Rhinosinusitis in granulomatosis with polyangiitis (GPA) is categorised as a secondary, diffuse and inflammatory chronic rhinosinusitis (CRS). It is one of the conditions that impacts the nasal microbiota. This study aimed to compare the nasal microbiomes of patients with GPA, CRS and NSP. A total of 31 patients were included in the study (18 GPA, 6 CRS and 7 nasal septum perforation (NSP)). In all patients, SNOT 22, a nasal endoscopy (Lund-Kennedy scale) and a brush swab were performed. The metagenomic analysis was carried out based on the hypervariable V3-V4 region of the 16S rRNA gene. At the genus level, statistically significant differences were observed in two comparisons: the GPA/NSP and the GPA/CRS groups. In the GPA/NSP group, the differences were related to four genera (Actinomyces, Streptococcus, Methylobacterium-Methylorubrum, Paracoccus), while in the GPA/CRS group, they were related to six (Kocuria, Rothia, Cutibacterium, Streptococcus, Methylobacterium-Methylorubrum, Tepidimonas). Patients with GPA had lower diversity compared to CRS and NSP patients. There were no statistically significant differences found for the Staphylococcus family and Staphylococcus aureus between the three groups.

OBJECTIVE: To describe and illustrate septal perforation shape through the documentation and analysis of length and height measurements. A secondary objective is to correlate perforation size to surgical and nonsurgical etiologies.
UNASSIGNED: Retrospective case series.
METHODS: Tertiary academic medical center.
METHODS: Length and height of consecutively treated perforations over a 3-year period were measured directly or through computed tomography. Mean differences in length and height measurements were compared and regression analysis used to determine perforation shape and the effect of etiology on perforation size. Perforations were classified by length into small (1-5 mm), medium (6-15 mm), and large (>15 mm) and correlated to shape and etiology.
RESULTS: One hundred twenty-four patients (mean age 50.4 years, 60.5% female) met study inclusion criteria. Height was less than length in 93% of perforations 5 mm or greater in length. Mean perforation height was significantly less than length for medium and large perforations (P < .001). Mean length and height measurements of nonsurgical perforations were greater than those for surgical perforations (P < .001).
CONCLUSIONS: Height is less than length in over 90% of septal perforations. Most perforations assume an elliptical shape as they enlarge. Accurate measurement and presentation of length and height is relevant information to perforation management decisions and for the evaluation of treatment outcomes.

OBJECTIVE: In the pediatric population, nasal septal perforations (NSP) are rare, and management is not well described. The use of various techniques has been reported in adults, including the use of interposition grafts, however this technique has not been described in the pediatric population. Our hypothesis is that the closure rate using absorbable d-lactide and l-lactide (each 50 %), polymer (PDLLA) plates as interposition grafts with temporalis fascia for NSP repair in the pediatric population will be an effective method compared to previous techniques.
METHODS: Chart review was performed on patients who underwent NSP repair before June 2021, results were compared to a prospective evaluation of an interposition plate graft for repair at a tertiary care children\'s hospital.
RESULTS: Fifteen patients via previous techniques and 5 patients via PDLLA and fascia graft were reviewed. Etiology of perforations included 45 % idiopathic, 25 % traumatic, and 15 % iatrogenic. In the previous techniques group, 10 were male, mean (median) age 14.4 years (15.2). Average size of NSP was 12.6 mm ± 6.6 mm (SD). 14/15 (93 %) patients had resolution of symptoms at 10-week follow-up, and 2/15 (13 %) required repeat repair. Five prospective patients were repaired with a PDLLA and fascia interposition graft, 4 were female, mean (median) age 14.6 years (Nassif and Scott, 2021 Feb 1) [14]. Average size of NSP was 11 mm ± 2.2 mm (SD). 100 % had resolution of symptoms at 10-week follow-up, 0 needed repeat surgery. No significant difference was found in size of NSP or in need for repeat procedure (p > 0.05) between the groups.
CONCLUSIONS: Use of absorbable PDLLA interposition grafts with temporalis fascia for NSP repair in the pediatric population is effective at closing and resolving symptoms associated with NSP.

