International Rhinologic Society Rhinology 0300-0729 2026 09 06 International consensus statement on nasal septal perforation EN I. AlobidRhinology and Skull Base Surgery Unit, ENT Department, Hospital Clinic, IDIBAPS, CIBERES, Universitat de Barcelona, Spain Centro Médico Teknon. Barcelona, Spain O. Garaycochea Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain M.J. Rojas-Lechuga Rhinology and Skull Base Surgery Unit, ENT Department, Hospital Clinic, IDIBAPS, CIBERES, Universitat de Barcelona, Spain S. Bansberg Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA P. Castelnuovo Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy J.R. Craig Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, MI, USA S. Delaney Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch in Galveston, Texas, USA D. Hanci Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey Y.J. Jang Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Y. Rusetsky Department of Otorhinolaryngology, Central State Medical Academy, Moscow, Russia A. Alqahtani Department of Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia S. Alsaleh Security Forces Hospitals Program, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia J.D. Bedoya Department of Otolaryngology, Universidad de Antioquia, Medellin, Colombia C. Callejas Department of Otolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, South Australia, Australia J.C. Ceballos Department of Otolaryngology, Centro Médico ABC, Ciudad de México, México A. Cordero Centro Otorrino, Ciudad de Guatemala, Guatemala S. Gode Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey R. Gohil Department of Otorhinolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK F. Mariño-Sánchez Rhinology and Skull Base Surgery Unit. Otolaryngology Department. Ramon y Cajal University Hospital. Madrid, Spain A. Obando Department of Otorhinolaryngology, Hospital México, San José, Costa Rica P. Pegoraro Instituto Superior de Otorrinolaringología y Fonoaudiologia, Córdoba, Argentina A.J. Psaltis Department of Otolaryngology Head and Neck Surgery, Adelaide University and Central Adelaide Health Network, Adelaide, Australia M. Tepedino Skull Base and Rhinology Department, Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil R. HarveyRhinology and Skull Base research group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia Faculty of Medicine and Health Science, Macquarie University, Sydney, Australia C. Hopkins Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK Journal Article 3510 10.4193/Rhin26.027 BACKGROUND: Nasal septal perforation (NSP) is a multifactorial condition characterised by a full-thickness defect in the nasal septum, with clinical presentation ranging from asymptomatic cases to significant nasal obstruction, crusting, epistaxis, and impaired quality of life. A major challenge in NSP management is the absence of standardised diagnostic and therapeutic protocols, contributing to inconsistent outcomes. This study aimed to develop an international consensus on the assessment, classification, and management of NSP to standardise linical decision-making and improve patient care. METHODOLOGY: A modified Delphi process was conducted over three iterative rounds involving 25 panellists from 15 countries across four continents. Structured questionnaires addressing NSP diagnosis and management were developed, distributed, and refined. Statements covered eight categories: assessment; physiopathology and causes; position; dimensions; non-surgical treatment; surgical treatment, follow-up and results; and quality of life. Consensus was defined as ≥70% agreement, with no more than 10% disagreement. RESULTS: Consensus was reached for 98.2% of the proposed statements. Fifty-six agreements included validated symptom assessment tools, imaging protocols, classification systems based on size and location, preferred medical and surgical treatments, perioperative care standards, and outcome evaluation methods. Areas without full consensus included the clinical relevance of superior-inferior perforation location, prognostic significance of mucosal oedema, the optimal abstinence period from intranasal drug use, and the necessity of early postoperative debridement. CONCLUSIONS: These expert consensus statements emphasise validated assessment tools, structured classification systems, and treatment approaches, providing a comprehensive framework to unify NSP management, guide future research, and improve patient outcomes.