NASAL NITRIC OXIDE IN RELATION TO PSYCHIATRIC STATUS OF PATIENTS WITH EMPTY NOSE SYNDROME

Summary of the Study on Nasal Nitric Oxide (nNO) and Psychiatric Status in Empty Nose Syndrome (ENS) Patients

This study explored the relationship between nasal nitric oxide (nNO) levels and psychiatric health in patients with Empty Nose Syndrome (ENS). ENS is a rare but severe condition often caused by excessive removal of nasal tissue during surgery. Symptoms include a paradoxical sensation of nasal blockage despite an open airway, dryness, difficulty breathing, sleep issues, anxiety, and depression. The study focused on whether nNO, a molecule produced in the nasal passages that plays a role in immune defense and ciliary function, could be a useful indicator for monitoring the condition and its associated mental health impacts.

Background

Nasal nitric oxide (nNO) is typically used as a biomarker for various airway conditions. For example, nNO levels are known to increase after surgeries for sinusitis, reflecting improved sinus function. However, the role of nNO in ENS, particularly how it changes after surgical treatment and how it relates to psychiatric symptoms like anxiety and depression, had not been previously explored. This study aimed to fill that gap.

Methods

The study involved two groups of patients: 19 with ENS and 12 with chronic hypertrophic rhinitis (CHR), a condition characterized by the thickening of nasal tissue, who served as a comparison group. All patients underwent surgical treatments—submucosal implantation for ENS patients and turbinoplasty for CHR patients. The researchers measured nNO levels and assessed psychiatric symptoms using standardized questionnaires (SinoNasal Outcome Test-22, Beck Depression Inventory-II, and Beck Anxiety Inventory) before surgery and at 3, 6, and 12 months after surgery.

Key Findings

Lower nNO Levels in ENS Patients: Before surgery, ENS patients had significantly lower nNO levels compared to CHR patients. This finding was consistent with the fact that ENS is associated with disrupted nasal physiology.

Post-Surgery Increase in nNO for ENS Patients: After undergoing submucosal implantation surgery, ENS patients showed a significant increase in nNO levels by the third month, which then plateaued and remained stable at 6 and 12 months. This suggests that the surgery helped restore some of the nasal functions in these patients.

Improvement in Psychiatric Symptoms: Alongside the increase in nNO levels, ENS patients experienced significant reductions in symptoms of depression and anxiety, as measured by the Beck Depression Inventory-II and Beck Anxiety Inventory. These improvements were not observed in CHR patients, who had normal psychiatric scores before surgery.

Correlation Between nNO and Psychiatric Health: The study found a significant correlation between the increase in nNO levels and the improvement in psychiatric symptoms in ENS patients. This suggests that nNO could potentially be used to monitor not only the physical recovery of ENS patients but also their mental health.

Different Responses in CHR Patients: CHR patients, who had higher nNO levels to begin with, did not show significant changes in nNO levels after their surgery, and their psychiatric symptoms remained stable, indicating a different mechanism of disease and recovery compared to ENS.

Conclusions

The study concluded that nNO levels are significantly lower in ENS patients compared to those with CHR, and that these levels increase following surgical intervention, paralleling improvements in anxiety and depression. This suggests that nNO could serve as an important biomarker for both the physical and psychological health of ENS patients. The findings offer new insights into the complex relationship between nasal physiology and mental health in ENS, highlighting the potential of nNO as a tool for monitoring patient outcomes post-surgery. Future research could explore this further and determine whether nNO measurements could become a standard part of ENS treatment protocols.

Evaluation of Depression and Anxiety in Empty Nose Syndrome After Surgical Treatment

The research report titled "Evaluation of Depression and Anxiety in Empty Nose Syndrome" investigates the psychological effects of Empty Nose Syndrome (ENS) and how surgical treatment can improve the mental health of patients suffering from this condition. ENS is a condition that can occur after nasal surgery, leading to a feeling of excessive nasal emptiness, which can cause various physical and psychological symptoms.

Summary of the Study

Background: ENS is not just about physical changes in the nasal cavity; it also involves psychological aspects. Patients often report feelings of anxiety and depression, which can significantly affect their quality of life. The study aimed to evaluate these psychological symptoms and see if surgical intervention could help.

Methods: The researchers used two main psychological assessment tools: the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). These tools help measure the levels of depression and anxiety in patients. The study involved patients who underwent a specific surgical procedure called endonasal submucosal implantation, where a material (Medpor) or bone grafts were placed in the nasal cavity to improve airflow and reduce symptoms.

Surgical Procedure: The surgery was performed under local anesthesia. The surgeons created a pocket in the nasal wall to insert the implant, aiming to restore a more normal nasal structure and function. The goal was to alleviate the symptoms of ENS and improve the patients' overall well-being.

Findings: After the surgery, patients showed significant improvements in both their depression and anxiety scores. The results indicated that many patients felt less anxious and depressed after the procedure. For example, specific symptoms like feelings of fear, nervousness, and difficulty relaxing were notably reduced.

Conclusions: The study concluded that surgical treatment for ENS not only helps with physical symptoms but also leads to significant improvements in psychological health. This suggests that addressing the physical aspects of ENS can have a positive ripple effect on mental health, providing a better quality of life for patients.

Key Takeaways

ENS is a complex condition that affects both the body and mind. Surgical intervention can effectively reduce symptoms of depression and anxiety in ENS patients. The study highlights the importance of considering psychological health when treating patients with ENS. Overall, this research emphasizes the need for a holistic approach to treating ENS, where both physical and psychological aspects are addressed to improve patient outcomes.

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.