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Update on empty nose syndrome

disease mechanisms, diagnostic tools, and treatment strategies

Gill, Amarbir S.a; Said, Menab; Tollefson, Travis T.a; Steele, Toby O.a,c

Current Opinion in Otolaryngology & Head and Neck Surgery: August 2019 - Volume 27 - Issue 4 - p 237–242
doi: 10.1097/MOO.0000000000000544
FACIAL PLASTIC SURGERY: Edited by Travis T. Tollefson
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Purpose of review To discuss the proposed pathophysiology of empty nose syndrome (ENS), summarize and evaluate the role of validated diagnostic tools in the diagnosis of ENS, and review the medical and surgical treatment strategies for patients with ENS.

Recent findings Historically, ENS has been associated with a reduction in nasal turbinate size; new data suggest that impaired trigeminal nerve function may also play a role in the pathophysiology of the disease. The newly validated empty nose syndrome 6 item questionnaires and Cotton test are steps forward to standardize the diagnosis of ENS. Finally, there has been a marked increase in surgical treatment strategies to reconstitute turbinate volume with various implant materials.

Summary The diagnosis of ENS remains controversial but the last several years have seen a rejuvenation of interest in this disease entity. The validated empty nose syndrome 6 item questionnaires and Cotton test provide a standardized and objective means by which to characterize ENS. Prevention of iatrogenic ENS through avoidance of excessive turbinate reduction remains critical in preventing paradoxical nasal obstruction. Nasal humidification, patient education, and treatment of possible concomitant medical conditions (e.g., depression) constitute first lines of treatment. We support the cautious use of these screening tools as adjuncts to clinical decision-making. Although injectable implants to augment turbinate volume show promise as a therapeutic surgical technique, there is insufficient data to fully support their use at this time.

aDepartment of Otolaryngology – Head and Neck Surgery, University of California Davis, Davis

bDepartment of Otolaryngology - Head and Neck Surgery, University of California Davis School of Medicine

cDepartment of Otolaryngology - Head and Neck Surgery, VA Northern California Healthcare System, Sacramento, California, USA

Correspondence to Toby O. Steele, MD, Department of Otolaryngology – Head and Neck Surgery, University of California Davis, Davis, CA 95616, USA. E-mail: tosteele@ucdavis.edu

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