Self-Induced Nasal Septal Perforation: Rhinotillexomania-A Different Entity From Nose Picking.

Abstract

Background: Nose picking is a common habit that rarely leads to mutilating self-injury. It is important to distinguish between rhinotillexomania (compulsive nose picking) as a disease and nose picking that results in or contributes to nasal septal perforation (NSP). The aim of this study is to investigate the impact of rhinotillexomania and NSP repair on sinonasal symptoms and quality of life (QoL).

Methodology/principal: Patients with symptomatic NSP due to rhinotillexomania and candidates for surgical repair were included. Sinonasal symptoms and QoL were measured using a visual analogue scale (VAS), Sinus CT scan, Barcelona Smell Test 24 (BAST-24), Sinonasal outcome test (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE), NOSE-Perf, and Medical Outcome Study Short Form (SF-36). Healthy volunteers without sinonasal disorders (n = 43) were also included.

Results: A total of 37 patients with Rhinotillexomania (20 male [54.1%]; mean age, 49.2 years [SD 15.4]) were recruited. Totally 32 patients (86.5%) had NSP with the posterior border anterior to the incisive canal. Follow-up data were registered for 29 patients with a mean follow-up duration of 22.1 months (standard deviation, SD 16.7). The overall success rate of NSP repair was 96.6%. Patients experienced significant improvement in sinonasal symptoms and QoL after surgery.

Conclusions: Rhinotillexomania is a distinct entity from nose picking. Multidisciplinary approach including behavior therapy and NSP repair are considered the best approaches to relieve sinonasal symptoms. Placing nasal silicone sheets is recommended when the diagnosis of rhinotillexomania is confirmed. The greater palatine artery flap combined with inverted edges appears to be the most effective approach.

Level of evidence: Level 3 Laryngoscope, 2024.