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

Abstract

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.

Impact of Psychologic Burden on Surgical Outcome in Empty Nose Syndrome

“…As a result, we suggest the importance of evaluating these ENS patients with SNOT‐25, which included six domains of rhinogenic symptoms, extra‐nasal rhinological symptoms, ear/facial symptoms, sleep dysfunction, psychological dysfunction, and empty nose symptoms. Previous studies by Jiang et al and our cohort also demonstrated the utility of SNOT‐25 as a measurement tool for patients with ENS 8,14 . However, diagnosis of ENS may require a subjective nasal obstruction and a paradoxical findings of patent nasal airway on objective endoscopic evaluation, as well as evaluation of the response to intervention, using the cotton test or other suitable methods 10…”

“…Lemogne et al also reported the successful management of an ENS patient with anxiety and depression by cognitive behavior therapy and a serotonin reuptake inhibitor 25 . Our previous studies reported a high prevalence of depression and anxiety among ENS patients and the effectiveness of surgical treatment with submucosal implantation 13,14 . Furthermore, ENS symptoms are associated with psychological burden and could be good predictors of moderate‐to‐severe depression 14 .…”

“…Previous studies have reported that ENS patients carried significant psychological burden of depression and anxiety and could be treated with surgical reconstruction of the nasal cavity 11,13,14,22,23 . Targeted symptom management could reduce the psychological burden 14 .…”

“…Patients with ENS also suffer from significant comorbid psychiatric problems such as chronic fatigue, frustration, irritability, anger, anxiety, or depression. As a result, affected patients often report a significant negative impact on the quality of life (QOL), working productivity, and daily living 11–15 …”

“…By using validated instruments and assessments including the Sinonasal Outcome Test‐25 (SNOT‐25), 8 the Beck Depression Inventory‐II (BDI‐II) 16 and Beck Anxiety Inventory (BAI), 17 our previous studies demonstrated a high prevalence of depression and anxiety among ENS patients and reported on the effectiveness of surgical treatment involving submucosal implantation with porous high‐density polyethylene (Medpor; Porex Surgical, Inc.) 13,18,19 . Furthermore, ENS symptoms are associated with psychological burden and could be good predictors of moderate‐to‐severe depression 14 . In this prospective case series, we further evaluated the impact of the psychological burden, such as anxiety and depression, on the surgical outcome of ENS.…”