Beyond structural defect: quality of life impact of nasal septal perforation in adults - a scoping review of validated patient-reported outcome measures.

BACKGROUND

Nasal septal perforation (NSP) is a structural defect of the nasal septum that can lead to significant symptoms and functional impairment. Although airflow dynamics and mucosal disruption have been proposed to explain symptom burden, the impact of NSP on patient quality of life (QoL) has not been systematically synthesized. The aim of this work is to systematically review the literature evaluating QoL outcomes in adults with NSP using validated patient-reported outcome measures.

METHODS

This review followed PRISMA-ScR guidelines. Searches were conducted in PubMed and Web of Science without date restrictions (latest update: October 2025). Eligible studies included adults with symptomatic NSP in whom QoL outcomes were reported using validated questionnaires. Two independent reviewers screened studies and extracted data.

RESULTS

From 686 records, 33 studies met inclusion criteria involving 1638 patients. Study designs were primarily case series (n=21) and cross-sectional studies (n=7), with sample sizes ranging from 6-202 patients. SNOT-22 scores across studies indicated moderate-to-severe QoL impairment (range 38.6-53.7). NOSE scores ranged from 39.0-80.0, while NOSE-Perf scores ranged from 13.8-26.4. Limited studies reported generic QoL outcomes (SF-36) or NSP-specific tools (SEPEQoL), but all reflected significant functional impact. Aetiology was most commonly postsurgical, and anterior perforations predominated. Studies reporting surgical outcomes consistently suggested substantial postoperative improvements across QoL instruments.

DISCUSSION: NSP is associated with clinically meaningful QoL impairment, particularly in rhinologic, sleep and psychological domains. Despite growing interest, evidence remains heterogeneous and limited by variable reporting of perforation characteristics and inconsistent use of QoL instruments. Standardized assessment and dedicated NSP-specific outcome measures are needed. Future research should focus on prospective, multicentred studies evaluating both symptom burden and long-term treatment outcomes.