Användning av blodplättsrikt fibrin (PRF) tillsammans med finfördelat brosk vid behandling av Empty Nose Syndrome.

Empty Nose Syndrome (ENS) är ett tillstånd som kan uppstå hos patienter som genomgått operationer i näsan där för mycket av näsmusslan tagits bort. Detta syndrom leder till allvarliga symtom som torr näsa, smärtsam andning genom näsan, paradoxal nästäppa, skorpbildning och sömnproblem. Målet med kirurgisk behandling är att återställa volymen av näsmusslan för att återfå normalt motstånd i näsan. En metod som används är endonasal mikroplastik, där broskimplantat placeras på näsans sidovägg för att skapa en ny näsmussla. I denna artikel presenteras två fall där patienter med ENS behandlades med endonasal mikroplastik, där man använde en platta av blodrikt fibrin (PRF) tillsammans med finfördelat brosk. PRF-plattan hjälpte till att återbilda näsmusslan effektivt. Detta kroppsegna material visade sig vara lämpligt för att behandla ENS.

Introduktion

Empty Nose Syndrome (ENS) är en sällsynt och försvagande sjukdom som kännetecknas av torr näsa, smärtsam andning genom näsan, paradoxal nästäppa, skorpbildning och sömnproblem. ENS beskrevs första gången 1994 av Eugene Kern och är en sjukdom som orsakas av att för mycket av näsmusslan har tagits bort under en operation i näsan. Förutom fysiska symtom kan patienter med ENS uppleva ångest och depression, vilket ibland kan leda till självmordstankar. Det är svårt att diagnostisera ENS eftersom inte alla patienter upplever dessa symtom efter en radikal operation av näsmusslan. Diagnos ställs ofta baserat på patientens beskrivning av symtomen. Ett nytt verktyg, "Empty Nose Syndrome 6-item Questionnaire" (ENS6Q), har utvecklats för att hjälpa till att identifiera patienter som misstänks ha ENS.

Syftet med kirurgisk behandling för ENS är att återuppbygga näsmotståndet genom att smalna av luftvägen med ett implantat. Detta implantat placeras i en submukosal ficka i näsväggen, vilket leder till återbildning av nässlemhinnan, bättre fuktbevarande i näshålan och en ökning av luftflödet genom näsan. För detta ändamål har olika material använts, såsom injicerbara fyllmedel, syntetiska implantat, allograftmaterial och kroppsegna material som brosk.

Ny forskning inom vävnadsteknik och regenerativ medicin har fokuserat på att utveckla kostnadseffektiva biomaterial för att reglera inflammation och förbättra läkningsprocesser. PRF (blodrikt fibrin) är ett kroppseget biokemiskt och biophysikaliskt produkt som levererar tillväxtfaktorer, cytokiner och immunceller för att stödja immunmodulation och vävnadsläkning. Användningen av PRF har nyligen blivit en lovande strategi för att förbättra broskets återbildningsprocess. Detta är den första studien som undersöker den kliniska tillämpningen av PRF och finfördelat brosk för att återställa den saknade näsmusslan.

Kirurgisk teknik

Operationerna utfördes under narkos på ett operationsrum. Brosk hämtades från patientens öra och finfördelades för att skapa en klibbig broskmassa. Ett blodprov togs och centrifugerades för att separera PRF, som sedan blandades med det finfördelade brosket. Efter att blandningen hade stabiliserats placerades den i en ficka under nässlemhinnan. Såret täcktes med Hemopatch® för att hålla broskimplantatet på plats.

Fallbeskrivningar

Fall 1: En 32-årig man som hade genomgått en näsoperation fem år tidigare, klagade på ihållande andningsproblem, nästäppa, torrhet i munnen, dålig sömn och huvudvärk. Efter operationen kände han att hans andning förbättrades avsevärt, och andra symtom som huvudvärk och torrhet försvann. Ett år efter operationen fanns broskimplantatet fortfarande kvar på sin plats.

Fall 2: En 55-årig man som hade genomgått flera operationer för sju år sedan upplevde ansiktsvärk, huvudvärk, kvävningskänslor och oro. Efter en ny operation rapporterade han förbättrad sömn, mer energi och minskad huvudvärk. Broskimplantatet var fortfarande på plats efter ett år.

Diskussion

Att behandla ENS är en utmaning, och det är svårt att lindra alla patientens symtom. Målet med medicinsk behandling är att fukta näshålan genom sköljning och använda fuktgivande salvor. Men kirurgiska behandlingar som återställer näsmusslans volym kan ge bättre resultat. PRF har visat sig vara ett lovande material för att hjälpa till med broskåterbildning, och det har använts framgångsrikt i de presenterade fallen.

