Validated Symptom Outcomes Following Septal Perforation Repair: Application of the NOSE‐Perf Scale

Abstract

ObjectiveThe Nasal Obstruction Symptom Evaluation (NOSE)‐Perf scale was developed and validated to measure symptoms associated with nasal septal perforations. This study reports the application of the NOSE‐Perf scale to evaluate symptom change following septal perforation repair.MethodsPatients with NOSE‐Perf evaluations ≥6 months following attempted perforation closure from July 2018 to December 2021 utilizing bilateral nasal mucosal flaps with an interposition graft were eligible for study inclusion. Change in NOSE‐Perf scores were noted. Patient demographics, perforation size, and concurrent functional procedures were analyzed for impact on symptom outcomes.ResultsOne‐hundred and seventeen patients met the study criteria. Seventy‐nine (67.5%) of the patients were female and the mean (range) age at surgery was 47.3 (14–78) years. Repair failure was noted in 7 (6.0%) patients. Mean (SD) preoperative NOSE‐Perf score was 25.3 (95% CI, 23.5–27.1) and postoperative score was 7.9 (95% CI, 6.5–9.3). Minimal clinically important difference (MCID) was estimated and greater than 91% of patients had improvement above this threshold. Patient age, perforation size, or concurrent functional procedures did not impact outcomes. Postoperative scores at short (2–4 months), intermediate (5–8 months), and long‐term (≥9 months) time periods showed significant improvement (all p < 0.001) compared to preoperative NOSE‐Perf scores.ConclusionSignificant reduction in nasal symptoms as measured by the NOSE‐Perf scale is noted following bilateral mucosal flap repair. Although the nose does not completely normalize following repair, clinically important improvement was noted in at least 91% of patients. The NOSE‐Perf scale is positioned to play a role in the standardization of septal perforation evaluation and outcomes assessment.Level of Evidence4 Laryngoscope, 134:3067–3072, 2024