Management of Nasal Septal Perforation: Grampian Experience

Objective: To establish the most common treatment option used for nasal septal perforation management at our tertiary referral centre. Study Design: Observational study. Place and duration of study: The study was conducted in 2011 at a tertiary referral centre in the North East of Scotland, UK. Methodology: Retrospective chart review of all patients over 4 years (2006-2010) who were identified to have a nasal septal perforation. Along with demographics, data were collected on symptoms, site and size of perforation, co-morbidities, preceding history of nasal trauma or surgery, treatment employed and frequency of clinical review. Microsoft excel was used to collect and analyse the data. Results: A total of 220 patients were identified. Common symptoms were nasal obstruction, crusting and nasal bleeding. Septal perforation was recorded as large (70/220=32%), medium (18/220=8%) and small (49/220=22%). The treatments used included: Saline douches, Vaseline, Bactroban ointment, Naseptin cream, Silastic splints, Silastic button insertion, perforation enlargement, cautery and surgical repair. Repair was attempted in 28 patients (13%). The outcome of surgical repair remained disappointing as the success rate was 11/28 = 40%. Conclusion: Septal perforation remains a common problem in rhinology. Almost 77% of our cohort was successfully managed with conservative measures alone. Few patients proceed to surgical repair and the results of this approach remain disappointing with a high failure rate on long-term follow-up.