A Systematic Review and Meta‐Analysis of Management Options for Empty Nose Syndrome: A Proposed Management Algorithm

Author:

Hussain Salman1ORCID,Hayat Jafar2,Almhanedi Hamad3,Alherz Mohammad4,Ebrahim Mahmoud3,Lari Ali5,Thamboo Andrew6

Affiliation:

1. Department of Otolaryngology–Head and Neck Surgery University of Ottawa Ottawa Ontario Canada

2. Faculty of Medicine University of Manchester Manchester UK

3. Department of Otolaryngology–Head and Neck Surgery McGill University Montreal Canada

4. Department of Anatomy Trinity College Dublin Dublin Ireland

5. Department of Orthopedic Surgery Alrazi Hospital Kuwait

6. Department of Otolaryngology–Head and Neck Surgery, St. Paul's Sinus Centre University of British Columbia Vancouver British Columbia Canada

Abstract

AbstractObjectiveEmpty nose syndrome (ENS) is an acquired condition characterized by paradoxical nasal obstruction and sensation of nasal dryness often accompanied by psychological disorders such as depression or anxiety, typically occurring after the loss of inferior turbinate tissue or volume in the setting of prior sinonasal surgery. This review aims to identify and evaluate the reported management options.Data SourcesPubMed, Scopus, and Web of Science.Review MethodsThe terms “empty nose syndrome” OR “atrophic rhinitis” were used in a systematic search of original articles since the year 1990, yielding 1432 individual studies. These were screened on the Covidence platform for inclusion if any intervention was reported for the treatment of ENS. A pooled analysis of standardized mean differences (SMDs) combined with a random effects model was employed to report outcomes in Empty Nose 6‐Item Questionnaire (ENS6Q), Sino‐Nasal Outcome Test (SNOT), anxiety, and depression scores.ResultsA total of 35 articles were included, comprising 957 individual ENS patients. Surgical interventions mostly in the form of meatus augmentation implants accounted for 26 out of the 36 articles. The remaining ten articles included medical and psychological management options. SMD in SNOT, ENS6Q, anxiety, and depression scores were reported and demonstrated statistically significant improvements in follow‐up periods of up to 1 year. All articles reported favorable outcomes following their chosen interventions.ConclusionThere is a paucity of evidence on the management of ENS and an absence of randomized controlled trials. Surgical intervention appears to be the current mainstay of treatment, but there is a potential role for psychological and medical management.

Publisher

Wiley

Reference36 articles.

1. Empty nose syndrome pathogenesis and cell‐based biotechnology products as a new option for treatment;Gordiienko IM;World J Stem Cells,2021

2. Management of postsurgical empty nose syndrome;Talmadge J;Facial Plast Surg Clin North Am,2019

3. Empty nose syndrome;Coste A;Eur Ann Otorhinolaryngol Head Neck Dis,2012

4. The functional and psychological burden of empty nose syndrome;Manji J;Int Forum Allergy Rhinol,2018

5. Empty nose syndrome and atrophic rhinitis;Shah K;Ann Allergy Asthma Immunol,2016

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