Slutsats

Resultaten i denna studie tyder på att kombinationen av PRF och finfördelat brosk är lämplig för behandling av ENS genom endonasal mikroplastik. Ytterligare studier behövs för att utveckla mer effektiva protokoll och jämföra effektiviteten av denna metod med andra behandlingar.

The Degree of Stress in Patients With Empty Nose Syndrome, Compared With Chronic Rhinosinusitis and Allergic Rhinitis

The research titled "The Degree of Stress in Patients With Empty Nose Syndrome, Compared With Chronic Rhinosinusitis and Allergic Rhinitis" aimed to investigate the psychological burden, specifically the prevalence and severity of depression, in patients diagnosed with Empty Nose Syndrome (ENS) compared to those with chronic rhinosinusitis (CRS) and allergic rhinitis (AR).

Study Overview

The study involved a cohort of patients diagnosed with ENS at Kosin University Hospital between January 2015 and May 2017. The diagnosis of ENS was based on a history of previous nasal surgery, subjective symptoms such as excessive nasal crusting, paradoxical nasal congestion, and a positive cotton test. The researchers excluded patients with a prior diagnosis of depression to focus on the psychological impact of ENS specifically.

To assess depression levels, the Beck Depression Inventory (BDI) was utilized, which categorizes depression into normal, mild, moderate, and severe based on total scores. Additionally, the Sino Nasal Outcome Test-22 (SNOT-22) was employed to evaluate the severity of nasal symptoms.

Results

The findings revealed that patients with ENS exhibited a significantly higher prevalence of depression compared to those with CRS and AR. Specifically, the study reported that 71% of patients with ENS experienced some degree of depression, with 13% showing mild depression, 33% moderate depression, and 25% severe depression. In contrast, the rates of depression in the CRS groups were lower, with 19% in CRS with polyps and 15% in CRS without polyps.

The study also highlighted that while the BDI scores were higher in the ENS group, there was no statistically significant correlation between the BDI scores and the SNOT-22 scores. This suggests that the severity of nasal symptoms does not directly correlate with the level of depression, indicating that other factors may contribute to the psychological distress experienced by ENS patients.

Conclusions

The research concluded that the degree and severity of depression in patients with ENS are notably higher than in those with other sinonasal diseases. This underscores the importance of recognizing and addressing the psychological aspects of ENS, as mental health issues may significantly impact the quality of life for these patients. The authors emphasized that the psychological burden associated with ENS should not be overlooked, advocating for a comprehensive approach to treatment that includes mental health assessments.

Overall, the study provided valuable insights into the mental health challenges faced by patients with ENS, highlighting the need for further research and consideration of psychological support in the management of this condition.

Identifying Residual Psychological Symptoms after Nasal Reconstruction Surgery in Patients with Empty Nose Syndrome

The study titled "Identifying Residual Psychological Symptoms after Nasal Reconstruction Surgery in Patients with Empty Nose Syndrome" investigates the psychological impact of nasal reconstruction surgery on patients diagnosed with Empty Nose Syndrome (ENS). ENS is a condition that can occur after nasal surgeries, leading to a range of debilitating symptoms, including a sensation of nasal obstruction despite having a patent airway, which can significantly affect patients' quality of life.

The researchers aimed to evaluate the psychological symptoms experienced by ENS patients both preoperatively and postoperatively, utilizing validated assessment tools such as the SNOT-25 (Sinus and Nasal Quality of Life Survey), ENS6Q (Empty Nose Syndrome 6-Questionnaire), BDI-II (Beck Depression Inventory-II), and BAI (Beck Anxiety Inventory). The study included 40 patients with ENS and a control group of 40 age- and sex-matched individuals.

Results indicated that both the BDI-II and BAI scores significantly improved six months and one year after surgery compared to preoperative scores. However, the postoperative scores for ENS patients remained significantly higher than those of the control group, suggesting that while surgery alleviated some psychological symptoms, residual symptoms persisted. Notably, a BDI-II score greater than 28.5 was identified as the optimal cutoff for predicting postoperative residual psychological symptoms.

The study concluded that a comprehensive psychological evaluation is crucial for ENS patients undergoing surgery. It highlighted the importance of recognizing individuals at risk for postoperative psychological distress and suggested that a multimodal approach, including both surgical and psychiatric interventions, is essential for achieving optimal therapeutic outcomes. This research underscores the significant psychological burden faced by ENS patients and the need for ongoing support even after surgical interventions.

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.