Septal perforation research watch
What is being published on nasal septal perforation, and what each study changes in plain words for a patient. Twenty-four publications, reviewed once a month.
Update cadence
This page is reviewed once a month. Last review: 13 September 2026. If something important is published between reviews, it is added as soon as we spot it.
How this watch is done
We are not doctors. This page does not judge the quality of studies: it flags what is published, gives the reference, and translates in plain words what it changes, or does not change, for someone living with a perforation. When we do not know, we say so.
What we follow
- A PubMed alert on “nasal septal perforation” and its variants
- The tables of contents of Rhinology, The Laryngoscope, International Forum of Allergy & Rhinology, European Archives of Oto-Rhino-Laryngology and Facial Plastic Surgery
- Clinical trial registries, ClinicalTrials.gov first, for regenerative techniques
- Reports from the support group, when they point to a publication we had missed
An entry is only added if the publication is identifiable: authors, journal, year, and a link where one exists. The full list of sources used across the site is in the footer and on the About and sources.
What has been published
Twenty-four publications, grouped by question rather than by date. Each entry gives its reference, then what it changes for you.
The shared framework
2026
International consensus statement on nasal septal perforation
Alobid I., Garaycochea O., Rojas-Lechuga M. J., Harvey R. J., Hopkins C. et al., Rhinology, September 2026
What it changes
Three voting rounds among 25 experts from 15 countries, 56 agreements: validated symptom tools, imaging protocols, classification by size and location, preferred treatments, perioperative care, outcome evaluation. Four points remain unsettled — whether the hole sitting high or low matters, the prognostic value of mucosal oedema, how long to stop inhaled drug use before surgery, and whether early debridement helps. It is the shared reference the field never had.
2026
Nose picking formally enters the causal chain
Pathophysiology section of the international consensus, Rhinology, 2026
What it changes
The panel agreed on a sequence: dryness, crust, picking, ulceration, ischaemia, perforation — and that picking can enlarge an existing perforation. The direct consequence for you: treating crusting is not comfort care, it is what stops the hole growing.
2023
State of the art: septal perforation repair
Garaycochea O., Santamaría-Gadea A., Alobid I., Current Opinion in Otolaryngology & Head and Neck Surgery, 2023
What it changes
The review that preceded the consensus, from the same Barcelona team. Useful for seeing how, in twenty years, this went from a procedure reputed to be a lottery to a codified operation.
Real-world rates
2022
Meta-analysis of closure techniques: 64 studies, 1,591 patients
Fermin J. et al., International Forum of Allergy & Rhinology, 2022
What it changes
The synthesis that lets you place the techniques against one another. It confirms none is good for everything: the choice depends on size, height and the state of the mucosa, not on the surgeon's preference.
2025
Closure of large perforations, 20 mm and above: 38 studies, 408 patients
Cheung M. H., Kim C. H., Nguyen S. A., Close M., Snyder V. et al., European Archives of Oto-Rhino-Laryngology, 2025
What it changes
84.4% closure in perforations averaging 22 mm long and 21 mm high. Size is therefore not a reason to give up, but it costs around ten points against small ones. The study also gives the causes: surgery 61%, unknown 37%, trauma 31%, drug use 28%.
2024
Survey of 356 German ENT surgeons on their own results
Lindemann J. et al., Laryngorhinootologie, 2024 · with the Ulm series
What it changes
This is the source of the 40 to 79% closure figure among practitioners who operate occasionally, against over 90% in expert centres. It also shows an optimism bias: surgeons who do operate quote markedly higher numbers than colleagues who do not.
2019
Anonymous survey of real-world success rates
Delaney S. & Kridel R., Facial Plastic Surgery, 2019
What it changes
Asked without their names attached, surgeons report noticeably lower results than they publish. This is the paper that justifies asking your own surgeon for their own figure, for your size of perforation, rather than the literature average.
The techniques
2026
74 repairs with bipedicled mucosal flaps
Chabuz C. A., Lee N. K., Winkler A. A., Facial Plastic Surgery & Aesthetic Medicine, 2026
What it changes
95% closure, and more to the point: breathing genuinely improves. NOSE scores improve in 78% of patients, by 29 points on average, and two thirds clear the threshold above which the difference is felt day to day. Mean follow-up only 7.5 months — worth keeping in mind.
2026
Systematic review of the anterior ethmoidal artery flap
16 studies retained from 2,838 records, literature from 1946 to 2026
What it changes
84.6% closure for perforations under 2.5 cm. The AEA flap leaves emerging-technique status: it is now a documented endoscopic option, with the advantage of leaving the turbinates alone.
2026
Three-layer composite graft for medium and large perforations
Laryngoscope Investigative Otolaryngology, 2026
What it changes
85.7% closure, 18 of 21 patients. Only one lasting sequela, a synechia; the other complications resolved on their own. A small series, but the idea — stacking three layers rather than two — is the one currently gaining ground for large perforations.
2026
Free mucosal grafting as an adjunct
Campion N. J., Couto A. M. et al. (Sydney group), The Laryngoscope, in press
What it changes
Laying a small piece of mucosa without a pedicle to speed regrowth over raw areas. Not a closure technique but a finishing detail that could shorten the crusting period after surgery.
2026
Smell, mucociliary clearance and quality of life after closure
Çelik R. C., Hancı D. et al., The Laryngoscope, 2026
What it changes
A prospective study: after closure, smell, mucociliary clearance and quality of life improve. In other words, closing is not only about removing crusting and whistling — the nose works again.
