Empty nose syndrome

Abstract

Empty nose syndrome (ENS) is an iatrogenic condition that results from traumatic injury, often overresection, of the turbinates during sinonasal surgery. The underlying etiology is not entirely understood but is thought to have multifactorial contributions including alterations in the native nasal airway anatomy, abnormal mucosal and neural healing, and decreased trigeminal sensitivity, among other possibilities and contributors. Patients typically present with an intense fixation on their sensations of nasal obstruction and congestion despite an anatomically patent airway on examination. Because many patients with ENS have been shown to have significant psychiatric comorbidities, multidisciplinary specialist care including psychiatry and pain services is essential. Diagnosis is often difficult due to the variability of presentation and severity of symptoms, but standard assessments exist including the empty nose syndrome 6-item questionnaire (ENS6Q) and cotton test. Patients can be initially managed with conservative measures through humidification, moisturization, and psychiatric testing/referral. Procedural approaches to improve the nasal airway include submucosal implantation of temporary, semi-permanent, and permanent materials. A realistic and empathetic approach to patient communication is necessary in order to help manage patients with ENS, and all plastic surgeons performing septorhinoplasty should be aware of the risk and treatment options of the disease.