Skip to main content
Log in

A CFD approach to understand nasoseptal perforations

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript



Nasoseptal perforations (NSP) are becoming common in the modern world, and can cause a wide variety of symptoms, including a sensation of nasal obstruction, epistaxis, crusting, dryness, headache, nasal pain and a whistling sound. There is an extensive range of surgical treatment techniques, but reported results were rarely statistically significant. The lack of consistent surgical results may be related to the lack of knowledge about the pathophysiology of NSP and how they affect the nasal flow. Computational fluid dynamics (CFD) has proved to be a very useful tool to study nasal function.


We have used CFD software (the program MECOMLAND® and the Digbody® tool for virtual surgery) to investigate the behaviour of the parameters R–\(\phi\) based on CFD results, when four subjects underwent virtual surgery to induce a septal perforation: two subjects with healthy noses and two patients suffering from nasal airway obstruction. For each case a CFD study was performed, before and after creating an anterior (close to nostrils) or a posterior (close to choanae) NSP.


In all cases analyzed, a posterior septal perforation did not result in a significant volumetric flow rate \({Q_{{\text{R}} \leftrightarrow {\text{L}}}}\) through the perforation between nasal passages. However, for anterior defects only in those nasal cavities considered diseased or unhealthy, high values of \({Q_{{\text{R}} \leftrightarrow {\text{L}}}}\) were found.


The induced NSP only rendered significant flow alterations in noses with preexisting nasal airway obstruction alterations, whereas in nasal cavities considered as normal the creation of a NSP did not produce significant differences between both sides. We strongly suggest that this finding can explain the variety of symptoms and the number of asymptomatic patients bearing NSP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Oberg D, Akerlund A, Johansson L, Bende M (2003) Prevalence of nasal septal perforation: the Skövde population-based study. Rhinology 41:72–75

    PubMed  Google Scholar 

  2. Gold M, Boyack I, Caputo N, Pearlman A (2017) Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging 43:80–82.

    Article  PubMed  Google Scholar 

  3. Passali D, Spinosi MC, Salerni L, Cassano M, Rodriguez H, Passali FM, Bellussi LM (2017) Surgical treatment of nasal septal perforations: SIR (Italian Society of Rhinology) experts opinion. Acta Otorrinolaringol Esp 68:191–196.

    Article  PubMed  Google Scholar 

  4. Bateman ND, Woolford TJ (2003) Informed consent for septal surgery: the evidence-base. J Laryngol Otol 117:186–189.

    Article  PubMed  CAS  Google Scholar 

  5. Hanci D, Altun H (2015) Repair of nasal septal perforation using middle turbinate flap (monopedicled superiory based bone included conchal flap): a new unilateral middle turbinate mucosal flap technique. Eur Arch Otorhinolaryngol 272:1707–1712.

    Article  PubMed  Google Scholar 

  6. Dinis PB, Haider H (2002) Septoplasty: long-term evaluation of results. Am J Otolaryngol 23:85–90

    Article  PubMed  Google Scholar 

  7. Hardcastle PF, White A, Prescott RJ (1988) Clinical and rhinometric assessment of the nasal airway—do they measure the same entity? Clin Otolaryngol Allied Sci 13:185–191

    Article  PubMed  CAS  Google Scholar 

  8. Hardcastle PF, White A, Prescott RJ (1988) Clinical or rhinometric assessment of the nasal airway—which is better? Clin Otolaryngol Allied Sci 13:381–385

    Article  PubMed  CAS  Google Scholar 

  9. Lam DJ, James KT, Weaver EM (2006) Comparison of anatomic, physiological, and subjective measures of the nasal airway. Am J Rhinol 20:463–470

    Article  PubMed  Google Scholar 

  10. Kjaergaard T, Cvancarova M, Steinsvåg SK (2008) Does nasal obstruction mean that the nose is obstructed? Laryngoscope 118:1476–1481.

    Article  PubMed  Google Scholar 

  11. André RF, Vuyk HD, Ahmed A, Graamans K, Nolst Trenité GJ (2009) Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 34:518–525.

    Article  PubMed  Google Scholar 

  12. Zhao K, Blacker K, Luo Y, Bryant B, Jiang J (2011) Perceiving nasal patency through mucosal cooling rather than air temperature or nasal resistance. PLoS One 6:e24618.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Martonen TB, Quan L, Zhang Z, Musante CJ (2002) Flow simulation in the human upper respiratory tract. Cell Biochem Biophys 37:27–36.

    Article  PubMed  CAS  Google Scholar 

  14. Grant O, Bailie N, Watterson J, Cole J, Gallagher G, Hanna B (2004) Numerical model of a nasal septal perforation. Stud Health Technol Inform 107:1352–1356

    PubMed  Google Scholar 

  15. Lee HP, Garlapati RR, Chong VFH, Wang DY (2010) Effects of septal perforation on nasal airflow: computer simulation study. J Laryngol Otol 124:48–54.

