Empty nose syndrome (ENS) is a secondary form of atrophic rhinosinusitis that arises from an identifiable underlying cause. Unlike primary atrophic rhinosinusitis, ENS is associated with a prior event that has altered nasal anatomy or mucosal integrity — and its management reflects that distinction.
Patients with ENS typically have a history of previous nasal surgery, trauma, or radiation therapy. Despite a patent nasal cavity, they develop a characteristic triad: excessive nasal crusting, malodor, and paradoxical nasal obstruction. This presentation — symptom burden in the absence of anatomical blockage — is the defining clinical challenge of this condition.
The management strategy centres on surgical turbinate reconstruction to restore nasal physiologic function. Several submucosal techniques are described; the choice among them depends on clinical factors covered in the full structured regimen.
The primary benchmark of treatment success is a significant improvement in the SNOT-22 score measured at one year after the surgical intervention.
DOI: 10.1177/01455613231185022
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.
Submucosal filler injections are ideal short-lived bulking agents to increase tissue deficit sites, and this procedure can be performed in the clinic.
The submucosal implantation of acellular dermis allografts is well-described for the surgical management of ENS.
There is a significant improvement of SNOT-22 preoperatively to 1 year postoperatively.
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