Chapter 2 - The scope of the empty nose syndrome (ENS)

Abstract

This chapter presents the scope of the empty nose syndrome (ENS). The term “empty nose syndrome” was coined by the Mayo Clinic team (Stenkvist and Kern) in 1994 when Dr. Monika Stenkvist, visiting surgeon and scientist, observed the noticeably and conspicuously empty nasal cavities on computerized tomography scans of patients missing almost all identifiable inferior and middle turbinate mucosal structures secondary to surgical resection of the turbinates followed by a multiple symptom complex arising months to years after their initial surgery (performed at sites other than Mayo Clinic). By definition, ENS is primarily an iatrogenic condition, a secondary atrophic rhinitis, secondary to turbinate trauma, in which a surgical resection removes various amounts of functioning nasal turbinate mucosal and submucosal (lamina propria, stroma) tissue. All of the various fluctuating symptoms seen in ENS are considered along with differentiating between primary and secondary atrophic rhinitis. The differential diagnosis of nasal atrophy and the diagnostic workup of these patients is presented. The history of surgical and nonsurgical turbinate reduction procedures is presented. Today, some authors consider ENS as a legitimate “physiologic disease entity” as do we.