Distinguishing computed tomography findings in patients with empty nose syndrome

This study, conducted by Andrew Thamboo and colleagues, addresses the challenge of diagnosing Empty Nose Syndrome (ENS), a controversial condition often arising after nasal surgeries such as inferior turbinate reduction (ITR). ENS is characterized by a range of debilitating symptoms, including a paradoxical sensation of nasal obstruction despite a clear nasal passage, dryness, pain, and even psychological distress. However, due to the lack of standardized diagnostic criteria, identifying ENS has been challenging for clinicians.

The researchers aimed to determine whether specific radiographic features, particularly those visible on computed tomography (CT) scans, could be used to objectively differentiate ENS patients from those who had undergone ITR but did not develop ENS, as well as from healthy individuals with no history of sinonasal procedures. The study involved analyzing CT scans from three groups: 65 patients diagnosed with ENS, patients with a history of ITR without ENS symptoms, and control patients with no sinonasal disease history.

Key measurements were taken at the level of the nasolacrimal duct, including the thickness of the mucosa in the nasal septum, inferior turbinate, nasal floor, and lateral nasal wall, across different segments of the nasal cavity (anterior, central, and posterior). The study found that the mucosal thickness in the central and posterior segments of the septum was significantly greater in ENS patients compared to both ITR without ENS patients and controls. Specifically, a septal mucosal thickness greater than 2.64 mm in the central nasal region and greater than 1.32 mm in the posterior nasal region were identified as potential markers for ENS, offering high sensitivity and specificity.

The findings support the notion that ENS is a distinct pathophysiological entity with measurable differences in nasal mucosa that can be identified through CT imaging. The study also suggested that the nasal septum, particularly in the central and posterior regions, exhibits dynamic hypertrophy in ENS patients, potentially contributing to their symptoms.

However, the study acknowledges limitations, including the retrospective design and the small sample size, particularly in the ENS group. Moreover, the role of excessive nasal hygiene practices in contributing to mucosal swelling in ENS patients was speculated but not proven. Despite these limitations, the study provides valuable insights into the potential for developing objective diagnostic criteria for ENS, which could greatly benefit patients suffering from this underrecognized condition.

The study did discuss Empty Nose Syndrome (ENS) extensively, highlighting the difficulties in diagnosing the condition and the need for objective criteria. The conclusions emphasize that specific CT findings, particularly related to mucosal thickness in the central and posterior nasal septum, could serve as important diagnostic markers for ENS. This could lead to better recognition and management of the condition, offering hope for patients who suffer from its often debilitating symptoms.