Conservative Treatment Comes First When Addressing ENS

Clinical Question

What are the recent treatment options and techniques for managing empty nose syndrome (ENS), and how and when should they be considered?

Bottom Line

Currently, initial treatment approaches to ENS prioritize conservative management; given the complexity and severity of the condition, patients and clinicians should approach surgical options with caution.

Background: Empty nose syndrome is a rare, iatrogenic disorder characterized by paradoxical nasal blockage despite a wide and patent nasal cavity. A poorly understood condition, ENS typically arises from the excessive removal or damage of the nasal turbinates and surrounding tissues. Management plans related to its pathogenesis have not reached consensus.

Study design: Systematic literature review

Setting: Head and Neck Oncology, Mahavir Cancer Sansthan & Research Centre, Patna, India

Synopsis: To summarize and evaluate current and emerging therapeutic approaches for ENS, researchers conducted a comprehensive search across multiple databases for studies of recent and newer available treatment options from 1970 to 2024. Of the 560 papers they identified, 18 were found to be relevant for review. Therapeutic approaches to ENS were categorized into conservative management (nasal humidification, irrigations, and acupuncture); surgical interventions; emerging therapies; and behavioral therapy. The results of their review did not reveal any consensus as to what the specific and best options are for these patients. Findings showed that surgical approaches, such as augmentation, filler injections, implants, and tissue reconstruction, have yielded varying degrees of success. Among the newer therapies, transplants using adipose-derived stem cells have provided symptom relief, and the use of other stem cells is being explored, as well as a range of new implant materials, such as Medpor and GlassBONE. Researchers also noted that cognitive behavioral therapy used to address the dysfunctional beliefs and avoidance often associated with ENS has demonstrated substantial efficacy, particularly when combined with pharmacological treatment.

Citation: Surbhi, et al. From dry cavities to healing pathways: innovations in managing empty nose syndrome. Indian J Otolaryngol Head Neck Surg. 2025;77:2055-2060. doi.org/10.1007/s12070-025-05445-0.