Impact of Psychologic Burden on Surgical Outcome in Empty Nose Syndrome

Abstract

Objectives /Hypothesis Empty nose syndrome (ENS) is a complicated condition currently thought to be caused by excessive surgical resection of turbinate tissue. Patients with ENS experienced significant psychological symptoms, such as depression and anxiety. This study aimed to evaluate the impact of the psychological burden on the surgical outcome of ENS. Study Design Prospective case series in a tertiary medical center. Methods Patients with ENS were prospectively recruited between 2015 and 2018. Validated instruments including the Sinonasal Outcome Test‐25 (SNOT‐25), Beck Depression Inventory‐II (BDI‐II), and Beck Anxiety Inventory (BAI) were used to evaluate patients with ENS prior to and 3, 6, and 12 months after nasal reconstruction surgery with submucosal Medpor implantation. Results A total of 54 ENS patients were enrolled during the study period. All three evaluations revealed significant improvement, and symptoms stabilized 3 months after surgery. Six months post‐operatively, SNOT‐25 scores were significantly associated with the pre‐operative BDI‐II and BAI scores (β = 0.64 and 0.87; P = .006 and <.001, respectively). Multivariate regression model revealed that only BAI scores were significantly associated with the six‐month post‐operative SNOT‐25 scores (adjusted β = 0.49, P = .036). Moreover, Spearman's correlation found close relationships between the post‐operative SNOT‐25 and the post‐operative BDI‐II and BAI scores (rs = 0.751 and 0.884, both P < .001). Conclusions Psychological evaluation can help predict surgical outcomes and identify patients with residual disease. These findings emphasize the importance of screening for psychological symptoms and structuring care by including psychological therapy in addition to surgery. Level of Evidence 4. Laryngoscope, 131:E694–E701, 2021

Suicidal thoughts in patients with empty nose syndrome

“…Our previous study also revealed that the ENS symptom domain in the SNOT-25 are associated with psychological burden and could be good predictors of moderate-to-severe depression. 12,16 The current study further demonstrated that the symptom of "Nose feels too open" may associate with suicidal thoughts. Our previous study 12 revealed sleep dysfunction and empty nose symptoms contribute to the psychological burden experienced by ENS patients.…”

“…Patients with ENS carry a significant psychological burden including depression and anxiety. 9,11,12,16,21 In the present study, we investigated the suicidal thoughts in ENS patients using validated "Nose feels too open" was the item in ENS6Q that was significantly more severe in ENS patients with suicidal thoughts than those without. This symptom may be the most devastating, mentally, and psychologically to patients.…”

“…Chinese versions of the Empty Nose Syndrome 6-item Questionnaire (ENS6Q), SNOT-25, BAI, and BDI-II were used to evaluate the subjective symptoms and quality of life in patients with ENS before and 6 months after surgical reconstruction. [16][17][18][19] Participants rated each item from 0 to 5, with 0 indicating no symptoms and 5 representing the most severe symptoms in SNOT-25 and ENS6Q evaluation. In addition, participants rated between 0 and 3 (symptom not present to strongly present) for each item in 21 items of the BDI-II and BAI evaluation, respectively, which has a total score of 0-63.…”

“…The pre-op BDI-II scores comprised 22 (35.5%) patients without depression (scores of 0-13), 10 (16.1%) patients with mild depression (scores of [14][15][16][17][18][19], seven (11.3%) patients with moderate depression (scores of 20-28), and 23 (37.1%) patients with severe depression (scores of 29-63).…”

“…[9][10][11][12][13] Our previous studies demonstrated a high prevalence of anxiety and depression among ENS patients using the Sino-Nasal Outcome Test-25 (SNOT-25), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II). 12,[14][15][16] The high prevalence of mental health disorders in ENS patients is an alert to the risk of suicide in these patients.…”