Empty Nose Syndrome Surgery Benefits Some, But Not All Patients

What are the outcomes of surgical intervention for empty nose syndrome (ENS)?

Background: In patients with ENS, ‘‘the absence of normal nasal structures is universal … and the symptoms of atrophic rhinitis [are] coupled with a cavernous nasal airway lacking identifiable turbinate tissue.’’ For many years, ENS was thought to be a form of secondary atrophic rhinitis, and it is unknown why some patients develop ENS following turbinate surgery. ENS management is challenging, and the evidence base for most treatment modalities remains low

Study design: Structured search of a total of 128 patients collated from eight studies, with an age range of 18 to 64 years.

Setting: Cochrane Collaboration database, U.S. National Institutes of Health database (ClinicalTrials), PubMed.

Synopsis: Most patients had been suffering with ENS for many years, and ENS surgery was generally deferred for at least one year after turbinectomy. The most common surgical technique involved a transnasal approach, in which implant material was secured within a submucosal pocket. Multiple implant sites in the lateral nasal wall, remnant of the inferior turbinate or septal area adjacent to the resected turbinate, were normally performed to narrow the nasal valve region. The weighted mean preoperative Sino-Nasal Outcome Test (SNOT)-20 and SNOT-25 scores were 48.3 and 65.9, respectively. The follow-up period varied widely (six to 48 months), and at the latest follow-up, these scores improved significantly, with at least 50% of patients reporting an improvement of 30 SNOT points or more. On the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinosinusitis Quality of Life (RhinolQoL) questionnaires, patients reported statistically significant improvement. No intra-operative complications were reported in any of the studies. Of three patients who had hyaluronic acid gel injections, the augmentation was completely resorbed in two patients at the 12-month follow-up. Because none of the patients were blinded to surgical intervention, however, some positive reporting bias may be expected.

Bottom line: Surgical intervention for ENS appears to result in clinical improvement; however, not all patients derived benefit. Clinical response varies among patients; up to 21% may report only marginal improvement.

Citation: Leong SC. The clinical efficacy of surgical interventions for empty nose syndrome: a systematic review. Laryngoscope. 2015;125:1557-1562.

—Reviewed by Amy Hamaker