Helping Shape International Standards in Nasal Septal Perforation Care

Mr Rohit Gohil, specialist nose and sinus surgeon in Edinburgh, has contributed to a major new International Consensus Statement on Nasal Septal Perforation, bringing together expert opinion from leading rhinologists around the world.

Published in the specialist journal Rhinology in September 2026, the International Consensus Statement on Nasal Septal Perforation was developed to address an important problem: despite the significant symptoms a septal perforation can cause, there has historically been considerable variation in how these patients are assessed and treated.

Mr Gohil was one of 25 expert panellists from 15 countries across four continents invited to contribute to the international consensus process. The panel considered virtually every aspect of septal perforation care, from diagnosis and investigation through to medical treatment, surgery, aftercare and assessment of patient quality of life.

For patients seeking septal perforation treatment in Edinburgh, Scotland or elsewhere in the UK, this work reflects Mr Gohil's particular specialist interest and expertise in this challenging area of nasal surgery.

What Is a Nasal Septal Perforation?

The nasal septum is the wall dividing the two sides of the nose. A septal perforation occurs when a hole develops through this wall.

Some perforations cause remarkably few problems. Others can produce troublesome symptoms including nasal crusting, recurrent nosebleeds, whistling when breathing, dryness, discomfort and a sensation of nasal obstruction. In more complex cases, the structural support of the nose may also be affected.

There are many potential causes. A perforation may occur following previous nasal surgery or trauma, but inflammatory disease, infection and other causes also need to be considered.

This is one reason why simply identifying a hole in the septum is not enough. Understanding why it developed, how large it is, where it is situated and—crucially—how much it is affecting the patient is fundamental to deciding what should happen next.

Why Was an International Consensus Needed?

Septal perforation is an unusual and highly specialised area of rhinology. Historically, surgeons around the world have differed in how perforations are measured, classified, investigated and treated.

The new consensus statement was designed to bring greater consistency to this process.

Using a structured three-round Delphi process, the international panel considered statements covering eight areas of septal perforation management. These included assessment, causes, position and dimensions of the perforation, non-surgical treatment, surgical treatment, follow-up, outcomes and quality of life.

A consensus was ultimately achieved on 98.2% of the proposed statements, producing 56 areas of agreement.

The result is a framework intended to help clinicians around the world make more consistent, evidence-informed decisions for patients with nasal septal perforations.

Expertise Means More Than Performing an Operation

Septal perforation surgery can be technically demanding, but expertise in this condition is about much more than knowing how to close a hole.

The first question should always be: does this perforation actually need an operation?

For some patients, symptoms can be controlled effectively with moisturisation, saline treatment and careful nasal care. Others may require investigation for an underlying cause before any surgical treatment should even be contemplated.

For patients with significant symptoms, however, septal perforation repair may be appropriate.

Successful treatment requires careful assessment of the size and location of the perforation, the health of the remaining nasal lining, previous surgery, the underlying cause and the remaining structural support of the nose. The new international consensus specifically emphasises this structured approach.

Importantly, success should not simply be thought of as "closing the hole". What ultimately matters is whether treatment improves the patient's symptoms and quality of life.

Complex Septal Perforation Surgery in Edinburgh

When surgery is appropriate, repairing a nasal septal perforation can require some of the most advanced techniques used in modern nasal surgery.

Healthy tissue needs to be carefully mobilised to reconstruct the lining of the septum while preserving its blood supply. Depending on the individual circumstances, different reconstructive techniques may be required, particularly for large septal perforations or revision cases following previous unsuccessful surgery.

This is where Mr Gohil's wider experience as a specialist rhinologist, rhinoplasty and nasal reconstructive surgeon is particularly valuable.

A septal perforation does not exist independently of the rest of the nose. Nasal airflow, septal support, previous operations, external nasal shape and the availability of healthy tissue may all influence the treatment plan.

The aim is therefore not simply technical closure, but to achieve a comfortable, functional and structurally stable nose.

Bringing International Expertise Back to Patient Care

Academic work matters most when it translates into better care for patients.

Contributing to an international consensus means discussing evidence and clinical experience with colleagues who have substantial expertise in the same condition. It requires questioning established practice, considering alternative approaches and agreeing which principles should underpin high-quality care.

For Mr Rohit Gohil, involvement in this work complements his clinical practice as a specialist nose and sinus surgeon in Edinburgh and his wider commitment to research, surgical education and training.

It also means that the approach taken with patients suffering from septal perforation is informed not simply by individual experience, but by active involvement in developing the international standards that are intended to guide the specialty.

Specialist Nasal Septal Perforation Assessment in Edinburgh

If you have been diagnosed with a nasal septal perforation, have persistent symptoms such as crusting or nosebleeds, or have previously undergone unsuccessful septal perforation surgery, a specialist assessment can help establish what options are realistically available.

Not every perforation needs surgery, and not every perforation should be treated in the same way.

Mr Gohil's approach is to understand the cause of the perforation, the anatomy of the nose, the severity of the symptoms and the priorities of the individual patient before recommending treatment.

His contribution to the new International Consensus Statement on Nasal Septal Perforation reflects a wider commitment to ensuring that patients in Edinburgh and beyond receive thoughtful, evidence-based and highly specialised care for this complex condition.

Read the publication: International Consensus Statement on Nasal Septal Perforation, published in Rhinology, 2026.