Distinguishing computed tomography findings in patients with empty nose syndrome

Abstract

These findings provide evidence there are 2 objective radiographic changes (central and posterior septal mucosa) that suggest ENS patients can be discriminated based on mucosal CT findings.

Defining surgical criteria for empty nose syndrome: Validation of the office‐based cotton test and clinical interpretability of the validated Empty Nose Syndrome 6‐Item Questionnaire

“…Using CT imaging, constant landmarks such as the agger nasi, the presence of the middle turbinate, and the nasolacrimal duct defined the central nasal region, where a cutoff of >2.64 mm of mucosal thickness provided the highest likelihood of differentiating ENS patients from those who had an inferior turbinate reduction surgery but lacked ENS symptoms. 3 Although these findings support a physiologic basis for mucosal alterations found in ENS patients, practically it is cumbersome to scroll through CT scans and confirm measurements in a clinical setting. By contrast, our data suggest that the cotton test is simple to perform, cheap, and quite reliable, and fascinatingly most ENS patients can virtually instantaneously provide feedback as to whether there is a perceived, functional improvement in the nasal airway and the quality of upper airway breathing.…”

“…We recently published objective CT findings that differentiate ENS patients from controls; however, in our experience, the utility of the cotton test, when placed in the inferior meatus, is a much more specific and “functional” test for determining whether an ENS patient is appropriate for inferior turbinate augmentation. Using CT imaging, constant landmarks such as the agger nasi, the presence of the middle turbinate, and the nasolacrimal duct defined the central nasal region, where a cutoff of >2.64 mm of mucosal thickness provided the highest likelihood of differentiating ENS patients from those who had an inferior turbinate reduction surgery but lacked ENS symptoms . Although these findings support a physiologic basis for mucosal alterations found in ENS patients, practically it is cumbersome to scroll through CT scans and confirm measurements in a clinical setting.…”

“…A wide constellation of secondary but prominent symptoms have been ascribed to patients afflicted with ENS, including dyspnea, nasal and pharyngeal dryness, facial and nasal pain, crusting, hyposmia, and depression . Evaluation of the ENS patient includes a comprehensive history and physical examination, rigid nasal endoscopy, and computed tomography (CT) imaging . Critical appraisal of the structures, contours, and tissue properties of the anterior nasal vestibule, external and internal nasal valves, septum, inferior and middle turbinates, and nasal floor and pyriform aperture is essential, and alternative fixed and dynamic sources of nasal obstruction (i.e., valve collapse, lateral nasal wall insufficiency, nasal vestibular body hypertrophy, polyps, neoplasm, etc.…”

“…1 Evaluation of the ENS patient includes a comprehensive history and physical examination, rigid nasal endoscopy, and computed tomography (CT) imaging. 3 Critical appraisal of the structures, contours, and tissue properties of the anterior nasal vestibule, external and internal nasal valves, septum, inferior and middle turbinates, and nasal floor and pyriform aperture is essential, and alternative fixed and dynamic sources of nasal obstruction (i.e., valve collapse, lateral nasal wall insufficiency, nasal vestibular body hypertrophy, polyps, neoplasm, etc.) 4 must be excluded for ENS, currently a diagnosis of exclusion, to be considered.…”

Investigating hyperventilation syndrome in patients suffering from empty nose syndrome

“…The physical examination of patients with ENS is poor, as nasal endoscopy is usually normal other than the consequences of the turbinate surgery. Imaging (besides the thickness of turbinal mucosa particularly in the central and posterior nasal region) and functional tests are also normal . ENS is associated with psychological symptoms such as frustration, irritability, anger, anxiety, and depression, as well as chronic fatigue, which all lead to poor tolerance of the symptoms .…”