The clinical efficacy of surgical interventions for empty nose syndrome: A systematic review.

OBJECTIVE To evaluate the outcomes of surgical intervention for empty nose syndrome (ENS). DATA SOURCE Cochrane Collaboration database, U.S National Institutes of Health database (ClinicalTrials), U.S National Library of Medicine (PubMed). REVIEW METHODS Structured search using medical subject-heading terms: nose, turbinate, surgery, atrophic rhinitis, and empty nose syndrome. RESULTS A total of 128 patients were collated from eight studies with an age range of 18 to 64 years. Most patients had been suffering with ENS for many years, up to 29.7 years. The most common surgical technique involved a transnasal approach with implant material secured within a submucosal pocket. Common implant material used in the studies included biosynthetic, and autologous cartilage. The weighted mean preoperative Sino-Nasal Outcome Test (SNOT)-20 and SNOT-25 scores were 48.3 and 65.9, respectively. At latest follow-up, these scores improved significantly to 24.4 and 33.3, respectively. Although all SNOT subdomains improved following surgery, the highest improvement was observed in ENS symptoms and psychological issues. SNOT scores improved by 3 months postsurgery and this trend continued over time, although available data was limited to only 12 months follow-up. Nevertheless, 10 patients had less than 10 points improvement, including three patients who had no change in SNOT scores. Extrusion of the implant occurred in six cases, and one developed chronic rhinosinusitis. CONCLUSION Surgical intervention for ENS appears to result in clinical improvement, although not all patients derived benefit. Long-term follow-up should be considered utilizing using both subjective (SNOT-25) and objective (rhinomanometry) measures of clinical outcome.