Assessment of Surgical Results in Patients With Empty Nose Syndrome Using the 25-Item Sino-Nasal Outcome Test Evaluation

Abstract

IMPORTANCE Empty nose syndrome (ENS) is an iatrogenic disorder, which severely affects the normal nasal breathing function. People affected by ENS may experience decreased productivity and lifestyle disruption. The 20-Item Sino-Nasal Outcome Test (SNOT-20) is a validated quality-of-life measurement and can be used to compare before and after intervention outcomes. OBJECTIVES To evaluate the effectiveness of the Medpor implant (Porex Surgical Inc) to improve the disease-specific quality of life in patients with ENS and to validate the 25-Item SNOT (SNOT-25) as an assessment tool in patients with ENS. DESIGN, SETTING, AND PARTICIPANTS We prospectively enrolled 24 patients from our hospital who received inferior turbinate reconstruction surgery after drug therapy failed to improve their symptoms. INTERVENTIONS All the patients underwent submucosal Medpor implant surgery to reconstruct their inferior turbinate. MAIN OUTCOMES AND MEASURES Patient assessments were based on the SNOT-25 questionnaire prior to surgery and at 3, 6, and 12 months after surgery. RESULTS The total scores of the SNOT-25 declined postoperatively, showing a significant difference at 3, 6, and 12 months after surgery compared with their initial visit (P = .045, P < .001, and P < .001, respectively). The 5 items most frequently reported by patients as important at their initial visit were "fatigue," "reduced concentration," "sadness," "dryness," and "nose is too open." The mean overall scores for these 5 important items also declined, showing statistically significant decreases compared with their initial visit (P < .05) and indicating that the items patients believed were important had improved. CONCLUSIONS AND RELEVANCE Medpor implant surgery in patients with ENS is associated with statistically significant improvements in disease-specific quality of life measures. The modified version of SNOT-20 Health Survey Scales, the SNOT-25,may be a useful measurement tool in patients with ENS.

Correlation between remnant inferior turbinate volume and symptom severity of empty nose syndrome

“…One of the strengths of our current study is the presentation of objective data on remnant inferior turbinate volume and its relationship with subjective symptoms in ENS patients. Previous studies have only focused on the subjective symptoms of these patients 2,3,8,11,[16][17][18] or were unable to clearly reveal the direct correlation between subjective symptoms and remnant turbinate tissue, which is strongly associated with aerodynamics, nasal humidification, temperature control, and mucociliary clearance of the nasal cavity. 5,6,[19][20][21][22] However, it was a single-center study with a small number of subjects, and therefore the limited statistical power is main weakness of this study.…”

“…Jiang et al reported that ENS patients seem to be in a constant state of dyspnea and felt suffocated due to decreased airflow resistance. Moreover, the constant abnormal breathing sensations lead to reduced concentration; chronic fatigue; and mood problems such as frustration, irritability, anger, and depression . Eventually, they explained that all of symptoms, including extra‐sinonasal and nose‐specific symptoms in ENS patients, must be related to reductions of turbinate tissue.…”

“…Moreover, the constant abnormal breathing sensations lead to reduced concentration; chronic fatigue; and mood problems such as frustration, irritability, anger, and depression. 16 Eventually, they explained that all of symptoms, including extra-sinonasal and nose-specific symptoms in ENS patients, must be related to reductions of turbinate tissue. However, our data indicate a positive correlation between extra-sinonasal symptoms and ITV in ENS.…”

Evaluation of depression and anxiety in empty nose syndrome after surgical treatment

“…In our previous retrospective study, the 22‐item Sino‐Nasal Outcome Test was applied in patients with ENS, and it was found that submucosal implantation of Medpor over the septum or nasal wall is a feasible surgical treatment for long‐term symptom relief . Houser and various other authors also showed clinical improvement after surgical intervention for ENS . The key outcome measurement used in our previous study and the studies mentioned above was the Sino‐Nasal Outcome Test (SNOT).…”

“…3 Houser and various other authors also showed clinical improvement after surgical intervention for ENS. 1,[6][7][8] The key outcome measurement used in our previous study and the studies mentioned above was the Sino-Nasal Outcome Test (SNOT). Although SNOT consisted of several symptoms in the psychological domain, it is not able to identify clinically meaningful psychological disorders and delineate nonclinical subjects.…”