Empty nose syndrome

Empty Nose Syndrome
Other namesSecondary atrophic rhinitis
ENS caused by loss of the inferior half of the left inferior turbinate.
SpecialtyOtolaryngology
SymptomsSensation of nasal suffocation despite clear airway, loss of airflow sensation
ComplicationsHyperventilation syndrome, depression, anxiety, fatigue
Usual onsetFollowing surgery or any procedure to the nasal interior
Differential diagnosisAnxiety, Hyperventilation
TreatmentArtificial nasal moisture, experimental corrective surgeries
FrequencyUnknown, but considered rare in medical literature

Empty nose syndrome (ENS) is a clinical syndrome in which there is a sensation of suffocation despite a clear airway. This syndrome is often referred to as a form of secondary atrophic rhinitis. ENS is a potential complication of nasal turbinate surgery or procedure.[1][2] Affected individuals have usually undergone a turbinectomy or turbinoplasty (resection or reduction respectively of structures inside the nose called turbinates), or other surgical procedures that injure the nasal turbinates.

There are a range of symptoms, including feelings of nasal obstruction, loss of airflow sensation, nasal dryness and crusting, and a sensation of being unable to breathe.[3] Sleep may be severely impaired due to one or a combination of these symptoms.[4] ENS onset can be immediately after surgery or delayed.[5]

The overall incidence of ENS is unknown due to the small body of epidemiological study and the lack of a dedicated International Classification of Diseases (ICD-10) code, which would allow incidence reporting of the syndrome. Many cases of ENS may be unrecognized, underdiagnosed, and unreported.[6]

ENS usually occurs with unobstructed nasal passages with a history of previous surgical intervention and sensations of suffocation or obstruction following recovery. Early literature attributed ENS to complete inferior turbinate resection, but later research demonstrated the syndrome in patients who had undergone a range of procedures that involved nasal turbinates (both middle and inferior), including conservative reductions.[3][7][8][9][10] Even unilateral (one-sided) ENS has been reported.[11][7]

The existence of ENS as a distinct medical condition is controversial. More ear, nose and throat (ENT) practitioners and plastic surgeons are recognizing the condition. The Haute-Autorité de Santé (HAS) published guidelines in 2022.[12] ENS is not fully understood and practitioner knowledge about altered nasal breathing in turbinate surgeries varies. Understanding why some individuals exhibit ENS symptoms while others do not and incorrectly attributing symptoms to psychological causes such as anxiety are common reasons people with ENS do not receive care.[3] ENS as a distinct condition is subject to debate, including whether it should be considered solely rhinologic or whether it may have neurological or psychosomatic aspects. Growing awareness of the syndrome and an increasing body of research has led to more acceptance by ENT practitioners.[3][7][13][14][15][16]