UNASSIGNED: This case report presents a unique manifestation of Mucocutaneous Leishmaniasis (MCL) in a 56-year-old woman with chronic nasal symptoms. Initially diagnosed with chronic sinusitis and septal perforation, the patient\'s history of a childhood sandfly bite and subsequent episodes of Leishmaniasis, revealed after nasal surgery, provided crucial information for accurate diagnosis.
UNASSIGNED: A retrospective review was conducted on this patient\'s electronic medical record.
UNASSIGNED: The patient\'s life-long struggle with nasal obstruction, congestion, and a septal perforation initially masked the underlying MCL. Sinus surgery and persistent symptoms further complicated the diagnostic process. Only after postoperative complications, including grainy skin texture extending into the nasal passages, did the patient recall the sandfly bite, prompting reevaluation and diagnosis of MCL. The case highlights the challenges of diagnosing MCL due to its varied presentation and potential mimicry of other chronic nasal conditions. It emphasizes the importance of thorough patient history-taking, especially when symptoms are atypical or persistent. Additionally, the report underscores the potential for unexpected postoperative complications in MCL patients and the need for vigilance in recognizing and assessing them.
UNASSIGNED: This case contributes to the understanding of MCL\'s diverse clinical presentation and the importance of early diagnosis and multidisciplinary management for prompt intervention and improved outcomes.

OBJECTIVE: To perform the translation, cultural adaptation, and validation of the NOSE-Perf Scale to Brazilian Portuguese.
METHODS: This study was divided into two stages. In the first stage, the questionnaire was submitted for translation and cultural adaptation, following the guidelines recommended by the ISPOR Task Force (International Society for Pharmacoeconomics and Outcomes Research). Then, the Brazilian Portuguese version of the NOSE-Perf scale was applied to a group with septal perforation and a control group. The group with perforation answered the questionnaire again after one month. Internal consistency, test-retest reliability, and discriminant validity were assessed.
RESULTS: The Brazilian Portuguese version of the NOSE-Perf scale was applied to 32 participants, 16 from the group with septal perforations and 16 controls. The instrument obtained high internal consistency, with Cronbach\'s alpha scores of 0.986. High reliability was also obtained, with Spearman\'s correlation coefficient of 0.996 (p < 0.001) and the intraclass correlation coefficient of 0.965 with a 95% Confidence Interval (95% CI) of 0.886‒0.988. The NSP group obtained a mean total score of 13.8 ± 12.6 and the control group a score of 2.3 ± 1.8, with a statistical difference between the groups (p < 0.001), demonstrating good discriminant validity.
CONCLUSIONS: The Brazilian Portuguese version of the NOSE-Perf scale is a reliable and valid instrument for measuring symptoms in patients with nasal septum perforations.
METHODS: Level 2-Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.

Nasal septal perforation (NSP) is a complex problem in otorhinolaryngology, which leads to impaired nasal breathing and dryness in the nose. This reduces the patient\'s quality of life and leads to psychological discomfort. The treatment of nasal septum perforation is selected taking into account the clinical manifestations, perforation parameters and general condition of the patient. Currently, a large number of different surgical methods have been described in order to closing the defect of nasal septum. To date, there is no universally accepted method for closing NSP, which stimulates the search and development of new treatment options.
OBJECTIVE: Under experimental conditions, to study a new method for closing nasal septum perforation using a collagen scaffold together with adipose stromal vascular fraction containing multipotent mesenchymal stromal cells.
METHODS: The experiment was carried out on a model of nasal septum perforation in 24 male rabbits divided into four groups, depending on the construct, implanted into the defect zone: the 1st group was the control group - without the introduction of implantation material; the 2nd group - collagen scaffold without adipose stromal vascular fraction; the 3rd group - collagen scaffold with xenogenic adipose stromal vascular fraction; the 4th group - collagen scaffold with allogeneic adipose stromal vascular fraction with further dynamic evaluation of endoscopic control on day 14, after 1 month, 3 months, and 6 months. At month 6, the animals were removed from the experiment, followed by morphological examination in color with hematoxylin and eosin, as well as safranin and methyl green.
RESULTS: As a result of the experiment using adipose stromal vascular fraction of allogeneic and xenogenic origin, closing of perforation of the nasal septum of a rabbit for 3 months of dynamic endoscopic control, as well as according to morphological research, was demonstrated.
CONCLUSIONS: Our study showed that the use of adipose stromal vascular fraction containing not only endothelial cells and pericytes, but also multipotent mesenchymal stromal cells in combination with a collagen scaffold closes the perforation of the nasal septum in a rabbit, without increasing the risk of violations of habitual vital activity.
Перфорация перегородки носа (ППН) приводит к нарушению функции носового дыхания и сухости в носу. Это снижает качество жизни пациента и ведет к психологическому дискомфорту. Лечение при перфорации носовой перегородки осуществляется с учетом клинических проявлений, параметров перфорации и общего состояния пациента. В настоящее время описано большое количество разнообразных хирургических методов с целью восстановления перегородки носа. Вместе с тем отсутствует универсальная методика закрытия ППН, что стимулирует поиск и разработку новых вариантов лечения.
UNASSIGNED: В условиях эксперимента изучить новый метод закрытия перфорации перегородки носа с применением коллагенового скаффолда совместно со стромально-васкулярной фракцией жировой ткани, содержащей мультипотентные мезенхимальные стромальные клетки.
UNASSIGNED: Эксперимент проводился на модели перфорации перегородки носа у 24 самцов кролика. Все животные разделены на четыре группы в зависимости от конструкта, имплантированного в зону дефекта: 1-я группа (контрольная) — без введения имплантационного материала; животным 2-й группы вводили коллагеновый скаффолд без стромально-васкулярной фракции жировой ткани; животным 3-й группы вводили коллагеновый скаффолд с ксеногенной стромально-васкулярной фракцией жировой ткани; животным 4-й группы вводили коллагеновый скаффолд с аллогенной стромально-васкулярной фракцией жировой ткани. На 14-е сутки, через 1 мес, 3 мес и 6 мес выполняли эндоскопический контроль. На 6-й месяц животных выводили из эксперимента с последующим морфологическим исследованием.
UNASSIGNED: В результате проведенного эксперимента с применением стромально-васкулярной фракции жировой ткани аллогенного и ксеногенного происхождения продемонстрировано закрытие перфорации перегородки носа кролика на 3-й месяц по данным динамического эндоскопического контроля и морфологического исследования.
UNASSIGNED: Наше исследование показало, что использование стромально-васкулярной фракции, содержащей в себе не только эндотелиальные клетки и перициты, но и мультипотентные мезенхимальные стромальные клетки в комплексе с коллагеновым скаффолдом, способствует закрытию перфорации перегородки носа у кролика и при этом не нарушает его привычную жизнедеятельность.

