Nasal septal perforation impairs olfaction and trigeminal function
Reviewed by Richard (Wei Chern) Gan

This is a cross-sectional study of patients with symptomatic nasal septal perforation (NSP) and a control group evaluated at Centro Médico Teknon and Hospital Clinic, Barcelona, Spain, from January 2017 to April 2024. Patients were above 18 years old. Patients with NSP from inflammatory or infectious causes and those with conditions that could alter olfaction, such as chronic rhinosinusitis, head injury, head and neck radiotherapy and neurodegenerative conditions, were excluded. NSP dimensions were measured via nasal endoscopy and CT scan. The most common cause of NSP in the study group was intranasal cocaine use followed by postsurgical causes. Mean perforation length was 21.5 mm, mean height 15.4 mm and mean total area 300.9 mm2; 41.5% anterior and 58.5% posterior. Mean VAS score for loss of sense of smell in the NSP group was 3.6, indicating moderate severity (3.6 in NSP vs. 0.1 in control). NSP patients scored significantly higher in specific smell-related items in questionnaires SNOT-22, NOSE-Perf item 10 and NOSE-Perf item 11. For olfactory testing using BAST-24, there was impairment in 26 patients (21.1%) for detection, 26 (21.1%) for memory and 85 (69.1%) for identification, significantly different from the control group. As for trigeminal sensitivity, 36 patients (29.3%) had impairment in detection, 66 (53.7%) in memory and 55 (44.7%) in identification, significantly worse compared to the control group. There were lower BAST-24 identification scores associated with higher perforation size and higher BMI. There was no significant difference in BAST-24 scores when comparing perforations involving olfactory epithelium and those not. This study highlights the olfactory impact of nasal septal perforations and also the correlation between its size and degree of impairment. – RWG

Nasal septal perforation has a negative impact on olfactory and trigeminal function.
Yuen-Ato K, Rojas-Lechuga MJ, Izquierdo-Domínguez A, et al.
RHINOLOGY
2026;64(4):521–30.