Dichapong Kanjanawasee1,2,3, Raewyn G Campbell2,4,5, Janet Rimmer5,6,7, Raquel Alvarado5, Jesada Kanjanaumporn1, Kornkiat Snidvongs1, Larry Kalish5,8,9, Richard J Harvey2,5, Raymond Sacks2,8. 1. Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 2. Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia. 3. Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 4. Department of Otorhinolaryngology-Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia. 5. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia. 6. Woolcock Institute, University of Sydney, Sydney, Australia. 7. Faculty of Medicine, Notre Dame University, Sydney, Australia. 8. Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia. 9. Faculty of Medicine, University of Sydney, Sydney, Australia.
Abstract
OBJECTIVE: The pathophysiology of empty nose syndrome (ENS) remains unclear despite significant research. The pathophysiologic mechanism of ENS was systematically reviewed. DATA SOURCES: MEDLINE and Embase. REVIEW METHODS: Data were systematically reviewed for studies that provided original data on pathophysiology. RESULTS: A total of 2476 studies were screened, and 19 met the inclusion criteria: 13 case-control and 6 cross-sectional. Nine pathophysiologic themes were identified.• Demographics: ENS symptoms had no relationship with climatic factors.• Symptomatology: ENS patients demonstrated high symptom severity.• Mental health: Anxiety and depression including hyperventilation were reported in >50% of ENS patients and correlated with ENS symptom severity.• Anatomic features: Structural changes in response to turbinate surgery were similar between ENS and non-ENS patients.• Airflow analysis: Airflow parameters were similar between ENS and non-ENS patients after turbinate surgery. On computational fluid dynamic analysis, differences were found on multiple outcomes.• Diagnostic testing: The menthol detection test was impaired in ENS, and cotton placement in the airway improved ENS symptoms.• Cognitive function: Functional magnetic resonance imaging showed activation in emotional processing area during breathing.• Olfactory function: Subjective impairment was reported in ENS, but quantitative measures were similar to non-ENS patients.• Mucosal physiology/innate immunity: Turbinate histopathology in ENS showed a tissue-remodeling pattern. Nasal nitric oxide level was lower in ENS patients. CONCLUSION: There is evidence of high comorbid mental health disorders in ENS patients. An abnormal trigeminal-thermoreceptor response may be present in some patients. The influence of altered airflow and the evidence of surgery as the cause for ENS are unclear.
OBJECTIVE: The pathophysiology of empty nose syndrome (ENS) remains unclear despite significant research. The pathophysiologic mechanism of ENS was systematically reviewed. DATA SOURCES: MEDLINE and Embase. REVIEW METHODS: Data were systematically reviewed for studies that provided original data on pathophysiology. RESULTS: A total of 2476 studies were screened, and 19 met the inclusion criteria: 13 case-control and 6 cross-sectional. Nine pathophysiologic themes were identified.• Demographics: ENS symptoms had no relationship with climatic factors.• Symptomatology: ENS patients demonstrated high symptom severity.• Mental health: Anxiety and depression including hyperventilation were reported in >50% of ENS patients and correlated with ENS symptom severity.• Anatomic features: Structural changes in response to turbinate surgery were similar between ENS and non-ENS patients.• Airflow analysis: Airflow parameters were similar between ENS and non-ENS patients after turbinate surgery. On computational fluid dynamic analysis, differences were found on multiple outcomes.• Diagnostic testing: The menthol detection test was impaired in ENS, and cotton placement in the airway improved ENS symptoms.• Cognitive function: Functional magnetic resonance imaging showed activation in emotional processing area during breathing.• Olfactory function: Subjective impairment was reported in ENS, but quantitative measures were similar to non-ENS patients.• Mucosal physiology/innate immunity: Turbinate histopathology in ENS showed a tissue-remodeling pattern. Nasal nitric oxide level was lower in ENS patients. CONCLUSION: There is evidence of high comorbid mental health disorders in ENS patients. An abnormal trigeminal-thermoreceptor response may be present in some patients. The influence of altered airflow and the evidence of surgery as the cause for ENS are unclear.
Entities:
Keywords:
empty nose syndrome; nasal perception; neurogenic dysfunction; psychogenic comorbidity
Authors: Nora Schmidt; Hans Behrbohm; Leonid Goubergrits; Thomas Hildebrandt; Jan Brüning Journal: Int J Comput Assist Radiol Surg Date: 2022-07-11 Impact factor: 3.421