Suicidal thoughts in patients with empty nose syndrome

Cc, Huang; Wu, Pei‐Wen; Lee, Cheng‐Chi; Huang, Chi‐Che; Lee, Ta‐Jen

doi:10.1002/lio2.730

Cited by 12 publications

(12 citation statements)

References 29 publications

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“…Another study also reported on a cohort of ENS individuals carrying a significant psychological burden and marked difficulties with many activities of daily life, suggesting a multimodal approach that included the surgical construction of tissues and cognitive–behavioral therapy (CBT) to address the psychological issue [ 13 ]. Our previous study also demonstrated that suicidal thoughts were frequently identified in patients with ENS [ 19 ]. Empty nose syndrome patients with suicidal thoughts experienced significantly more severe symptoms, impaired quality of life, and greater psychological burden than those without suicidal thoughts.…”

Section: Discussionmentioning

confidence: 96%

“…Furthermore, the severity of preoperative psychological symptoms is an important determining factor for surgical outcomes and residual disease after nasal reconstruction surgery [ 18 ]. Suicidal ideation can be identified in up to 37.1% and 6.5% of patients with ENS before and after nasal reconstruction surgery, respectively [ 19 ]. Thus, it is important to evaluate psychological symptoms in patients with ENS, even after nasal reconstruction surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Huang

et al. 2023

JCM

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Background: Empty nose syndrome (ENS) is a syndrome of paradoxical nasal obstruction that is thought to be mostly caused by inappropriate turbinate procedures. This study aimed to investigate depression- and anxiety-associated psychological symptoms in patients with ENS before and after surgical reconstruction, and to compare them with those of control subjects. Methods: Patients with ENS were prospectively enrolled. The Sino-Nasal Outcome Test-25 (SNOT-25), Empty Nose Syndrome 6-item questionnaire (ENS6Q), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) were used to evaluate the participants before and after reconstruction surgery with submucosal Medpor implantation (Stryker, Kalamazoo, MI), as well as control subjects at enrollment. Results: Forty patients with ENS and forty age- and sex-matched controls were recruited. Patients with ENS experienced significant improvement in SNOT-25, ENS6Q, BDI-II, and BAI scores after surgery, but all were significantly greater than those in the control group. Nine patients with ENS (22.5%) had postoperative residual psychological symptoms. Preoperative BDI-II and BAI scores were significant predictors of postoperative residual psychological symptoms. The optimal cut-off value was BDI-II > 28.5 (sensitivity, 77.8%; specificity, 77.4%) in receiver operating characteristic curve analysis. Conclusions: The nasal and psychological evaluations in patients with ENS significantly improved after nasal reconstruction surgery, but both were significantly greater than those in the control group. Identifying individuals who may experience postoperative residual symptoms and providing a multimodal approach, including surgical reconstruction and psychiatric treatment, are suggested.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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

Huang

et al. 2023

JCM

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“…Depression is a common psychiatric health issue affecting an estimated 5% of adults worldwide. 39 However, approximately 70% of patients with ENS have been shown to experience depression 4 , 6 , 11 which is much higher than the global prevalence. In this present investigation, 68.6% presented a depressive status before surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Utility of Serum Interleukine-6 Level in Empty Nose Syndrome

Hsueh¹,

Lee²,

Huang³

et al. 2023

Int. J. Med. Sci.

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Objectives: Empty nose syndrome (ENS), a complication resulting from surgical procedures on turbinate tissue, is characterized by paradoxical nasal obstruction with wide nasal airways. Patients with ENS often also experience psychiatric symptoms, and psychiatric disorder detection remains dependent on subjective evaluation. Objective biomarkers for mental status assessment in patients with ENS are unestablished. This study aimed to evaluate the role of serum interleukin-6 (IL-6) levels in the mental status of patients with ENS. Methods: Overall, 35 patients with ENS who underwent endonasal submucosal implantation surgery were prospectively included in the study. The Sino-Nasal Outcome Test-25 (SNOT-25), Empty Nose Syndrome 6-item Questionnaire (ENS6Q), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II) were used to assess the physical and psychiatric symptoms of these patients preoperatively, and 3, 6, and 12 months postoperatively. Serum IL-6 levels were analyzed 1 day before surgery. Results: All subjective assessments significantly improved 3 months after surgery and plateaued at 12 months. Patients with higher serum preoperative IL-6 levels tended to experience more severe depression. Regression analysis showed that a preoperative serum IL-6 level > 1.985 pg/mL was significantly correlated with severe depression status in patients with ENS (odds ratio = 9.76, p = 0.020). Conclusions: ENS patients with higher preoperative serum IL-6 levels were more likely to have severe depressive burden. Since more suicidal thoughts or attempts were noted in these patients, timely treatment plan for patients with high levels of serum IL-6 is crucial and may consider psychotherapy after surgical treatment.

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“…One systematic review with six studies found that anxiety and depression were elevated in ENS patients (65%-73% and 51%-71%, respectively) [8] . One cross-sectional study found a high prevalence of anxiety and depression warranting treatment, with decreased productivity at work and other activities [14] . Symptom severity correlated with depression and anxiety severity, overall pain/ discomfort, and impairment in activities of daily living.…”

Section: Symptomsmentioning

confidence: 99%

Empty nose syndrome

Go,

Deane,

Friedman

2024

Plast Aesthet Res

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Empty nose syndrome (ENS) is an iatrogenic condition that results from traumatic injury, often overresection, of the turbinates during sinonasal surgery. The underlying etiology is not entirely understood but is thought to have multifactorial contributions including alterations in the native nasal airway anatomy, abnormal mucosal and neural healing, and decreased trigeminal sensitivity, among other possibilities and contributors. Patients typically present with an intense fixation on their sensations of nasal obstruction and congestion despite an anatomically patent airway on examination. Because many patients with ENS have been shown to have significant psychiatric comorbidities, multidisciplinary specialist care including psychiatry and pain services is essential. Diagnosis is often difficult due to the variability of presentation and severity of symptoms, but standard assessments exist including the empty nose syndrome 6-item questionnaire (ENS6Q) and cotton test. Patients can be initially managed with conservative measures through humidification, moisturization, and psychiatric testing/referral. Procedural approaches to improve the nasal airway include submucosal implantation of temporary, semi-permanent, and permanent materials. A realistic and empathetic approach to patient communication is necessary in order to help manage patients with ENS, and all plastic surgeons performing septorhinoplasty should be aware of the risk and treatment options of the disease.

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Suicidal thoughts in patients with empty nose syndrome

Cited by 12 publications

References 29 publications

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

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

Utility of Serum Interleukine-6 Level in Empty Nose Syndrome

Empty nose syndrome

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