BACKGROUND: Surgical closure of large nasoseptal perforation (NSP) is challenging. The use of an extended anterior ethmoidal artery (eAEA) flap to reconstruct NSP may present with difficulties for NSPs which have their upper edge in a high position.
METHODS: We propose adding a \"donut-shape\" flap from surrounding septal tissue to the eAEA flap. Thus, the inverted edges of this flap allow to cover the uppermost aspect of the NSP. A series of 18 patients with complete closure of NSPs was included.
CONCLUSIONS: This novel \"Boot-on-Donut\" technique consisting of the eAEA flap (Boot) and inverted edges (Donut) is a feasible procedure that allows to reconstruct large NSP located superiorly.

Nasal septum perforation (NSP) occurs secondary to many underlying etiologies, including facial trauma, drug use, malignancy, infection, or autoimmune disease. We present the case of a 39-year-old female with a past medical history of cocaine use disorder who presented with symptoms concerning facial cellulitis unresponsive to antibiotic therapy. Physical exam and subsequent imaging revealed the presence of NSP. The patient underwent a full workup exploring potential etiologies of NSP in the setting of cocaine use disorder, with lab results indicating Pseudomonas aeruginosa and Pseudomonas putida cellulitis as well as a positive perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) assay. This case highlights the importance of maintaining a broad differential diagnosis for the etiology of NSP and avoiding anchoring bias.