  1. ^ Cite error: The named reference :0 was invoked but never defined (see the help page).
  2. ^ deShazo, Richard D; Stringer, Scott P (February 2011). "Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery". Current Opinion in Allergy & Clinical Immunology. 11 (1): 1–7. doi:10.1097/ACI.0b013e328342333e. ISSN 1528-4050. PMID 21157302. S2CID 27205163.
  3. ^ a b c d Kuan, EC; Suh, JD; Wang, MB (2015). "Empty nose syndrome". Current Allergy and Asthma Reports. 15 (1) 493. doi:10.1007/s11882-014-0493-x. PMID 25430954. S2CID 43309184.
  4. ^ Huang, C.-C.; Lee, C.-C.; Wei, P.-W.; Chuang, C.-C.; Lee, Y.-S.; Chang, P.-H.; Huang, C.-C.; Fu, C.-H.; Lee, T.-J. (2022-10-28). "Sleep impairment in patients with empty nose syndrome". Rhinology Journal. 61 (1): 47–53. doi:10.4193/Rhin22.117. PMID 36306524.
  5. ^ Wise, Sarah K.; Damask, Cecelia; Roland, Lauren T.; Ebert, Charles; Levy, Joshua M.; Lin, Sandra; Luong, Amber; Rodriguez, Kenneth; Sedaghat, Ahmad R.; Toskala, Elina; Villwock, Jennifer; Abdullah, Baharudin; Akdis, Cezmi; Alt, Jeremiah A.; Ansotegui, Ignacio J. (April 2023). "International consensus statement on allergy and rhinology: Allergic rhinitis – 2023". International Forum of Allergy & Rhinology. 13 (4): 293–859. doi:10.1002/alr.23090. ISSN 2042-6976.
  6. ^ Talmadge, Jason; Nayak, Jayakar V.; Yao, William; Citardi, Martin J. (November 2019). "Management of Postsurgical Empty Nose Syndrome". Facial Plastic Surgery Clinics of North America. 27 (4): 465–475. doi:10.1016/j.fsc.2019.07.005. ISSN 1558-1926. PMID 31587766. S2CID 203850289.
  7. ^ a b c Sozansky J, Houser SM (Jan 2015). "Pathophysiology of empty nose syndrome". Laryngoscope. 125 (1): 70–4. doi:10.1002/lary.24813. PMID 24978195. S2CID 29735233.
  8. ^ Houser, Steven M. (2007-09-01). "Surgical Treatment for Empty Nose Syndrome". Archives of Otolaryngology–Head & Neck Surgery. 133 (9): 858–863. doi:10.1001/archotol.133.9.858. ISSN 0886-4470. PMID 17875850. Although total turbinate excision is most frequently the cause of ENS, lesser procedures (eg, submucosal cautery, submucosal resection, cryosurgery) to reduce the turbinates may cause problems as well if performed in an overly aggressive manner.
  9. ^ "FFAAIR | Syndrome du Nez Vide (SNV)". www.ffaair.org (in French). Retrieved 2019-09-11. suite d'interventions endonasales diverses (turbinectomie, turbinoplastie, cautérisation)
  10. ^ Saafan. "Empty nose syndrome: etiopathogenesis and management". www.ejo.eg.net. Retrieved 2019-09-11. ENS is a complication of middle and/or inferior turbinate surgery, most frequently total turbinate excision, but also with minor procedures such as submucosal cautery, submucosal resection, laser therapy, and cryosurgery if performed in an aggressive manner
  11. ^ Talmadge, Jason; Nayak, Jayakar V.; Yao, William; Citardi, Martin J. (November 2019). "Management of Postsurgical Empty Nose Syndrome". Facial Plastic Surgery Clinics of North America. 27 (4): 465–475. doi:10.1016/j.fsc.2019.07.005. PMID 31587766.
  12. ^ Cite error: The named reference :1 was invoked but never defined (see the help page).
  13. ^ Leong SC (Jul 2015). "The clinical efficacy of surgical interventions for empty nose syndrome: A systematic review". Laryngoscope. 125 (7): 1557–62. doi:10.1002/lary.25170. PMID 25647010. S2CID 206202553.
  14. ^ Coste, A; Dessi, P; Serrano, E (2012). "Empty nose syndrome". European Annals of Otorhinolaryngology, Head and Neck Diseases. 129 (2): 93–7. doi:10.1016/j.anorl.2012.02.001. PMID 22513047.
  15. ^ Hildenbrand, T; Weber, RK; Brehmer, D (2011). "Rhinitis sicca, dry nose and atrophic rhinitis: a review of the literature". European Archives of Oto-Rhino-Laryngology. 268 (1): 17–26. doi:10.1007/s00405-010-1391-z. PMID 20878413. S2CID 34729974.
  16. ^ Payne SC (2009). "Empty nose syndrome: what are we really talking about?". Otolaryngologic Clinics of North America. 42 (2): 331–7, ix–x. doi:10.1016/j.otc.2009.02.002. PMID 19328896.
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