SLEEP IMPAIRMENT IN PATIENTS WITH EMPTY NOSE SYNDROME

C-C Huang 1, C-C Lee 2, P-W Wu 3, C-C Chuang 4, Y-S Lee 5, P-H Chang 6, C-C Huang 1, C-H Fu 1, T-J Lee 7

PMID: 36306524
DOI: 10.4193/Rhin22.117

Abstract

Background: Empty nose syndrome (ENS) is characterized by paradoxical nasal obstruction that usually occurs after turbinate surgery. Patients with ENS may also experience significant psychiatric symptoms and sleep dysfunction, which negatively affect the quality of life of affected subjects. This study aimed to evaluate sleep impairment and sleepiness in patients with ENS.

Methods: Patients with ENS and control participants were recruited prospectively. The Sino-Nasal Outcome Test-25 (SNOT-25), Empty Nose Syndrome 6-item Questionnaire (ENS6Q), Epworth Sleepiness Scale (EpSS), and modified sleep quality index (MSQI) were used to evaluate the participants before and after nasal surgery.

Results: Forty-eight patients with ENS and forty-eight age- and sex-matched control subjects were enrolled. The SNOT-25, ENS6Q, EpSS, and MSQI scores in the ENS group were all significantly higher than those in the control group before and after surgery. After surgery, ENS patients all exhibited significant improvements in SNOT-25, ENS6Q, EpSS, and MSQI scores. Regression analysis revealed that SNOT-25 score was a significant predictor of EpSS and MSQI in preoperative evaluations. ENS patients experiencing daytime sleepiness suffered from significantly more "dryness of nose" and "suffocation" than those not experiencing daytime sleepiness.

Conclusions: Patients with ENS experienced significantly impaired sleep quality and sleepiness. Nasal reconstruction surgery improved the sleep quality of ENS patients. The severity of sleep dysfunction is associated with the severity of ENS symptoms. Recognizing individuals with significant sleep impairment and sleepiness and providing appropriate management are critical issues for ENS patients.

DISTINCT HISTOPATHOLOGY CHARACTERISTICS IN EMPTY NOSE SYNDROME

The research titled "Distinct Histopathology Characteristics in Empty Nose Syndrome" investigates the histopathological changes associated with Empty Nose Syndrome (ENS), a condition characterized by nasal obstruction and a sensation of emptiness despite having a patent nasal airway. The study was conducted at Chang Gung Memorial Hospital in Taiwan and involved a cohort of patients diagnosed with ENS who underwent submucosal reconstruction surgery.

Key Findings:

Histopathological Changes: The study identified several distinct histopathological features in ENS patients compared to a control group consisting of patients with benign pituitary tumors. Notably, ENS patients exhibited:

Increased squamous metaplasia (relative risk [RR], 3.54; P = .018).

More submucosal fibrosis (RR, 11.33; P = .008).

A significantly lower number of submucosal glands (mean grading for ENS was 1.71 compared to 3.17 for controls; P = .013).

Thermoreceptor Expression: The research also explored the expression of thermoreceptors, particularly TRPM8, in the nasal mucosa of ENS patients. The findings suggested a decrease in TRPM8 expression, which may play a role in the pathophysiology of ENS.

Psychological Impact: The study noted that patients with ENS had elevated scores on depression and anxiety scales prior to surgical intervention. Postoperative assessments indicated significant improvements in both rhinological and psychological outcomes, suggesting that surgical treatment not only alleviates physical symptoms but also enhances mental well-being.

Conclusions:

The authors concluded that the histopathological changes observed in ENS patients, particularly the increased squamous metaplasia and submucosal fibrosis, may contribute to the pathophysiological mechanisms underlying the syndrome. The study emphasizes the importance of recognizing these histological features to better understand ENS and improve diagnostic and therapeutic approaches. Furthermore, the findings regarding TRPM8 expression warrant further investigation to clarify its role in ENS. Overall, the research highlights the complex interplay between anatomical changes in the nasal mucosa and the clinical manifestations of ENS, advocating for a more nuanced understanding of this condition.

This study represents a significant step in elucidating the histopathological characteristics of ENS and underscores the need for continued research to develop effective diagnostic and treatment strategies for affected patients.

A Review of the Scientific Report: "Suicidal Thoughts in Patients with Empty Nose Syndrome"

The study titled "Suicidal Thoughts in Patients with Empty Nose Syndrome" investigates the prevalence and characteristics of suicidal thoughts among patients diagnosed with Empty Nose Syndrome (ENS). ENS is a condition characterized by paradoxical nasal obstruction despite having a clear nasal airway, leading to significant psychological distress. The research was conducted between 2016 and 2021, involving 62 patients who were prospectively recruited from the Department of Otolaryngology.

Key Findings: The study found that 23 out of the 62 patients (approximately 37%) reported suicidal thoughts. Among these patients, varying degrees of suicidal ideation were noted, with 20 patients indicating thoughts of self-harm without intent to act, two expressing a desire to kill themselves, and one patient indicating a willingness to carry out the act if given the chance. The study utilized several validated questionnaires, including the SNOT-25, ENS6Q, BAI, and BDI-II, to assess the psychological state of the participants and identify the presence of suicidal thoughts.

The results highlighted that patients with suicidal thoughts experienced significantly more severe symptoms, impaired quality of life, and a greater psychological burden compared to those without such thoughts. Notably, the item "nose feels too open" from the ENS6Q was significantly more severe in patients with suicidal ideation, indicating a strong correlation between the perception of nasal obstruction and mental health issues.

Conclusions: The study concluded that suicidal thoughts are prevalent among patients with ENS, emphasizing the need for early identification and intervention. The authors stressed the importance of recognizing individuals at risk of suicide and providing appropriate psychological support to prevent tragic outcomes. They also noted that the degree of depression and anxiety in these patients warrants further investigation, suggesting that future studies should include larger sample sizes and collaborate with mental health specialists to better understand the relationship between ENS, depression, and suicidal thoughts.

Overall, the research underscores the critical need for comprehensive mental health assessments in patients with ENS, as well as the integration of psychological care into the treatment plans for these individuals. The findings serve as a call to action for healthcare providers to be vigilant in screening for suicidal ideation and to implement strategies that address both the physical and psychological aspects of ENS.

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