OBJECTIVE: High success rates (SR) for surgical septal perforation repair (SPR) of over 90 % are reported in the literature. We think that realistic SR are significantly lower and wanted to confirm this thesis with the help of a survey among ear, nose, throat ENT specialists from Germany. Surgical trends were also queried.
METHODS: An anonymous online survey among ENT specialists in Germany was conducted. 356 doctors participated. The collected SR were statistically evaluated, and the operative trends were analysed. It applies a significance level α = 0.05. The SR were collected for 3 different size categories (<1 cm, 1-2 cm, >2 cm).
RESULTS: The SR for SPR <1 cm (median 79 %) was higher than that for 1-2 cm (60 %) and >2 cm (40 %). Surgeons estimated SR significantly higher (90 %, 75 %, 50 %; p-value <0.001 each) than non-surgeons (80 %, 50 %, 25 %). Hospital-based physicians (90 %, 70 %, 50 %) reported significantly higher SR than ambulatory physicians (80 %, 50 %, 30 %, p-value <0.001 each). No linear relationship was found between the total number of SPR performed and SR (r <1cm = 0.16, r1-2cm = 0.18, r >2cm = 0.19). Most SPR were performed with the bridge flap technique (73 %), a closed surgical approach (85 %), an interposition graft (74 %) and postoperative splinting (94 %).
CONCLUSIONS: The subjective SR suggest that the SR of SPR is lower than described in the literature. This may be due to short follow-up times, small patient populations and a retrospective design of existing studies. The variety of surgical possibilities confirms the complexity of SPR. Optimising the design of future studies could help to collect realistic SR.
UNASSIGNED: In der Literatur beschriebene Erfolgsquoten (EQ) operativer Septumperforationsverschlüsse (SPV) von über 90 % erscheinen aufgrund der Komplexität des SPV zu hoch. Ziel der Befragung war die Erhebung subjektiver EQ sowie aktueller operativer Trends unter deutschen HNO-Ärzten.
METHODS: Eine anonyme Online-Befragung wurde unter deutschen HNO-Fachärzten durchgeführt. 356 Ärzte nahmen teil. Die erhobenen EQ wurden statistisch ausgewertet und die operativen Trends analysiert. Es gilt ein Signifikanzniveau α = 0,05. Die EQ wurden für 3 verschiedene Größenkategorien erhoben (<1 cm, 1–2 cm, >2 cm).
UNASSIGNED: Die EQ für SPV <1 cm (Median 79%) war höher als die für 1–2 cm (60%) und >2 cm (40%). Operierende Ärzte schätzten die EQ signifikant höher ein (90%, 75%, 50%; p-Wert je <0,001) als Nicht-Operierende (80%, 50%, 25%). Krankenhausärzte (90%, 70%, 50%) gaben signifikant höhere EQ als ambulante Ärzte an (80%, 50%, 30%, p-Wert je <0,001). Es wurde kein linearer Zusammenhang zwischen der Gesamtzahl durchgeführter SPV und den EQ festgestellt (r <1cm=0,16, r1–2cm=0,18, r >2cm=0,19). Die meisten SPV wurden mit der Brückenklappentechnik (73%), einem geschlossenen Zugangsweg (85%), einem Interponat (74%) und postoperativer Schienung (94%) durchgeführt.
UNASSIGNED: Die subjektiven EQ legen nahe, dass diese in der Realität niedriger einzuschätzen sind als in der Literatur. Dies kann an kurzen Follow-up-Zeiten, kleinen Patientenkollektiven und dem retrospektiven Design bestehender Studien liegen. Die Vielzahl operativer Möglichkeiten bestätigt die Komplexität des SPV. Eine Optimierung des Designs zukünftiger Studien könnte helfen, realistische EQ zu erheben.

OBJECTIVE: Septal perforation (SP) cause heterogeneous symptoms depending on the anatomical location, highlighting scabs, nasal obstruction and/or epistaxis. The use of questionnaires to determine the quality of life in different pathologies is increasing in sinonasal pathologies and in patients with SP the NOSE-Perf questionnaire was constructed, currently validated in English. The aim of this study is the translation, cross-cultural adaptation, and validation of the NOSE-Perf questionnaire into Spanish.
METHODS: Prospective single-centre study of 81 patients (38 with SP and 43 controls), visited in the rhinology section of a tertiary hospital. Adaptation and translation NOSE-Perf into Spanish and validation using the NOSE and NOSE-Perf questionnaire in Spanish.
RESULTS: Significant differences were found in the mean NOSE-Perf score and in the mean NOSE score (IC95% = 21.2-26.9; p < 0.001 and IC95% = 53.8-70.5; p < 0.001) between SP group and control group. Pearson\'s correlation between the two questionnaires NOSE-Perf and NOSE in the SP group was 0.74 (95% CI = 0.56-0.86; p < 0.001). In the control group it was r = 0.85 (95%CI = 0.73-0.91; p < 0.001). Cronbach\'s alpha coefficient of the NOSE-Perf was 0.95 (IC 95% = 0.93-0.96) for internal consistency. The reliability evaluation was carried out by test-retest, and a strong Pearson correlation was obtained between the questionnaires r = 0.94 (CI95% = 0.85-0.97; p < 0.001) and r = 0.89 (95%CI = 0.77-0.95; p < 0.001).
CONCLUSIONS: The Spanish version of the NOSE-Perf is as reliable and valid as the English version, which makes it possible to assess the impact on quality of life that it causes in patients with perforations in the Spanish-speaking population.