Without closing the hole
2025
Five-year audit of silastic septal buttons, Plymouth (NHS)
Wong A., Mehana M., Khalil H., Cureus, September 2025 · 77 patients, 2019-2024
What it changes
The figure to know before accepting a button: only half the patients (50.6%) needed nothing further. A quarter needed one replacement, 5% several, and 15.6% ended up having it removed. Add 7.8% local infections, 5.2% granulation tissue and 2.6% migrations. In that centre surgery was not offered beyond 2 cm — which partly explains the reliance on buttons.
2026
Surgical repair versus 3D-printed customised prosthesis
Gomes P. L., Kumar N., Bansberg S. F., Marino M. J., Lal D., Miglani A., The Laryngoscope, 2026
What it changes
A head-to-head comparison in one centre: surgical closure succeeded in every operated patient, with no complications in either group. The custom-printed prosthesis is a genuine fallback, better tolerated than the prefabricated button — but it is still a prosthesis, for life.
2017
Posterior septectomy: what airflow simulation shows
Otto B. A., Li C., Farag A. A. et al., International Forum of Allergy & Rhinology, 2017 · 7(7):718-725
What it changes
When a large posterior perforation cannot be closed, deliberately removing the back of the septum creates a single cavity and removes the turbulence. Series report symptom improvement in nearly 8 of 10 patients. It is not a repair, it is an accepted trade-off.
2015
Nasal prosthetics: systematic review and meta-analysis
Taylor R. J. & Sherris D. A., Otolaryngology–Head and Neck Surgery, 2015
What it changes
The reference synthesis on buttons, predating the Plymouth audit. Read alongside it: ten years separate the two, and the real-world numbers are less favourable than the published series.
Measuring and understanding
2003
Prevalence in the general population: the Skövde study
Öberg D., Åkerlund A., Johansson L. et al., Rhinology, 2003
What it changes
0.9% of the adult population. It is the only general-population study, and it is over twenty years old — recent imaging-based estimates run higher. The point to take away: this is not a rare condition.
2011
What predicts the outcome of a repair
Moon I. J., Kim S. W., Han D. H. et al., Auris Nasus Larynx, 2011 · 38(1):52-57 · 35 patients
What it changes
Two lessons that still hold. The strongest success factor is complete coverage by flaps on both sides. And two things predict persistent symptoms despite achieved closure: a large perforation, and a history of nasal trauma or surgery. In this 35-patient series, 48% re-perforated, a failure tied to the size of the hole and to one-sided coverage.
2026
Perforation and empty nose syndrome: the cotton test can mislead
International Forum of Allergy & Rhinology, 2026 · 4-patient series, Saitama University
What it changes
In patients with both a perforation and severely atrophic turbinates, the cotton test was negative before closure and turned positive afterwards in 3 of 4. In other words: while the hole is open, you cannot conclude anything about empty nose. Close first, retest after.
2021
NOSE-Perf: a scale built for perforations
Taylor R. J. et al., validation, 2021 · applied in 2024 to 117 operated patients
What it changes
Twelve questions, scored 0 to 48. This is the tool the 2026 consensus recommends using before and after surgery. Applied to 117 patients, it showed a clear score drop after closure with bilateral flaps and an interposition graft. There is no validated French version.
Still experimental
2024
Cartilage grown from your own cells (N-TEC)
Kaiser B. et al., International Journal of Surgery, 2024 · phase I, five patients, Basel
What it changes
Cartilage engineered in the laboratory from a small nasal sample, then reimplanted. Feasibility shown, efficacy not established. It is the most advanced avenue, and it remains years from routine practice.
2025
Stem cells and mucosal regeneration: systematic review
PRISMA search to May 2025, six databases
What it changes
A blunt conclusion: potentially promising results, no serious adverse effects, but high-quality randomised trials are needed before drawing any conclusion. The review also restates the real range for conventional surgery, 53 to 90%.
2024
3D-printed polycaprolactone nasal mesh
Trial NCT06439927, Helwan University · recruiting since August 2024
What it changes
A bespoke resorbable scaffold placed to guide mucosal regrowth. The trial is still recruiting: the kind of study to watch, not a treatment to ask for.
2026
Bioengineered septum implant: printed silicone and chondrocyte hydrogel
Regenerative Biomaterials, 2026
What it changes
Laboratory work: a 3D-printed silicone scaffold filled with a fibrin gel seeded with cartilage cells. Nothing clinical yet; we list it because it shows where the research is heading.
The landmark series
Outside this grouping because they span years: Bansberg S. et al. (Mayo Clinic), 392 patients, and Raghavan U. et al., 154 patients. These are the series behind “more than 9 in 10 perforations close” when the operator does dozens a year. Their follow-up and numbers are exactly what the rest of the literature lacks.
What the literature still does not say
- No randomised trial comparing two techniques head to head. Almost all the data are retrospective single-surgeon series.
- Almost no follow-up beyond two years, even though late re-perforations happen.
- No validated French version of the symptom scales (NOSE-Perf, SEPEQOL).
- Nothing solid on what becomes of an untreated perforation: how many enlarge, and how fast.
This is not our own verdict. It comes from the methodological review by House T. et al., Otolaryngology–Head and Neck Surgery, 2025, which examined publications from 2012 to 2024 to measure how heterogeneous the evaluation methods are. See the publication
Did we miss a publication?
If you have read a study, an audit or a trial that belongs here, send it over. A link is enough; we read it and add it if it is identifiable.
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