Investigating hyperventilation syndrome in patients suffering from empty nose syndrome

Mangin, David; Béquignon, E.; Zerah-Lancner, Françoise; Isabey, Daniel; Louis, Bruno; Adnot, Serge; Papon, Jean‐François; Coste, A.; Boyer, Laurent; Mayne, Marie Devars du

doi:10.1002/lary.26599

Cited by 25 publications

(52 citation statements)

References 31 publications

(70 reference statements)

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“…The difference in the shape and slope of the pressure profile could also suggest that deeper, more forced breaths (which would increase the pressure drop) may be needed to mimic normal, healthy breathing. Mangin et al showed that one potential effect of continual deep breathing is hyperventilation as well as hypocapnia, which is one of the symptoms cited by longstanding, chronic ENS patients. With the insertion of cotton, it is possible that the need to compensate for these pressure discrepancies through deep breathing may no longer be necessary.…”

Section: Discussionmentioning

confidence: 99%

The cotton test redistributes nasal airflow in patients with empty nose syndrome

Malik

Thamboo

Dholakia

et al. 2020

Int Forum Allergy Rhinol

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Background: Empty nose syndrome (ENS) remains a controversial disease primarily associated with inferior turbinate tissue loss. Co on placement into the inferior meatus o en alleviates ENS symptoms within minutes, but the physiologic explanation for this phenomenon is unknown. Computational fluid dynamics (CFD) was employed to evaluate the mechanisms of altered nasal airflow conferred by co on testing. Methods:Six ENS patients (12 sides) with pre-existing sinus computed tomography (CT) imaging were enrolled a er marked symptomatic improvement (decrease in score on the Empty Nose Syndrome 6-Item Questionnaire [ENS6Q] of >7 points) with office-based co on testing. The fashioned co on plug was labeled in situ with iohexol contrast spray, and sinus CT was immediately obtained to detect co on contouring in the inferior meatus. CT imaging from pre-and post-co on placement was analyzed using comparative CFD techniques. Results:A er co on placement, significant symptomatic improvement and reduced ENS6Q scores (16.8 ± 4.1 to 3.1 ± 2.4; p < 0.001) were recorded. Using CFD, co on placement produced an expected 21% increase in upper airway resistance (p < 0.05). However, a significant shi in the nasal airflow distribution was also detected, with a transition of airflow vectors away from a middle meatus jetstream (−41%; p < 0.002). Conclusion:Objective CFD assessment confirmed that the co on test not only increases nasal resistance, but also restores airflow distribution to the inferior meatus in symptomatic ENS patients. These results highlight the potential efficacy of co on test in ENS patients and further bolster the utility of this tool in identifying appropriate candidates for the inferior meatus augmentation procedure. C 2020 ARS-AAOA, LLC.

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Section: Discussionmentioning

confidence: 99%

The cotton test redistributes nasal airflow in patients with empty nose syndrome

Malik

Thamboo

Dholakia

et al. 2020

Int Forum Allergy Rhinol

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“…Patients with ENS may also experience mucosal dryness, nasal congestion, facial pain and headache on inspiration, and excessive nasal crusting and discharge (1,2,7) . Affected patients often report a significant negative impact on the quality of life (QOL) and psychological status, productivity loss, and lifestyle disruption (8)(9)(10) . As a result, a validated instrument, the Sinonasal Outcome Test-25 (SNOT-25), was developed by Houser (2) .…”

Section: Introductionmentioning

confidence: 99%

“…These five additional items may better assess the symptoms of ENS patients (7) . ENS patients also experience anxiety and depression that may lead to suicide attempts in extreme cases (8)(9)(10) . Our previous study (10) using validated instruments including the Beck Depression Inventory-II (BDI-II) (11) and Beck Anxiety Inventory (BAI) (12) found that depression and anxiety are common among ENS patients and could be effectively improved after surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

What drives depression in empty nose syndrome? A Sinonasal Outcome Test-25 subdomain analysis

Wu²,

et al. 2019

Rhin

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Background: Empty nose syndrome (ENS) is a debilitating disorder characterised by paradoxical nasal obstruction after excessive surgical excision of nasal tissues. ENS negatively impacts the quality of life (QOL) and psychological status of patients. This study aimed to determine the associations among disease-specific QOL impairments and the severity of anxiety and depression before and after surgery in ENS patients. Methods: A total of 68 ENS patients were prospectively recruited and underwent submucosal Medpor implantation. QOL impairments and the severity of anxiety and depression were evaluated using the Sinonasal Outcome Test-25 (SNOT-25), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) 1 day before and 6 months after surgery. Results: The BDI-II and BAI scores were significantly associated with the total score and ear/facial symptoms, psychological dysfunction, sleep dysfunction, and empty nose symptoms domains of the SNOT-25. Surgery improved disease-specific and psychological symptoms. Post-operative changes in the BDI-II score were correlated with changes in the total score and sleep dysfunction and empty nose symptoms domains of the SNOT-25. A SNOT-25 total score of > 60, sleep dysfunction domain score of > 18, and empty nose symptoms domain score of > 14 were good predictors of moderate-to-severe depression. Conclusions: ENS symptoms are associated with psychological burden and could be good predictors of moderate-to-severe depression. Targeted symptom improvement could reduce the psychological burden.

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“…Finally, a recent article that addresses hyperventilation syndrome in patients suffering from empty nose syndrome was published in 2017. 284 However, nasal breathing after turbinate and septal surgery can cause seemingly unexplained complications with a MAD. It is recommended to include a question in the health intake questionnaire asking if this surgery has been performed by those providing MAD therapy for OSA patients.…”

Section: Sleep-related Breathing Disordersmentioning

confidence: 99%

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

Cagna

Donovan

McKee³

et al. 2019

The Journal of Prosthetic Dentistry

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Investigating hyperventilation syndrome in patients suffering from empty nose syndrome

Abstract: 2b Laryngoscope, 127:1983-1988, 2017.

Cited by 25 publications

References 31 publications

The cotton test redistributes nasal airflow in patients with empty nose syndrome

The cotton test redistributes nasal airflow in patients with empty nose syndrome

What drives depression in empty nose syndrome? A Sinonasal Outcome Test-25 subdomain analysis

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

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