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.

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.