Empty nose syndrome: etiopathogenesis and management

Magdy Eisa Saafan,Hassan Moustafa Hegazy,Osama A Albirmawy

doi:10.4103/1012-5574.186540

Magdy Eisa Saafan, Hassan Moustafa Hegazy + Show 1 more

Open Access

https://doi.org/10.4103/1012-5574.186540

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Abstract

Empty nose syndrome (ENS) is an iatrogenic disorder most often recognized by the presence of paradoxical nasal obstruction despite an objectively wide patent nasal cavity. It occurs after inferior and/or middle turbinate resection; however, individuals with normal turbinates and intranasal volume may also complain of ENS. Its pathophysiology remains unclear, but it is probably caused by wide nasal cavities affecting the neurosensitive receptors and inhaled air humidification. Neuropsychological involvement is also suspected. Not every patient undergoing radical turbinate resection experiences the symptoms of ENS. ENS can affect the normal breathing function of the nasal cavity, with subsequent deterioration in patients’ quality of life. The diagnosis is made on the basis of the patients’ history, endoscopic examination of the nasal cavity, imaging (computed tomography imaging and functional MRI), and rhinomanometry. Prevention is the most important strategy; thus, the inferior and middle turbinate should not be resected without adequate justification. Management is problematic including nasal cavity hygiene and humidification, with surgery reserved for the most severe cases. The surgery aims at partial filling of the nasal cavity using different techniques and implant materials. In this paper, we review both the etiology and the clinical presentation of ENS, and its conservative and surgical management. Empty nose syndrome (ENS) is encountered after inferior and/or middle turbinate resection; however, it can occur in patients with seemingly normal turbinates. Rhinologists should avoid routine resection of the inferior and middle turbinates. It is not certain why some patients develop ENS, whereas others do not. The frequent association with psychiatric disorders and possibly psychosomatic pathologies indicate the possible role of psychological stress in some patients. Its diagnosis relies on clinical suspicion and physical examination. Nasal augmentation surgery can improve the quality of life of patients by restoring nasal anatomy toward the premorbid state.

Highlights

The descriptive term ‘empty nose syndrome (ENS)’ was originally coined in 1994 by Kern and Stenkvist to describe empty space in the region of the inferior and middle turbinates on coronal computed tomographic images of the patients [1]
One point of concern is the frequent association with psychiatric disorders and psychosomatic pathologies, for example, fibromyalgia and functional colopathy, in addition to the possible role of psychological stress and neurological component in certain patients [5,6,7]
Retrospective case series for comparison between costal and conchal cartilage implants to construct neoturbinates under general anesthesia Submucosal injections of hyaluronic acid preparations into the inferior nasal concha and under the mucous membrane of the septum under local anesthesia as an officebased procedure. They reported that total scores of the SNOT-25 decreased postoperatively, showing a significant difference at 3, 6, and 12 months after surgery compared with their initial visit, which indicates that the quality of life in patients with empty nose syndrome (ENS) was considerably improved The SNOT-25 scores showed that both groups experienced a significant improvement after surgery, and there was no statistical evidence for a significant difference between the two groups

Summary

Introduction

The descriptive term ‘empty nose syndrome (ENS)’ was originally coined in 1994 by Kern and Stenkvist to describe empty space in the region of the inferior and middle turbinates on coronal computed tomographic images of the patients [1]. With reduced mucosal surface area and a lack of physiologic turbulent airflow in ENS patients, the nasal mucosa cannot carry out its primary functions of air conditioning and cleansing. (4) air entering the nose in ENS patients fails to stimulate the cool thermoreceptors in the nasal mucosa, it still activates pulmonary stretch receptors, signaling the brain that adequate ventilation is occurring [2]. This conflicting message may explain the distress associated with breathing in ENS patients.

Results

Conclusion

Conflicts of interest