Effective Diagnosis and Treatment of Empty Nose Syndrome

The article "Diagnosis and Management of Empty Nose Syndrome" provides a comprehensive overview of Empty Nose Syndrome (ENS), a condition that arises primarily as a result of surgical interventions on the nasal turbinates, leading to a loss of tissue and subsequent symptoms that can significantly affect patients' quality of life.

Key Discoveries:

Definition and Symptoms: ENS is characterized by paradoxical nasal obstruction, dryness, and a sense of suffocation despite having a patent nasal airway. The condition was first described by Eugene Kern and Monika Stenkvist in 1994, highlighting its association with tissue loss following turbinate resection. The article emphasizes that ENS is distinct from atrophic rhinitis, although they share some overlapping symptoms.

Iatrogenic Nature: The research underscores that ENS is primarily an iatrogenic disorder, often resulting from aggressive surgical techniques such as turbinectomy or laser ablation. These procedures can lead to significant alterations in nasal airflow sensation and mucosal integrity, which are critical for effective nasal breathing.

Nasal Airflow Sensation: The authors discuss the physiological relationship between nasal airflow sensation and the respiratory center, suggesting that changes in airflow sensation can lead to the perception of nasal obstruction. This insight is crucial for understanding the underlying mechanisms of ENS and guiding treatment approaches.

Management Strategies: The article reviews various management strategies for ENS, noting that many patients have previously failed conservative medical management and have been misdiagnosed. While aggressive nasal hygiene and moisturizers may provide limited relief, surgical options such as submucosal implantation of acellular dermis have shown promise. In a study cited, patients reported subjective improvements in symptoms post-implantation, including enhanced sense of smell and reduced dryness.

Assessment Tools: The authors highlight the importance of comprehensive assessment tools, such as the SNOT-25 questionnaire, which includes ENS-specific questions to aid in the recognition and diagnosis of the condition. This tool helps clinicians better understand the patient's experience and tailor management strategies accordingly.

Conclusions:

The research concludes that ENS is a complex and often underrecognized condition that requires a nuanced understanding of nasal physiology and airflow dynamics. The authors advocate for a cautious approach to turbinate surgery, emphasizing the need for preserving mucosal integrity to prevent ENS. They also call for further research into the pathophysiology of ENS and the development of effective treatment modalities. The findings underscore the importance of clinical suspicion and thorough assessment in diagnosing ENS, as well as the need for individualized treatment plans that address the unique symptoms and experiences of each patient.

In summary, the article provides valuable insights into the diagnosis and management of ENS, highlighting the need for awareness among clinicians and the importance of preserving nasal function during surgical interventions.

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.