    Article  PubMed  CAS  Google Scholar 

  16. Faramarzi M, Baradaranfar MH, Abouali O, Atighechi S, Ahmadi G, Farhadi P, Keshavarzian E, Behniafard N, Baradaranfar A (2014) Numerical investigation of the flow field in realistic nasal septal perforation geometry. Allergy Rhinol (Providence) 5:e70–e77.

    Article  Google Scholar 

  17. Li L, Han D, Zhang L, Li Y, Zang H, Wang T, Liu Y (2016) Impact of nasal septal perforations of varying sizes and locations on the warming function of the nasal cavity: a computational fluid-dynamics analysis of 5 cases. Ear Nose Throat J 95:E9–E14

    PubMed  Google Scholar 

  18. Zhou B, Huang Q, Cui S, Liu Y, Han D (2013) Impact of airflow communication between nasal cavities on nasal ventilation. ORL J Otorhinolaryngol Relat Spec 75:301–308.

    Article  PubMed  Google Scholar 

  19. Cannon DE, Frank DO, Kimbell JS, Poetker DM, Rhee JS (2013) Modeling nasal physiology changes due to septal perforations. Otolaryngol Head Neck Surg 148:513–518.

    Article  PubMed  Google Scholar 

  20. Otto BA, Li C, Farag AA, Bush B, Krebs JP, Hutcheson RD, Kim K, Deshpande B, Zhao K (2017) Computational fluid dynamics evaluation of posterior septectomy as a viable treatment option for large septal perforations. Int Forum Allergy Rhinol 7:718–725.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Burgos MA, Sanmiguel-Rojas E, del Pino C, Sevilla-García MA, Esteban-Ortega F (2017) New CFD tools to evaluate nasal airflow. Eur Arch Otorhinolaryngol 274:3121–3128.

    Article  PubMed  CAS  Google Scholar 

  22. Burgos MA, Sanmiguel-Rojas E, Singh N, Esteban-Ortega F (2018) DigBody®: a new 3D modeling tool for nasal virtual surgery. Comput Biol Med 98:118–125.

    Article  PubMed  CAS  Google Scholar 

  23. Sanmiguel-Rojas E, Burgos MA, del Pino C, Sevilla-García MA, Esteban-Ortega F (2018) Robust nondimensional estimators to assess the nasal airflow in health and disease: mathematical estimators to assess nasal airflow. Int J Numer Methods in Biomed Eng 34:e2906.

    Article  Google Scholar 

  24. Burgos MA, Sanmiguel-Rojas E, Martín-Alcántara A, Hidalgo-Martínez M (2014) Effects of the ambient temperature on the airflow across a Caucasian nasal cavity. Int J Numer Methods Biomed Eng 30:430–445.

    Article  CAS  Google Scholar 

  25. ITK-Segmentation & registration toolkit.

  26. Taylor DJ, Doorly DJ, Schroter RC (2010) Inflow boundary profile prescription for numerical simulation of nasal airflow. J R Soc Interface 7(44):515–527.

    Article  PubMed  CAS  Google Scholar 

  27. Kim SK, Na Y, Kim J-I, Chung S-K (2013) Patient specific CFD models of nasal airflow: overview of methods and challenges. J Biomech 46:299–306.

    Article  PubMed  Google Scholar 

  28. Goh AY, Hussain SSM (2007) Different surgical treatments for nasal septal perforation and their outcomes. J Laryngol Otol 121:419–426.

    Article  PubMed  CAS  Google Scholar 

  29. Chen PG, Floreani S, Wormald P-J (2018) The utility of enlarging symptomatic nasal septal perforations. Ear Nose Throat J 97:E41–E43

    PubMed  Google Scholar 

  30. Bhattacharyya N (2007) Clinical symptomatology and paranasal sinus involvement with nasal septal perforation. Laryngoscope 117:691–694.

    Article  PubMed  Google Scholar 

  31. Leong SC, Webb CJ (2018) Sino-Nasal Outcome Test-22 quality-of-life patterns in patients presenting with nasal septal perforation. Clin Otolaryngol 43:604–608.

    Article  PubMed  CAS  Google Scholar 

  32. Alobid I, Langdon C, López-Chacon M, Enseñat J, Carrau R, Bernal-Sprekelsen M, Santamaría A (2018) Total septal perforation repair with a pericranial flap: Radio-anatomical and clinical findings. Laryngoscope 128:1320–1327.

    Article  PubMed  Google Scholar 

  33. Morera Serna E, Ferrán de la Cierva L, Fernández MT, Canut SQ, Mesquida JA, Purriños FJG (2017) Endoscopic closure of large septal perforations with bilateral Hadad-Bassagasteguy flaps. Eur Arch Otorhinolaryngol 274:1521–1525.

    Article  PubMed  Google Scholar 

Download references


The authors acknowledge the access to the patient database of the University Hospital Virgen del Rocío of Sevilla (Spain).


None reported.

Author information

Authors and Affiliations


Corresponding author

Correspondence to E. Sanmiguel-Rojas.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burgos, M.A., Sanmiguel-Rojas, E., Rodríguez, R. et al. A CFD approach to understand nasoseptal perforations. Eur Arch Otorhinolaryngol 275, 2265–2272 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: