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Gwak JW, Kim DH, Jang YJ. Application of a Novel 3D-Printed Nasal Plug as a Conservative Treatment for Empty Nose Syndrome. Laryngoscope 2024; 134:3935-3940. [PMID: 38544462 DOI: 10.1002/lary.31414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE Empty nose syndrome (ENS) is commonly treated by surgery, albeit with limited success. Herein, we introduce our experience of applying a newly developed "3D-printed nasal plug" as an alternative conservative treatment modality. METHODS This retrospective study included 20 patients (14 males, 6 females; mean age 46.5 ± 13.5 years) with ENS who underwent the application of the 3D-printed nasal plug at Asan Medical Center between June 2022 and May 2023. Symptom improvement was assessed by Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) before and after applying the nasal plug. Clinical results, such as duration and frequency of plug use, discomfort, and level of satisfaction, were investigated. RESULTS The mean follow-up duration was 40.3 ± 24.2 weeks. The average duration of nasal plug usage was 10.8 h per day and 5.3 days a week. The ENS6Q scores improved from 19.6 ± 4.6 to 6.8 ± 5.1 (mean reduction 12.8 ± 5.9) after 30 minutes of wearing. Symptom "nose feelings too open" was improved most by a score of 3.0 ± 1.5 (p < 0.001). Thirteen patients (65.0%) reported that the effectiveness of the plug, initially confirmed at the first wearing, was well maintained during the entire follow-up. Four patients (20.0%) wore the nasal plug uninterruptedly throughout the week, whereas nine patients (45.0%) wore it intermittently as needed. Frequently reported complaints with plug usage were 'displacement of the plug' and 'cosmetic concerns' about the visible hook portion. CONCLUSION A 3D-designed nasal plug can be a useful conservative treatment option for ENS patients. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3935-3940, 2024.
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Affiliation(s)
- Jang Wook Gwak
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Don-Han Kim
- Department of Digital Content, University of Ulsan, Ulsan, Republic of Korea
| | - Yong Ju Jang
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Buiret G. Autologous fat injection for empty-nose syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:235-239. [PMID: 37925359 DOI: 10.1016/j.anorl.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
AIMS Inferior meatus augmentation by injection or implants is one of the treatments for empty-nose syndrome (ENS), but levels of evidence of efficacy are low. We present the technique and evaluate our experience. The primary objective was to analyze changes in Empty Nose Syndrome 6-item Questionnaire (ENS6Q) scores after treating patients with ENS by autologous fat injection. Secondary objectives were the analysis of the evolution of each of the six ENS6Q items and identification of complications. Eleven patients underwent a minimally invasive approach to limit nasal airflow using fat injection between March 2021 and December 2022. RESULTS Ten of the 11 patients showed a decrease in overall ENS6Q score (P=0.0058); 6 had a final ENS6Q score<11. Ten were satisfied with the procedure, but remained symptomatic. The procedure did not result in any complications. CONCLUSION These encouraging results confirm the data in the literature suggesting that fat injection improves symptomatology in empty nose syndrome. However, like other minimally invasive approaches to limit nasal airflow, it does not eliminate all symptoms. These results need to be confirmed by studies on larger cohorts with longer follow-up, preferably in a multicenter setting.
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Affiliation(s)
- G Buiret
- Service d'ORL et de Chirurgie Cervicofaciale, Centre Hospitalier de Valence, 179, boulevard du Maréchal-Juin, 26953 Valence, France.
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Huang CC, Sun PH, Wu PW, Huang CC, Chang PH, Fu CH, Lee TJ. Computed Tomographic Evaluations in Patients with Empty Nose Syndrome. Laryngoscope 2024; 134:2105-2110. [PMID: 38009472 DOI: 10.1002/lary.31204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE We aimed to evaluate computed tomography (CT) images of patients with empty nose syndrome (ENS), investigate the impact of reconstruction surgery on sinus inflammation, and identify the optimal airspace diameter after surgery. METHODS We conducted a retrospective case series analysis, identifying and enrolling patients with ENS with perioperative CT findings. The clinical characteristics of the participants were collected, and the modified Lund-Mackay (mLM) CT scores were determined. The anterior airspace diameter was evaluated by measuring the distance between the septum and the lateral nasal wall on the coronal plane at the level of the nasolacrimal duct. RESULTS Twenty patients with ENS and perioperative CT images were enrolled. The mean total mLM CT score and all subsite scores showed no significant changes after surgery. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) score, Sino-nasal Outcome Test-25 (SNOT-25) score, sleep symptoms domain, psychological domain, and empty nose symptoms domain were significantly associated with anterior airspace diameter in the regression analysis. CONCLUSION There was no significant difference in sinus inflammation between preoperative and postoperative CT evaluations. The anterior airspace diameters were significantly associated with ENS6Q and SNOT-25 scores. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2105-2110, 2024.
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Affiliation(s)
- Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping Hsueh Sun
- Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsiang Fu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
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Dholakia SS, Grimm D, Daum R, Bravo DT, Salvi N, Zarabanda D, Overdevest JB, Thamboo A, Nakayama T, Nayak JV. The Serpentine Sign: A Reliable Endoscopic and Radiographic Finding in Empty Nose Syndrome. Laryngoscope 2024; 134:1089-1095. [PMID: 37702458 DOI: 10.1002/lary.30938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE Empty nose syndrome (ENS) is a relatively uncommon disease that greatly impacts the quality of life and presents diagnostic challenges. We sought to identify objective clinical findings unique to patients with ENS, and in doing so identified compensatory mucosal hypertrophy in an alternating, undulating swelling on endoscopy and coronal computerized tomography (CT) that we have termed the "Serpentine Sign." Here, we investigated whether this radiographic finding is a reliable manifestation in ENS patients. METHODS Retrospective review was undertaken to identify ENS patients with past turbinoplasty, an ENS6Q score of at least 11/30, and symptomatic improvement with the cotton placement test. Control patients without complaints of ENS symptoms (ENS6Q < 11) were identified for comparison. ENS and control patients had coronal CT imaging available to evaluate for the Serpentine Sign, as well as ENS6Q scores, and histologic analysis of nasal tissue. RESULTS 34 ENS and 74 control patients were evaluated for the presence of the Serpentine Sign. Of the 34 patients with ENS, 18 exhibited this radiographic finding on CT imaging (52.9%) compared to 0 of the 74 control patients (p < 0.0001). Further analysis demonstrated that ENS patients with the Serpentine Sign had lower median scores on ENS6Q than ENS patients without (17.5 vs. 22, p = 0.033). Histology revealed disorganized subepithelium rich in seromucinous glands similar to the nasal septum swell body. CONCLUSION The "Serpentine Sign" is a unique presentation of hypertrophic change to the nasal septum soft tissue that is specific to ENS patients and may serve as a reliable radiographic and endoscopic finding in diagnosis. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1089-1095, 2024.
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Affiliation(s)
- Sachi S Dholakia
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Grimm
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rachel Daum
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Dawn T Bravo
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Nicole Salvi
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Zarabanda
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jonathan B Overdevest
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andrew Thamboo
- Department of Otolaryngology - Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tsuguhisa Nakayama
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Otolaryngology - Head and Neck Surgery, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Jayakar V Nayak
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Otolaryngology - Head and Neck Surgery, VA Palo Alto Health Care System, Palo Alto, California, USA
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Chang CF. Using platelet-rich fibrin scaffolds with diced cartilage graft in the treatment of empty nose syndrome. EAR, NOSE & THROAT JOURNAL 2024; 103:NP168-NP172. [PMID: 34569297 DOI: 10.1177/01455613211045567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Empty nose syndrome (ENS) is a rare entity in patients who undergo sinonasal surgery due to over-resection of the turbinate. This syndrome leads to debilitating symptoms that include dry nose, painful nasal breathing, paradoxical nasal obstruction, crusting, and sleep disorder. The goal of surgical treatment is to reestablish the volume of the turbinates to rehabilitate the nasal resistance. Endonasal microplasty with cartilage implants on the lateral wall of the nasal cavity is useful for creating the neoturbinate. Here, we present 2 cases that describe the management of empty nose syndrome by endonasal microplasty using platelet-rich fibrin (PRF) scaffolds embedded with a diced cartilage graft. The integration of the PRF scaffolds with diced cartilage efficiently facilitated the reestablishment of the neoturbinate. This autologous biomaterial is suitable for the treatment of ENS.
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Affiliation(s)
- Chin-Fang Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Jen-Ai Hospital, Taichung, Taiwan
- Rong Hsing Research Center For Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Basic Medical Education Center, Central Taiwan University of Science and Technology, Taichung, Taiwan
- Department of Medical Education and Research, Jen-Ai Hospital, Taichung, Taiwan
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Park MJ, Bae M, Kim JH, Chung Y, Jang YJ, Yu MS. Impact of long-term nasal airflow deprivation on sinonasal structures and chronic rhinosinusitis in total laryngectomy patients. Laryngoscope Investig Otolaryngol 2024; 9:e1214. [PMID: 38362182 PMCID: PMC10866595 DOI: 10.1002/lio2.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/02/2023] [Accepted: 01/02/2024] [Indexed: 02/17/2024] Open
Abstract
Objective Total laryngectomy (TL) patients are good models in which to evaluate the effects of nasal airflow cessation on the sinonasal tract. Here, we evaluated changes in sinonasal structures and association with sinus opacification in the computed tomography (CT) images 3 years post-TL. Methods Patients who underwent TL from 2005 to 2017 in a teaching academic center were reviewed retrospectively. Patients with a final follow-up CT taken less than 3 years after TL, tracheoesophageal puncture, inadequate CT image, or history of sinonasal surgery were excluded. The control group included patients who underwent a partial laryngectomy or hypopharyngectomy without requiring a tracheotomy for more than a month. Altogether, 45 TL patients and 38 controls were selected. The volume of all four paranasal sinuses, inferior turbinate soft tissue volume (ITSTV), maxillary sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS) were measured on preoperative and postoperative CT scans. Results The mean duration between surgery and the final CT scan was 6.3 ± 2.4 and 5.5 ± 2.3 years for the TL and control groups, respectively. Neither group showed significant changes in the four paranasal sinuses' volume or MSNO mucosa width. The ITSTV decreased significantly, from 4.6 ± 1.3 to 2.8 ± 1.1 mL (p < .001), in the TL group, regardless of the presence of nasal septal deviation, showing ITSTV reduction on both concave and convex sides. By contrast, the control group showed no significant changes in ITSTV. Postoperative LMS changes in both groups were insignificant. The number of patients with LMS aggravation or alleviation was the same in both groups, regardless of preoperative sinus opacification. Conclusions Paranasal sinus structures and sinus opacification are not affected significantly by nasal airflow cessation; however, the inferior turbinate mucosa is affected by long-term discontinuation of nasal airflow. Level of Evidence 4 (case-control study).
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Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
- Department of Otorhinolaryngology—Head and Neck SurgeryInha University School of MedicineIncheonKorea
| | - Mirye Bae
- Department of Otorhinolaryngology—Head and Neck SurgeryBundang Jesaeng General Hospital, Daejin Medical CenterSeongnamKorea
| | - Ji Heui Kim
- Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Yoo‐Sam Chung
- Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Yong Ju Jang
- Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
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Park MJ, Jang YJ. Facial Pain Triggered by Inferior Turbinate Partial Resection in a Patient with a Previous History of Inferior Meatal Antrostomy: A Case Report. Ann Otol Rhinol Laryngol 2024; 133:115-118. [PMID: 37377141 DOI: 10.1177/00034894231180948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVES Inferior meatal antrostomy (IMA) is regarded as a safe method, with minimal complications, for managing various lesions in the maxillary sinus. However, in patients with persisting IMA window, resection of the inferior turbinate may result in direct airflow into the antrum, irritating the antral mucosa. METHODS Case report and review of literature. RESULTS/CASE The present report describes a 29-year-old man who previously underwent unilateral IMA for the excision of a dentigerous cyst. The patient did not report any facial pain following the excision of the cyst. One year later, this patient underwent partial resection of the inferior turbinate for the resolution of nasal stuffiness by another surgeon. Soon after surgery, the patient developed severe facial and ocular pain on the side of the IMA, with the pain being especially aggravated upon inhalation. Endoscopy and computed tomography (CT) revealed a persisting IMA window. The patient's severe discomfort was thought to result from direct airflow into the maxillary sinus, as the resected turbinate may have altered normal nasal airflow. A unilateral inferior meatal augmentation procedure (IMAP) with an autologous ear cartilage implant was performed, resulting in complete relief of pain and discomfort. CONCLUSIONS Although IMA alone is a relatively safe surgical procedure, care should be taken when performing inferior turbinoplasty in patients with persistent IMA opening.
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Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Graduate School of Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Hosokawa Y, Miyawaki T, Omura K, Akutsu T, Kimura R, Ikezono T, Otori N. Surgical Treatment for Empty Nose Syndrome Using Autologous Dermal Fat: Evaluation of Symptomatic Improvement. EAR, NOSE & THROAT JOURNAL 2022:1455613221130885. [PMID: 36174975 DOI: 10.1177/01455613221130885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Empty nose syndrome (ENS) is caused by nasal turbinate surgery. The standard treatment for ENS is an inferior meatus augmentation procedure (IMAP) in which autologous tissue such as auricular cartilage, rib cartilage, or artificial material is transplanted into the nasal cavity. However, some challenges like a very small auricular cartilage are associated with these autologous tissue types. Moreover, since using rib cartilage is a highly invasive technique, the scar on the chest from where the harvesting is done is easily visible, and the artificial material is susceptible to infection. We used autologous dermal fat (ADF) in IMAPs in our study for the following reasons: the quantity of ADF could be increased or reduced as needed, ADF is considered a safer option than rib cartilage because it is harvested from superficial tissue, it is superior in terms of cosmetic appearance to harvested rib cartilage, and it has a lower risk of infection than any artificial material.Objective: The purpose of our study was to investigate the efficacy and safety of IMAPs using ADF.Methods: We included nine patients with ENS who underwent an IMAP using ADF. The patients' backgrounds and responses to the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) were recorded. Changes in each item of the ENS6Q before and after surgery (up to 3 months) were analyzed.Results: The postoperative ENS6Q total score and parameters were significantly better than their preoperative counterparts. Nasal dryness improved slightly less than other symptoms. There were no complications.Conclusions: The IMAP using ADF was effective in improving ENS symptoms; however, some physiological functions were difficult to improve, and dryness persisted. Autologous dermal fat is larger than auricular cartilage, less invasive than rib cartilage, and has a lower risk of infection than artificial material.
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Affiliation(s)
- Yu Hosokawa
- Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan
- Department of Otorhinolaryngology, the Jikei University School of Medicine, Tokyo, Japan
- Septorhinoplasty Clinic, Jikei University Hospital, Tokyo, Japan
| | - Takeshi Miyawaki
- Septorhinoplasty Clinic, Jikei University Hospital, Tokyo, Japan
- Department of Plastic Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, the Jikei University School of Medicine, Tokyo, Japan
| | - Taisuke Akutsu
- Department of Otorhinolaryngology, the Jikei University School of Medicine, Tokyo, Japan
| | - Ryohei Kimura
- Department of Otorhinolaryngology, the Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuo Ikezono
- Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, the Jikei University School of Medicine, Tokyo, Japan
- Septorhinoplasty Clinic, Jikei University Hospital, Tokyo, Japan
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Hassan C, Malheiro E, Béquignon E, Coste A, Bartier S. Sublabial bioactive glass implantation for the management of primary atrophic rhinitis and empty nose syndrome: Operative technique. Laryngoscope Investig Otolaryngol 2022; 7:6-11. [PMID: 35155777 PMCID: PMC8823167 DOI: 10.1002/lio2.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/26/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Atrophic rhinitis (AR) and empty nose syndrome (ENS) are chronic diseases characterized by a paradoxical nasal obstruction. These rare syndromes tend to occur after nasal surgery of the inferior turbinates in ENS and can be idiopathic in AR. Medical treatments alone are often insufficient. Surgical options are challenging and numerous resorbable and nonresorbable implants have been described in small series, with as many surgical techniques described. Whereas current surgical procedures are for risk of extrusions, graft rejections or poor lasting results, the use of GlassBONE™ (Sodimed®, Avignon, France), a bioactive glass, for a vestibular approach in AR and ENS has never been reported for this indication. METHODS We described an original technique of nasal submucoperiosteal bilateral ceramic glass implantation in two patients with AR and ENS. RESULTS The two cases presented a postoperative satisfying endoscopic and sinus CT-scan results with filling of the nasal cavities, with less crusts and a complete wound healing. They had no short-term complications. CONCLUSION This innovative approach is easily feasible and could be an option considered for the surgical management of AR and ENS. Level of evidence: 4.
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Affiliation(s)
- Charles‐Henri Hassan
- Service d'ORL et de chirurgie cervico‐faciale, Centre Hospitalier Intercommunal de CréteilFrance
| | - Emeline Malheiro
- Service d'ORL et de chirurgie cervico‐faciale, Centre Hospitalier Intercommunal de CréteilFrance
| | - Emilie Béquignon
- Service d'ORL et de chirurgie cervico‐faciale, Centre Hospitalier Intercommunal de CréteilFrance
- Service d'ORL et de chirurgie cervico‐faciale, AP‐HP, Centre Hospitalier Universitaire Henri MondorCréteilFrance
- Université Paris‐Est Créteil (UPEC), Ecole de MédecineCréteilFrance
- INSERM U955CréteilFrance
- CNRS, ERL 7240CréteilFrance
| | - André Coste
- Service d'ORL et de chirurgie cervico‐faciale, Centre Hospitalier Intercommunal de CréteilFrance
- Service d'ORL et de chirurgie cervico‐faciale, AP‐HP, Centre Hospitalier Universitaire Henri MondorCréteilFrance
- Université Paris‐Est Créteil (UPEC), Ecole de MédecineCréteilFrance
- INSERM U955CréteilFrance
- CNRS, ERL 7240CréteilFrance
| | - Sophie Bartier
- Service d'ORL et de chirurgie cervico‐faciale, Centre Hospitalier Intercommunal de CréteilFrance
- Service d'ORL et de chirurgie cervico‐faciale, AP‐HP, Centre Hospitalier Universitaire Henri MondorCréteilFrance
- Université Paris‐Est Créteil (UPEC), Ecole de MédecineCréteilFrance
- INSERM U955CréteilFrance
- CNRS, ERL 7240CréteilFrance
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Kanjanawasee D, Campbell RG, Rimmer J, Alvarado R, Kanjanaumporn J, Snidvongs K, Kalish L, Harvey RJ, Sacks R. Empty Nose Syndrome Pathophysiology: A Systematic Review. Otolaryngol Head Neck Surg 2021; 167:434-451. [PMID: 34665687 DOI: 10.1177/01945998211052919] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The pathophysiology of empty nose syndrome (ENS) remains unclear despite significant research. The pathophysiologic mechanism of ENS was systematically reviewed. DATA SOURCES MEDLINE and Embase. REVIEW METHODS Data were systematically reviewed for studies that provided original data on pathophysiology. RESULTS A total of 2476 studies were screened, and 19 met the inclusion criteria: 13 case-control and 6 cross-sectional. Nine pathophysiologic themes were identified.• Demographics: ENS symptoms had no relationship with climatic factors.• Symptomatology: ENS patients demonstrated high symptom severity.• Mental health: Anxiety and depression including hyperventilation were reported in >50% of ENS patients and correlated with ENS symptom severity.• Anatomic features: Structural changes in response to turbinate surgery were similar between ENS and non-ENS patients.• Airflow analysis: Airflow parameters were similar between ENS and non-ENS patients after turbinate surgery. On computational fluid dynamic analysis, differences were found on multiple outcomes.• Diagnostic testing: The menthol detection test was impaired in ENS, and cotton placement in the airway improved ENS symptoms.• Cognitive function: Functional magnetic resonance imaging showed activation in emotional processing area during breathing.• Olfactory function: Subjective impairment was reported in ENS, but quantitative measures were similar to non-ENS patients.• Mucosal physiology/innate immunity: Turbinate histopathology in ENS showed a tissue-remodeling pattern. Nasal nitric oxide level was lower in ENS patients. CONCLUSION There is evidence of high comorbid mental health disorders in ENS patients. An abnormal trigeminal-thermoreceptor response may be present in some patients. The influence of altered airflow and the evidence of surgery as the cause for ENS are unclear.
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Affiliation(s)
- Dichapong Kanjanawasee
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Raewyn G Campbell
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Otorhinolaryngology-Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Woolcock Institute, University of Sydney, Sydney, Australia.,Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Jesada Kanjanaumporn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Larry Kalish
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Richard J Harvey
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Raymond Sacks
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia
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Gordiienko IM, Gubar OS, Sulik R, Kunakh T, Zlatskiy I, Zlatska A. Empty nose syndrome pathogenesis and cell-based biotechnology products as a new option for treatment. World J Stem Cells 2021; 13:1293-1306. [PMID: 34630863 PMCID: PMC8474723 DOI: 10.4252/wjsc.v13.i9.1293] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/29/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
Empty nose syndrome (ENS) is a rare complication that develops after partial or complete turbinectomy. The main feature of ENS is paradoxical nasal obstruction feeling despite objectively wide nasal airway. ENS pathogenesis is multifactorial and includes changes in laminar physiological airflow, disruption of mucosa functions and deficient neural sensation. This leads to the development of ENS symptomatology such as dyspnea, nasal dryness, nasal burning, nasal obstruction, feeling of suffocation and even comorbid psychiatric disorders that significantly impairs life quality. Specific effective treatment of ENS does not exist up to date. In this review we outline existing biomaterial for surgical reconstitution of nasal anatomy and discuss the perspective of stem cell-based technologies in ENS management. The main focus is directed to justification of rationality application of adult mesenchymal stem cells (MSCs) from different tissues origin and neural crest-derived stem cells (NCSCs) based on their intrinsic biological properties. MSCs transplantation may stimulate mucosa tissue regeneration via trophic factors secretion, direct transdifferentiation into epithelial cells and pronounced immunosuppressive effect. From the other hand, NCSCs based on their high neuroprotective properties may reconstitute nerve structure and functioning leading to normal sensation in ENS patients. We postulate that application of cell-based and tissue-engineered products can help to significantly improve ENS symptomatology only as complex approach aimed at reconstitution of nasal anatomy, recovery the nasal mucosa functionality and neural tissue sensation.
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Affiliation(s)
- Inna M Gordiienko
- Biotechnology Laboratory, Medical Company “Good Cells”, Kyiv 03115, Ukraine
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology NAS of Ukraine, Kyiv 03022, Ukraine
| | - Olga S Gubar
- Institute of Molecular Biology and Genetics NAS of Ukraine, Kyiv 03143, Ukraine
| | - Roman Sulik
- Biotechnology Laboratory, Medical Company “Good Cells”, Kyiv 03115, Ukraine
| | - Taras Kunakh
- Biotechnology Laboratory, Medical Company “Good Cells”, Kyiv 03115, Ukraine
| | - Igor Zlatskiy
- State Institute of Genetic and Regenerative Medicine, National Academy of Medical Sciences of Ukraine, Kyiv 04114, Ukraine
| | - Alona Zlatska
- Biotechnology Laboratory, Medical Company “Good Cells”, Kyiv 03115, Ukraine
- State Institute of Genetic and Regenerative Medicine, National Academy of Medical Sciences of Ukraine, Kyiv 04114, Ukraine
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Kim CH, Kim J, Song JA, Choi GS, Kwon JH. The Degree of Stress in Patients With Empty Nose Syndrome, Compared With Chronic Rhinosinusitis and Allergic Rhinitis. EAR, NOSE & THROAT JOURNAL 2019; 100:NP87-NP92. [PMID: 31272211 DOI: 10.1177/0145561319858912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Depression is a mental health disease of growing public health concern because depressive mood affects the sufferer's daily life and is also associated with productivity decline. Depression that is caused by other diseases or substances is referred to as secondary depression, which is an important distinction because curing the underlying cause could subsequently regulate depressive mood. Empty nose syndrome (ENS), also known as "paradoxical obstruction of the nose," is a condition in which the major symptom is difficulty breathing, despite having sufficient breathing space in the nose. Empty nose syndrome has been increasing in prevalence in Korea. We found that patients with this ENS have a tendency toward depressive mood, which can escalate so far as to lead to suicide attempts. Thus, herein, we aimed to investigate the psychological burden on patients with ENS. METHODS We divided patients into 4 groups: ENS (group A), chronic rhinosinusitis with polyp (CRS c polyp, group B), chronic rhinosinusitis without polyp (CRS s polyp, group C), and allergic rhinitis (AR, group D). We estimated and compared Beck Depression Inventory (BDI) scores among the 4 groups, and we investigated the relationship between depression index and nasal cavity area in patients with ENS. RESULTS The ENS group (A) had depression prevalence of 71% with varying severity, which was much higher than group B (19%), group C (15%), and group D (27%). The correlation between nasal cavity volume and BDI score for the ENS group was not statistically significant. CONCLUSION The degree and severity of depression in patients with ENS was higher than in patients with CRS or AR. Furthermore, there was no relationship between depression severity and nasal cavity volume in the patients with ENS. Thus, physicians should be careful not to dismiss the accompanying mental health problems of patients with ENS.
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Affiliation(s)
- Chang Hoi Kim
- Department of Otolaryngology-Head and Neck Surgery, 65366Kosin University College of Medicine, Busan, Korea
| | - Jooyeon Kim
- Department of Otolaryngology-Head and Neck Surgery, 65366Kosin University College of Medicine, Busan, Korea
| | - Ji Ah Song
- Department of Otolaryngology-Head and Neck Surgery, 65366Kosin University College of Medicine, Busan, Korea
| | - Gil Soon Choi
- Department of Internal Medicine, Allergic Division, 65366Kosin University College of Medicine, Busan, Korea
| | - Jae Hwan Kwon
- Department of Otolaryngology-Head and Neck Surgery, 65366Kosin University College of Medicine, Busan, Korea
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Kim DY, Hong HR, Choi EW, Yoon SW, Jang YJ. Efficacy and Safety of Autologous Stromal Vascular Fraction in the Treatment of Empty Nose Syndrome. Clin Exp Otorhinolaryngol 2018; 11:281-287. [PMID: 29764011 PMCID: PMC6222192 DOI: 10.21053/ceo.2017.01634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/29/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Regenerative treatment using stem cells may serve as treatment option for empty nose syndrome (ENS), which is caused by the lack of turbinate tissue and deranged nervous system in the nasal cavity. We aimed to assess the efficacy and safety of the autologous stromal vascular fraction (SVF) in the treatment of ENS. METHODS In this prospective observational clinical study, we enrolled 10 ENS patients who volunteered to undergo treatment of ENS through the injection of autologous SVF. Data, including demographic data, pre- and postoperative Sino-Nasal Outcome Test-25 (SNOT-25) scores, overall patient satisfaction, and postoperative complications, were prospectively collected. Nasal secretion was assessed using the polyurethane foam absorption method, and the levels of biological markers were analyzed in both ENS group and control group using enzyme-linked immunosorbent assay. The SVF extracted from abdominal fat was diluted and injected into both inferior turbinates. RESULTS Among the 10 initial patients, one was excluded from the study. Subjective satisfaction was rated as "much improved" in two and "no change" in seven. Among the improved patients, the mean preinjection SNOT-25 score was 55.0 and the score at 6 months after injection was 19.5. However, the average SNOT-25 score of nine participants at 6 months after injection (mean±standard deviation, 62.4±35.8) did not differ significantly from the baseline SNOT25 score (70.1±24.7, P>0.05, respectively). Among the various inflammatory markers assessed, the levels of interleukin (IL)-1β, IL-8, and calcitonin gene-related peptide were significantly higher in ENS patients. Compared with preinjection secretion level, the nasal secretions from SVF-treated patients showed decreased expressions of IL-1β and IL-8 after injection. CONCLUSION Although SVF treatment appears to decrease the inflammatory cytokine levels in the nasal mucosa, a single SVF injection was not effective in terms of symptom improvement and patient satisfaction. Further trials are needed to identify a more practical and useful regenerative treatment modality for patients with ENS.
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Affiliation(s)
- Do-Youn Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Ran Hong
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Yong Ju Jang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Ma ZX, Quan-Zeng, Jie-Liu, Hu GH. Assessment of postsurgical outcomes between different implants in patients with empty nose syndrome: A meta-analysis. J Int Med Res 2017; 45:1939-1948. [PMID: 29098901 PMCID: PMC5805217 DOI: 10.1177/0300060517715167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives The aim of this study was to evaluate the impact of surgery and different
implant materials on subjective outcomes in patients with empty nose
syndrome (ENS). Methods Postsurgical outcomes were assessed in a meta-analysis of patients with ENS
who underwent treatment with different implants. Results We identified 122 relevant studies, and 6 were included in the meta-analysis
(4 prospective trials and 2 randomized controlled trials). A significant
difference was found between the preoperative and postoperative Sino-Nasal
Outcome Test (SNOT) scores for different implants. With respect to implant
materials, significant differences were observed between
autografts/allografts (AG) and foreign material grafts (FGs). A subgroup
analysis of different countries showed that more patients from China
underwent surgical implant therapy than patients from other countries. Conclusions This meta-analysis suggests that surgery can improve the symptoms and SNOT
scores of patients with ENS, AGs are more effective than FGs in patients
with ENS, and that more patients from China undergo surgical implant therapy
than patients from other countries.
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Affiliation(s)
- Zu-Xia Ma
- 1 Department of Otorhinolaryngology, The First People's Hospital of Zunyi, Zunyi, China.,2 Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan-Zeng
- 2 Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie-Liu
- 2 Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guo-Hua Hu
- 2 Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Park MJ, Jang YJ. Successful management of primary atrophic rhinitis by turbinate reconstruction using autologous costal cartilage. Auris Nasus Larynx 2017; 45:613-616. [PMID: 28669540 DOI: 10.1016/j.anl.2017.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/29/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
Initial management of primary atrophic rhinitis is conservative, with nasal ointments, saline irrigation, and antibiotics prescribed to relieve symptoms. However, in cases that show no improvement, a surgical approach is considered. Recently, many studies have reported successful surgical outcomes using various nasal implants. However, no study has reported implantation of autologous costal cartilage in PAR patients. We report here the case of a 63-year-old woman diagnosed with PAR that was intractable to medical therapy. Under general anesthesia, bilateral inferior turbinate reconstruction with autologous costal cartilage was successfully performed without any complications. One month after surgery, her symptoms improved dramatically. At the 2-year follow-up, her Sinonasal Outcome Test 25 (SNOT-25) score was 6, down from an initial score of 108. Her OMU CT showed improved sinonasal mucosal thickness and disappearance of thick mucosal secretion compared with preoperative CT image. Although this is a single case experience, it is suggested that turbinate reconstruction using autologous costal cartilage can serve as promising surgical modality for management of atrophic rhinitis.
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Affiliation(s)
- Marn Joon Park
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Ju Jang
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Aesthetic and functional outcomes in patients with a nasal prosthesis. Int J Oral Maxillofac Surg 2017; 46:1446-1450. [PMID: 28521966 DOI: 10.1016/j.ijom.2017.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/09/2017] [Accepted: 04/27/2017] [Indexed: 02/03/2023]
Abstract
The aim was to evaluate the aesthetic and functional outcomes in patients with a nasal prosthesis after radical tumour resection. A questionnaire with 15 domains was created to evaluate the satisfaction of patients with their nasal prosthesis. Correlations with the results of the University of Washington Quality of Life (UWQOL) questionnaire, which was also completed by the patients, were analyzed. Forty-three patients with a partial or total nasal prosthesis completed the questionnaire. Twenty-seven patients were male and 16 were female; their median age was 62 years. The median follow-up time after tumour resection was 33 months. The best result was obtained for overall function (85.5) and the worst result for nasal crusts (58.5). The average daily duration of prosthesis use was 17.4h. There were sex-dependent and age-dependent differences in the domain 'self-confidence', age-dependent differences in the domain 'stability during sporting activities', and differences in the domain 'nose bleed' depending on the time since tumour resection. All patients would recommend this rehabilitation after rhinectomy. 'Satisfaction with function' had the most influence on UWQOL domains. The nasal prosthesis is a well-accepted rehabilitation after rhinectomy. The results for appearance are comparable to those obtained for nasal reconstruction, and high scores were found for the functional domains.
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Mangin D, Bequignon E, Zerah-Lancner F, Isabey D, Louis B, Adnot S, Papon JF, Coste A, Boyer L, Devars du Mayne M. Investigating hyperventilation syndrome in patients suffering from empty nose syndrome. Laryngoscope 2017; 127:1983-1988. [DOI: 10.1002/lary.26599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/16/2017] [Accepted: 03/07/2017] [Indexed: 11/05/2022]
Affiliation(s)
- David Mangin
- Department of Otorhinolaryngology and Facial Cervical Surgery; Intercommunal Hospital Center of Créteil; Créteil France
- Department of Otorhinolaryngology and Facial Cervical Surgery; Public Hospital Network of Paris, Henri Mondor Hospital; Créteil France
| | - Emilie Bequignon
- Department of Otorhinolaryngology and Facial Cervical Surgery; Intercommunal Hospital Center of Créteil; Créteil France
- Department of Otorhinolaryngology and Facial Cervical Surgery; Public Hospital Network of Paris, Henri Mondor Hospital; Créteil France
- National Institute of Health and Medical Research INSERM, U955, Institut Mondor Recherche Médical (IMRB); Créteil France
- Faculty of Medicine; Paris East University; Créteil France
- The national Center for Scientific Research CNRS, ERL 7240, Créteil, 94010, France
| | - Francoise Zerah-Lancner
- National Institute of Health and Medical Research INSERM, U955, Institut Mondor Recherche Médical (IMRB); Créteil France
- Faculty of Medicine; Paris East University; Créteil France
- The national Center for Scientific Research CNRS, ERL 7240, Créteil, 94010, France
- Department of Physiology and Functional Explorations; Public Hospital Network of Paris, Henri Mondor Hospital; Créteil France
| | - Daniel Isabey
- National Institute of Health and Medical Research INSERM, U955, Institut Mondor Recherche Médical (IMRB); Créteil France
- Faculty of Medicine; Paris East University; Créteil France
- The national Center for Scientific Research CNRS, ERL 7240, Créteil, 94010, France
| | - Bruno Louis
- National Institute of Health and Medical Research INSERM, U955, Institut Mondor Recherche Médical (IMRB); Créteil France
- Faculty of Medicine; Paris East University; Créteil France
- The national Center for Scientific Research CNRS, ERL 7240, Créteil, 94010, France
| | - Serge Adnot
- National Institute of Health and Medical Research INSERM, U955, Institut Mondor Recherche Médical (IMRB); Créteil France
- Faculty of Medicine; Paris East University; Créteil France
- Department of Physiology and Functional Explorations; Public Hospital Network of Paris, Henri Mondor Hospital; Créteil France
| | - Jean-François Papon
- National Institute of Health and Medical Research INSERM, U955, Institut Mondor Recherche Médical (IMRB); Créteil France
- The national Center for Scientific Research CNRS, ERL 7240, Créteil, 94010, France
- Department of Otorhinolaryngology and Facial Cervical Surgery; Public Hospital Network of Paris, Bicêtre Hospital; Le Kremlin-Bicêtre France
- Faculty of Medicine; Paris South University; Le Kremlin-Bicêtre France
| | - André Coste
- Department of Otorhinolaryngology and Facial Cervical Surgery; Intercommunal Hospital Center of Créteil; Créteil France
- Department of Otorhinolaryngology and Facial Cervical Surgery; Public Hospital Network of Paris, Henri Mondor Hospital; Créteil France
- National Institute of Health and Medical Research INSERM, U955, Institut Mondor Recherche Médical (IMRB); Créteil France
- Faculty of Medicine; Paris East University; Créteil France
- The national Center for Scientific Research CNRS, ERL 7240, Créteil, 94010, France
| | - Laurent Boyer
- National Institute of Health and Medical Research INSERM, U955, Institut Mondor Recherche Médical (IMRB); Créteil France
- Faculty of Medicine; Paris East University; Créteil France
- Department of Physiology and Functional Explorations; Public Hospital Network of Paris, Henri Mondor Hospital; Créteil France
| | - Marie Devars du Mayne
- Department of Otorhinolaryngology and Facial Cervical Surgery; Intercommunal Hospital Center of Créteil; Créteil France
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Saafan ME, Hegazy HM, Albirmawy OA. Empty nose syndrome: etiopathogenesis and management. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2016. [DOI: 10.4103/1012-5574.186540] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thamboo A, Velasquez N, Ayoub N, Nayak JV. Distinguishing computed tomography findings in patients with empty nose syndrome. Int Forum Allergy Rhinol 2016; 6:1075-1082. [PMID: 27409044 DOI: 10.1002/alr.21774] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/13/2016] [Accepted: 02/19/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Given the lack of basic diagnostic criteria for empty nose syndrome (ENS), we sought to define whether consistent radiographic characteristics could be identified to aid in the development of such criteria. METHODS Computed tomography (CT) scans were collected from 65 patients diagnosed with ENS, patients with a history of submucosal inferior turbinate reduction (ITR) without ENS, and patients without a history of sinonasal procedures. Measurements were taken at the level of the nasolacrimal duct, including the inferior turbinate (IT) mucosal thickness, and the widest distances between septum-IT, nasal floor-IT, lateral nasal wall-IT, and septum-lateral nasal wall. The thickest sites of soft tissue density of the nasal cavity floor, septum, and lateral wall were also measured in the anterior, central, and posterior segments of the nasal cavity. RESULTS The mucosal thickness of both the central and posterior segments of the septum in ENS subjects was significant when compared to ITR without ENS (p < 0.01) and control subjects (p < 0.01). Constant landmarks such as the agger nasi, the presence of middle turbinate, and the nasolacrimal duct defined a simple set of landmarks that can serve as the start of the central-nasal region, and a cutoff >2.64 mm and >1.32 mm in the central nasal and posterior nasal regions provided the highest likelihood of differentiating ENS patients from ITR without ENS patients. CONCLUSION These findings provide evidence there are 2 objective radiographic changes (central and posterior septal mucosa) that suggest ENS patients can be discriminated based on mucosal CT findings.
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Affiliation(s)
- Andrew Thamboo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Nathalia Velasquez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Noel Ayoub
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
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Bastier PL, Fierens S, Champel S, Ribadeau-Dumas A, de Gabory L. ß-Tricalcium Phosphate Implants in the Surgical Treatment of Empty Nose Syndrome. Otolaryngol Head Neck Surg 2016; 155:514-7. [PMID: 27143707 DOI: 10.1177/0194599816644908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/28/2016] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess the efficacy and morbidity of a β-tricalcium phosphate implant in the treatment of empty nose syndrome after turbinectomy. Only patients with a history of inferior turbinectomy and a complaint of permanent paradoxical nasal obstruction were included. β-Tricalcium phosphate ceramic implants were implanted under the mucoperiosteal plane of the lateral nasal wall to replace the head of the inferior turbinate. Symptoms and quality of life were assessed by 2 questionnaires: the Nasal Obstruction Symptom Evaluation and Rhinosinusitis Quality of Life. Fourteen patients were included. The mean follow-up was 19.4 ± 13.4 months. Scores for the Nasal Obstruction Symptom Evaluation and Rhinosinusitis Quality of Life (frequency, bothersomeness, and impact) significantly improved after surgery (respectively, 73.9 ± 21.8 to 34.6 ± 28.6, 44.6 ± 17.1 to 34.8 ± 20.3, 43.6 ± 22.4 to 70.7 ± 21.5, and 59.9 ± 21.1 to 27.2 ± 25.3; P < .05). The use of ß-tricalcium phosphate seems efficient to repair empty nose syndrome by endonasal microplasty and shows a low complication rate.
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Affiliation(s)
- Pierre-Louis Bastier
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Centre F-X Michelet, Bordeaux, France
| | - Sylvestre Fierens
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Centre F-X Michelet, Bordeaux, France
| | - Sylvain Champel
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Centre F-X Michelet, Bordeaux, France
| | - Alix Ribadeau-Dumas
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Centre F-X Michelet, Bordeaux, France
| | - Ludovic de Gabory
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Centre F-X Michelet, Bordeaux, France
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21
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Acupuncture treatment of empty nose syndrome: A case report. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2016. [DOI: 10.1016/j.jtcms.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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22
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Hong HR, Jang YJ. Correlation between remnant inferior turbinate volume and symptom severity of empty nose syndrome. Laryngoscope 2015; 126:1290-5. [DOI: 10.1002/lary.25830] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/11/2015] [Accepted: 11/19/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Hye Ran Hong
- Department of Otolaryngology; Asan Medical Center, College of Medicine, University of Ulsan; Seoul Republic of Korea
| | - Yong Ju Jang
- Department of Otolaryngology; Asan Medical Center, College of Medicine, University of Ulsan; Seoul Republic of Korea
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23
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Velasquez N, Huang Z, Humphreys IM, Nayak JV. Inferior turbinate reconstruction using porcine small intestine submucosal xenograft demonstrates improved quality of life outcomes in patients with empty nose syndrome. Int Forum Allergy Rhinol 2015; 5:1077-81. [PMID: 26332403 DOI: 10.1002/alr.21633] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/08/2015] [Accepted: 07/28/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND We describe the surgical technique for use of small intestine submucosal (SIS) xenograft implant for inferior turbinate reconstruction and report our early results in a pilot case series of patients suffering from symptoms consistent with empty nose syndrome (ENS). METHODS We report an observational prospective cohort study of ENS patients undergoing inferior turbinate reconstruction using porcine SIS xenograft. Effects of the procedure on quality of life (QOL) were assessed through serial 25-item Sino-Nasal Outcome Test (SNOT-25) scores and analyzed by 1-way analysis of variance (ANOVA) between the initial visit and 1, 4, and 12 weeks after surgery. RESULTS Three patients with ENS underwent inferior turbinate reconstruction. No unexpected complications were noted over the 12-week follow-up course. Despite mild partial reabsorption of the SIS implant, neoturbinates were maintained in all patients. The mean preoperative score SNOT-25 was 77.6 (maximum 125). The mean postoperative scores were 65 at 1 week, 57 at 4 weeks, and 55 at 12 weeks (p < 0.01). Furthermore, for the "difficulty with nasal breathing" and "nose is too open" subdomains, statistically significant improvement was also noted at weeks 4 and 12 postoperatively (p < 0.05 and p <0.01, respectively). CONCLUSION The use of porcine SIS xenograft for inferior turbinate reconstruction appears to be safe and effective in the treatment of patients diagnosed with ENS. This study demonstrates statistically significant improvement in global QOL metrics and nasal-specific subdomains following inferior turbinate reconstruction/neoturbinate creation for ENS as evaluated through serial SNOT-25 scores.
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Affiliation(s)
- Nathalia Velasquez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.,Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
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Abstract
Empty nose syndrome (ENS) is a rare, late complication of turbinate surgery. The most common clinical symptoms are paradoxical nasal obstruction, nasal dryness and crusting, and a persistent feeling of dyspnea. Little is known about the pathogenesis of ENS, though it is speculated that anatomical changes leading to alterations in local environment, disruption of mucosal cooling, and disruption of neurosensory mechanisms are strongly implicated. The diagnosis is clinical, though often difficult to make due to the poor correlation between subjective and objective findings. Medical therapies include mucosal humidification, irrigations, and emollients. Surgical therapy should be reserved for refractory cases and may involve turbinate reconstruction, most commonly using implantable biomaterials. Ultimately, prevention of this feared complication through turbinate-sparing techniques is essential.
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25
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Leong SC. The clinical efficacy of surgical interventions for empty nose syndrome: A systematic review. Laryngoscope 2015; 125:1557-62. [PMID: 25647010 DOI: 10.1002/lary.25170] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/01/2014] [Accepted: 12/18/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the outcomes of surgical intervention for empty nose syndrome (ENS). DATA SOURCE Cochrane Collaboration database, U.S National Institutes of Health database (ClinicalTrials), U.S National Library of Medicine (PubMed). REVIEW METHODS Structured search using medical subject-heading terms: nose, turbinate, surgery, atrophic rhinitis, and empty nose syndrome. RESULTS A total of 128 patients were collated from eight studies with an age range of 18 to 64 years. Most patients had been suffering with ENS for many years, up to 29.7 years. The most common surgical technique involved a transnasal approach with implant material secured within a submucosal pocket. Common implant material used in the studies included biosynthetic, and autologous cartilage. The weighted mean preoperative Sino-Nasal Outcome Test (SNOT)-20 and SNOT-25 scores were 48.3 and 65.9, respectively. At latest follow-up, these scores improved significantly to 24.4 and 33.3, respectively. Although all SNOT subdomains improved following surgery, the highest improvement was observed in ENS symptoms and psychological issues. SNOT scores improved by 3 months postsurgery and this trend continued over time, although available data was limited to only 12 months follow-up. Nevertheless, 10 patients had less than 10 points improvement, including three patients who had no change in SNOT scores. Extrusion of the implant occurred in six cases, and one developed chronic rhinosinusitis. CONCLUSION Surgical intervention for ENS appears to result in clinical improvement, although not all patients derived benefit. Long-term follow-up should be considered utilizing using both subjective (SNOT-25) and objective (rhinomanometry) measures of clinical outcome.
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Affiliation(s)
- Samuel C Leong
- Division of Rhinology and Anterior Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Aintree, Liverpool, United Kingdom
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Jung JH, Baguindali MA, Park JT, Jang YJ. Costal cartilage is a superior implant material than conchal cartilage in the treatment of empty nose syndrome. Otolaryngol Head Neck Surg 2013; 149:500-5. [PMID: 23728068 DOI: 10.1177/0194599813491223] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the outcomes of endonasal microplasty in treating empty nose syndrome by comparing the use of costal and conchal cartilage implants to construct neoturbinates. STUDY DESIGN Case series with chart review. SETTING Tertiary referral center. SUBJECTS AND METHODS A total of 31 patients who were diagnosed with empty nose syndrome and underwent endonasal microplasty with conchal cartilage (n = 17) or costal cartilage implants (n = 14) were included. Each patient's clinico-demographic profile was reviewed to compare the conchal cartilage group and the costal cartilage groups. Pre- and postoperative Sino-Nasal Outcome Test (SNOT-25) scores were also compared. RESULTS Both groups showed a significant improvement in SNOT-25 scores following surgery (P < .05). The group who received costal cartilage implants demonstrated more significant improvements than the conchal cartilage group in terms of the mean difference between pre- and postoperative SNOT-25 scores (P = .023). Symptom outcomes related to depression demonstrated significant improvements in the conchal cartilage group (P < .05), while in the costal cartilage group, in addition to these 3 variables, 7 items related to functional problems also demonstrated significant improvements (P < .05). CONCLUSIONS Costal cartilage is a more useful material than conchal cartilage as implants for the treatment of empty nose syndrome patients.
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Affiliation(s)
- Jae Hoon Jung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
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Jiang C, Shi R, Sun Y. Study of inferior turbinate reconstruction with Medpor for the treatment of empty nose syndrome. Laryngoscope 2012. [PMID: 23208803 DOI: 10.1002/lary.23908] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patients with empty nose syndrome experience considerable discomfort in their daily lives and treatment is difficult for their physicians. The purpose of this study was to evaluate the outcome of an empty nose syndrome treatment via reconstruction of the inferior turbinate with porous polyethylene (Medpor). DESIGN AND METHOD A prospective self-controlled study was conducted, and 19 patients suffering from empty nose syndrome underwent a surgical therapy through submucosal implantation of Medpor in order to reconstruct their inferior turbinate. The outcome was assessed by comparison of the preoperative and follow-up symptoms, nasal endoscopy findings, CT scans, mucociliary clearance, acoustic rhinometry, and the Sino-Nasal Outcome Test-20 scores. RESULTS In a follow-up period of 3 to 18 months, all patients reported subjective symptom improvements and a statistically significant improvement of the Sino-Nasal Outcome Test scores was achieved (P < 0.05). Mucociliary clearance assessments showed improvements at 3, 6, and 12 months postoperatively, but without statistical significance. Acoustic rhinometry assessments showed postoperative improvements of nasal resistance, nasal volume, and minimum cross-sectional area with a significant overall average score (P < 0.05). CONCLUSION The reconstruction of inferior turbinate with Medpor is a new promising approach to treat patients with empty nose syndrome. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Chenyan Jiang
- Department of Otorhinolaryngology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine & Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
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Empty nose syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:93-7. [DOI: 10.1016/j.anorl.2012.02.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 02/15/2012] [Indexed: 02/07/2023]
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