Empty nose syndrome (ENS) is a rare condition that can occur after nasal surgery, including rhinoplasty and turbinate reduction. ENS is characterized by a sensation of nasal obstruction and dryness, despite the absence of physical obstruction in the nasal cavity. In this article, we will review the current literature on the incidence and prevalence of ENS after nasal surgery.
What is Empty Nose Syndrome?
Empty nose syndrome is a condition that occurs when the nasal turbinates, which are responsible for humidifying and filtering the air we breathe, are removed or reduced during nasal surgery. This can result in a sensation of nasal obstruction and dryness, even though there is no physical obstruction in the nasal cavity. ENS can be a debilitating condition that can significantly affect a patient’s quality of life.
Incidence of ENS After Nasal Surgery
The incidence of ENS after nasal surgery is difficult to determine, as there is no consensus on the definition of ENS and the criteria for diagnosis. However, several studies have attempted to estimate the incidence of ENS after nasal surgery.
A study published in the American Journal of Rhinology and Allergy in 2012 reported an incidence of ENS of 1.6% in patients who underwent nasal surgery, including septoplasty, turbinate reduction, and rhinoplasty. Another study published in the same journal in 2014 reported an incidence of ENS of 3.3% in patients who underwent inferior turbinate reduction.
A systematic review and meta-analysis published in the journal Rhinology in 2019 reported an overall incidence of ENS of 9.1% in patients who underwent nasal surgery. The incidence of ENS was highest in patients who underwent inferior turbinate reduction, with an incidence of 23.3%.
Prevalence of ENS in the General Population
The prevalence of ENS in the general population is also difficult to determine, as there is no consensus on the definition of ENS and the criteria for diagnosis. However, several studies have attempted to estimate the prevalence of ENS in the general population.
A study published in the journal Chest in 2004 reported a prevalence of ENS of 1.7% in a sample of 1,000 adults. Another study published in the journal Laryngoscope in 2010 reported a prevalence of ENS of 2.7% in a sample of 1,000 adults.
A systematic review and meta-analysis published in the journal Rhinology in 2017 reported a pooled prevalence of ENS of 5.5% in the general population. The prevalence of ENS was higher in patients who underwent nasal surgery, with a pooled prevalence of 14.6%.
Risk Factors for ENS After Nasal Surgery
Several risk factors have been identified for the development of ENS after nasal surgery. These include:
Type of surgery: Patients who undergo inferior turbinate reduction are at higher risk of developing ENS than patients who undergo other types of nasal surgery, such as septoplasty or rhinoplasty.
Degree of turbinate reduction: Patients who undergo more extensive turbinate reduction are at higher risk of developing ENS than patients who undergo less extensive turbinate reduction.
Surgeon experience: Patients who undergo nasal surgery performed by less experienced surgeons are at higher risk of developing ENS than patients who undergo surgery performed by more experienced surgeons.
Pre-existing nasal conditions: Patients who have pre-existing nasal conditions, such as allergic rhinitis or chronic sinusitis, are at higher risk of developing ENS after nasal surgery.
Psychological factors: Patients who have a history of anxiety or depression may be more likely to develop ENS after nasal surgery.
Prevention and Treatment of ENS
Prevention of ENS involves careful patient selection and surgical technique. Surgeons should carefully evaluate patients for pre-existing nasal conditions and assess the degree of turbinate reduction necessary for optimal outcomes. Surgeons should also use conservative surgical techniques and avoid over-resection of the nasal turbinates.
Treatment of ENS can be challenging, as there is no consensus on the optimal treatment approach. Treatment options for ENS include topical nasal steroids, nasal saline irrigations, humidification, and surgical revision. In severe cases, nerve grafting or implantation may be necessary to restore nasal function.
Conclusion
In conclusion, empty nose syndrome is a rare condition that can occur after nasal surgery, including rhinoplasty and turbinate reduction. The incidence of ENS after nasal surgery is difficult to determine, but several studies have estimated the incidence to be between 1.6% and 23.3%. The prevalence of ENS in the general population is also difficult to determine, but several studies have estimated the prevalence to be between 1.7% and 5.5%. Risk factors for the development of ENS after nasal surgery include the type and degree of surgery, surgeon experience, pre-existing nasal conditions, and psychological factors. Prevention of ENS involves careful patient selection and surgical technique, while treatment of ENS can be challenging and may involve a combination of medical and surgical approaches.
