Mental health burden of empty nose syndrome compared to chronic rhinosinusitis and chronic rhinitis

Abstract

Background Empty nose syndrome (ENS) is characterized by the paradoxical perception of nasal obstruction despite patent sinonasal anatomy after surgery. We investigated the relationship between ENS, and anxiety, depression, obsessive‐compulsive disorder, and somatic symptom disorder (SSD) compared to individuals with chronic rhinitis (CR) and chronic rhinosinusitis (CRS). Methods This cross‐sectional survey study compared ENS and CR and CRS patients. A total of 116 patients participated: 58 ENS patients from digital support groups, and 58 CRS and CR patients from tertiary rhinology clinics. Study participants completed four validated surveys: (1) Empty Nose Syndrome 6‐Item Questionnaire, (2) Rhinosinusitis Disability Index (RSDI), (3) Obsessive Compulsive Inventory – Revised (OCI‐R), and (4) PRIME MD Patient Health Questionnaire (PHQ). Results ENS patients exhibited a mean RSDI of 78.6, 95% confidence interval [CI] 72.8–84.5, compared to 25.2, 95% CI 18.6–31.8 for CRS/CR patients (p < 0.0001). This difference was seen across all subdomains. Using the PHQ, 53% of ENS patients met diagnostic thresholds for SSD compared to 14% of CRS patients (p < 0.0001). In relation to obsessive compulsive disorder (OCD), 18.37% of ENS patients compared to 8.62% of CRS/CR patients scored above the diagnostic threshold (>21) on the OCI‐R questionnaire (p = 0.159). Conclusion ENS patients had diminished sinonasal quality of life and a higher prevalence of comorbid anxiety and depression, compared to CR and CRS. ENS patients were more likely to exceed thresholds for OCD and SSD compared to controls. Future studies are needed to assess the role of SSD in ENS to help optimize treatment for these complex patients.

Identifying Residual Psychological Symptoms after Nasal Reconstruction Surgery in Patients with Empty Nose Syndrome

“…Previous studies have demonstrated that anxiety and depression are prevalent comorbidities in patients with ENS [ 13 , 14 , 15 , 16 ]. Surgical reconstruction of the nasal cavity can reduce the airspace as well as the airflow in ENS patients and is effective in improving both nasal and psychological symptoms.…”

“…Beyond physical symptoms, patients with ENS may carry significant psychological symptoms, including chronic fatigue, frustration, irritability, anger, anxiety, and depression [ 13 , 14 , 15 , 16 ]. Using a questionnaire investigation, our previous study showed that 51% of ENS patients experienced comorbid depression and 73% experienced comorbid anxiety [ 15 ].…”

Development of Injectable Calcium Sulfate and Self-Setting Calcium Phosphate Composite Bone Graft Materials for Minimally Invasive Surgery

“…The symptoms are most often referred as the presence of paradoxical nasal obstruction despite an objectively patent nasal cavity, a lack of airflow sensation, a feeling of suffocation, nasal dryness, and neuropathic pain [ 40 ]. The first line of management includes nasal moisturization and humidification, supportive therapies of concomitant medical conditions (e.g., panic, anxiety, and depression) [ 41 , 42 ], and surgery. Surgical treatment to augment the loss of turbinate volume with temporary fillers, synthetic implants, and autologous materials has been reported to be an effective method [ 38 , 40 , 43 ].…”

A 3‐year follow‐up study after nasal reconstruction surgery in patients with empty nose syndrome

“…The Chinese versions of the Sino‐Nasal Outcome Test‐25 (SNOT‐25), ENS6Q, Beck Anxiety Inventory (BAI), and Beck Depression Inventory‐II (BDI‐II) were used to assess the severity of symptoms and psychological burden (depression and anxiety) before and after surgery 2,7,8 . Questionnaire surveys were completed by participants in person when returned to the clinic.…”