This protocol applies to patients who develop atrophic rhinosinusitis as part of empty nose syndrome (ENS), where an identifiable underlying cause — prior nasal surgery, trauma, or radiation therapy — has disrupted nasal mucosal function. The nasal cavity remains anatomically open, yet patients experience a triad of paradoxical nasal obstruction, excessive crusting, and malodor that markedly impairs quality of life.
Unlike primary atrophic rhinosinusitis, ENS has a clear precipitating history. Patients generally present with excessive nasal crusting, malodor, and paradoxical nasal obstruction in the nasal cavity despite a widely patent airway. In contrast to primary atrophic rhinosinusitis, these patients have an identifiable antecedent — typically nasal surgery, trauma, or radiation therapy — as the driver of mucosal atrophy.
Management centres on restoring nasal mucosal moisture and airway humidity. The structured regimen incorporates hydration strategies using saline and oil-based lubrication, alongside measures aimed at returning humidity to the nasal cavity. Where psychological symptoms accompany the condition, the full protocol includes specific adjunctive interventions.
ENS patients typically present with excessive nasal crusting, malodor emanating, and paradoxical nasal obstruction in the nasal cavity.
In contrast to primary AR, patients with ENS generally have an underlying cause of symptoms such as trauma, radiation therapy, and nasal surgery.
Medical treatment includes hydration with saline or oil-based lubricants, mucosal moisturization, increased fluid intake, intermittent closure of the nostrils (to return humidity), and an aggressive regimen of nasal saline sprays.
For patients with psychological symptoms, cognitive behavioral therapy might help, and the careful use of newer-generation antidepressants might complement therapy.
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