septal perforation symptoms. The proposed NOSE‐Perf instrument was distributed to consecutive patients evaluated for NSP, those with nasal obstruction without NSP, and a control group without rhinologic complaints. Questionnaires were redistributed to the subgroup with NSP prior to treatment of the perforation.ResultsThe study instrument was completed by 31 patients with NSP, 17 with only nasal obstruction, and 22 without rhinologic complaint. Internal consistency was high throughout the entire instrument (Cronbach α = 0.935; 95% CI, 0.905‐0.954). Test‐retest reliability was demonstrated by very strong correlation between questionnaires completed by the same patient at least 1 week apart (r = 0.898, P <. 001). Discriminant validity was confirmed via a receiver operating characteristic (P <. 001, area under the curve = 0.700). The NOSE‐Perf scale was able to distinguish among all 3 study groups (P <. 001) and between NSP and nasal obstruction (P =. 024). When used alone, the NOSE scale could not discriminate between NSP and nasal obstruction (P =. 545).ConclusionsThe NOSE‐Perf scale is a validated and reliable clinical assessment tool that can be applied to adult patients with NSP.

ObjectiveThis study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported.Study DesignCase series.SettingTertiary care center.MethodsIn this institutional review board–approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow‐up.ResultsFifty‐six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3‐41) mm in length by 9.3 (range, 2‐23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow‐up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs.ConclusionPatients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.

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ObjectivesTo review our experience with secondary surgery for persistent nasal obstruction following successful septal perforation repair and describe the potential contribution of the nasal swell body (NSB) to obstruction.Study DesignRetrospective chart review.MethodsIRB‐approved retrospective chart review of perforation repairs utilizing bilateral mucosal flaps performed by the senior author from October 2008 through April 2019 was performed. Patients who underwent secondary surgery for persistent nasal obstruction were identified. Data regarding patient demographics, perforation characteristics, primary closure technique, and secondary surgical procedures for persistent postoperative obstruction were analyzed. Nasal Obstruction Symptom Evaluation (NOSE) scores were assessed pre and post revision surgery.ResultsThirty‐four patients (14.7% of 232 successful repairs) met study criteria. Of those, 30 patients underwent revision septal surgery. An inferiorly advanced NSB was surgically reduced in 9.9% (23/232) of patients following successful closure to improve persistent obstruction. There was no incidence of reperforation. All patients undergoing NSB reduction reported improved nasal airflow postoperatively and 13 completed the NOSE questionnaire. The mean preoperative NOSE score (95% CI) was 52.7 (42.2–63.2; median, 50). The mean postoperative NOSE score (95% CI) was 19.2 (12.8–25.6; median, 15). The difference between the preoperative and postoperative NOSE scores was statistically significant (P< .001).ConclusionsRepair of a septal perforation using a superior bipedicle flap carries the potential for the NSB to contribute to persistent postoperative nasal obstruction. The swell body can be surgically reduced, without re‐perforation, to relieve obstructive symptoms in the patient with a successful perforation repair.Level of EvidenceIVLaryngoscope, 2020