What drives depression in empty nose syndrome? A Sinonasal Outcome Test-25 subdomain analysis

The study titled "What Drives Depression in Empty Nose Syndrome? A Sinonasal Outcome Test-25 Subdomain Analysis" investigates the relationship between disease-specific quality of life impairments and the severity of anxiety and depression in patients with Empty Nose Syndrome (ENS). The primary goal of the research was to determine how various aspects of ENS impact psychological distress and to evaluate how these associations change following surgical intervention.

Study Design and Methods

The study included 68 patients diagnosed with ENS, a condition characterized by paradoxical nasal obstruction following excessive surgical removal of nasal tissues. To address ENS symptoms, patients underwent submucosal Medpor implantation, a surgical procedure aimed at improving nasal airflow and function. The impact of ENS on patients' quality of life and psychological status was assessed using the Sinonasal Outcome Test-25 (SNOT-25), the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI). Evaluations were conducted one day before surgery and again six months after the procedure.

Results

The study found significant correlations between the severity of anxiety and depression (as measured by BDI-II and BAI scores) and various domains of the SNOT-25, which includes measures of total score, ear/facial symptoms, psychological dysfunction, sleep dysfunction, and empty nose symptoms. Improvements in ENS symptoms were associated with reductions in depression and anxiety. Notably, changes in BDI-II scores post-operatively were correlated with improvements in the SNOT-25’s total score, as well as in the sleep dysfunction and empty nose symptoms domains.

Furthermore, the study identified specific SNOT-25 scores as predictors of moderate-to-severe depression. Scores exceeding 60 on the total SNOT-25, above 18 in the sleep dysfunction domain, and greater than 14 in the empty nose symptoms domain were strong indicators of significant depressive symptoms.

Conclusions

The findings indicate that ENS symptoms significantly affect psychological well-being, and specific quality of life impairments can predict moderate-to-severe depression. The study highlights the importance of addressing both physical and psychological aspects of ENS. Improvements in ENS symptoms, particularly related to sleep dysfunction and empty nose symptoms, were associated with reductions in depression and anxiety. This suggests that targeted management of these symptoms could substantially reduce the psychological burden experienced by ENS patients.

In summary, the research provides important insights into the relationship between ENS and mental health, demonstrating that effective treatment of ENS symptoms can lead to significant improvements in psychological outcomes. The study underscores the need for comprehensive treatment approaches that address both the physical and psychological dimensions of ENS to enhance overall patient well-being.

IMPACT OF SLEEP DYSFUNCTION ON PSYCHOLOGICAL BURDEN IN PATIENTS WITH EMPTY NOSE SYNDROME

The study titled "Impact of Sleep Dysfunction on Psychological Burden in Patients with Empty Nose Syndrome" aimed to explore the relationship between sleep disturbances and psychological symptoms in patients diagnosed with Empty Nose Syndrome (ENS). The research involved 46 patients who had undergone nasal reconstruction surgery using submucosal Medpor implantation between 2016 and 2021.

Study Design and Methods

Patients included in the study were diagnosed with ENS, characterized by paradoxical nasal obstruction following inferior turbinate surgery. The diagnosis was confirmed through symptoms, endoscopic findings, and a positive cotton test. Patients with other sinonasal conditions or psychiatric disorders were excluded. The study utilized the Empty Nose Syndrome 6-item Questionnaire (ENS6Q), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Epworth Sleepiness Scale (EpSS), and Modified Sleep Quality Index (MSQI) to evaluate sleep quality, psychological burden, and symptom severity before and 6 months after surgery.

Results

The study revealed significant improvements in ENS symptoms, sleep quality, and psychological distress following surgery. Scores on the ENS6Q, EpSS, MSQI, BDI-II, and BAI all showed significant reductions post-operatively. Specifically, the ENS6Q score decreased from 16.7 to 7.5, EpSS from 11.1 to 7.5, MSQI from 27.9 to 16.9, BDI-II from 20.0 to 7.3, and BAI from 20.1 to 9.7, with all changes being statistically significant (p < 0.001).

The study also identified a strong association between sleep dysfunction and psychological symptoms. Notably, 41.3% of patients experienced moderate-to-severe depression preoperatively. The study used receiver operating characteristic (ROC) curves to determine the sensitivity and specificity of the EpSS and MSQI in detecting moderate-to-severe depression. The ROC analysis revealed that the EpSS and MSQI were effective in identifying depression, with significant areas under the curve (AUC) indicating their utility in clinical settings.

Conclusions

The research underscored the significant impact of sleep dysfunction on psychological symptoms in ENS patients. The findings highlight the importance of addressing sleep issues as part of the management plan for ENS. Improved sleep quality post-surgery was associated with reduced psychological burden, indicating that effective management of sleep disturbances could enhance overall mental health outcomes. The study advocates for integrating sleep evaluation into the care of ENS patients to address and mitigate associated psychological distress.

Overall, this study provides valuable insights into the interplay between sleep and psychological health in ENS patients and supports the need for comprehensive approaches to managing both sleep dysfunction and psychological symptoms in this population.

INVESTIGATING HYPERVENTILATION SYNDROME IN PATIENTS SUFFERING FROM EMPTY NOSE SYNDROME

David Mangin 1 2, Emilie Bequignon 1 2 3 4 5, Francoise Zerah-Lancner 3 4 5 6, Daniel Isabey 3 4 5, Bruno Louis 3 4 5, Serge Adnot 3 4 6, Jean-François Papon 3 5 7 8, André Coste 1 2 3 4 5, Laurent Boyer 3 4 6, Marie Devars du Mayne 1

PMID: 28407251    DOI: 10.1002/lary.26599

Abstract

Objectives/hypothesis: Patients with empty nose syndrome (ENS) following turbinate surgery often complain about breathing difficulties. We set out to determine if dyspnea in patients with ENS was associated with hyperventilation syndrome (HVS). We hypothesized that lower airway symptoms in ENS could be explained by HVS.

Study design: Observational prospective study.

Methods: All consecutive patients referred to our center for ENS over 1 year were invited to participate. Patients completed the Nijmegen score and underwent a hyperventilation provocation test (HVPT) and arterial blood gas and cardiopulmonary tests. HVS was defined by a delayed return of the end-tidal partial pressure of carbon dioxide in the expired gas to baseline during HVPT. Patients with HVS were asked to complete the Sinonasal Outcome Test (SNOT)-16 questionnaire before and after a specific eight-session respiratory rehabilitation program.

Results: Twenty-two of the 29 patients referred for ENS during the study period were eligible for inclusion and underwent a complete workup. HVS was diagnosed in 17 of these patients (77.3%). In the five patients who completed the SNOT-16, the score was significantly lower after rehabilitation.

Conclusions: This study suggests that HVS is frequent in patients with ENS, and that symptoms can be improved by respiratory rehabilitation. Pathophysiological links between ENS and HVS deserve to be further explored.

Level of evidence: 2b Laryngoscope, 127:1983-1988, 2017.

Keywords: Empty nose syndrome; dyspnea; hyperventilation syndrome; hyperventilation test; nasal obstruction.

© 2017 The American Laryngological, Rhinological and Otological Society, Inc.