Empty nose syndrome

SummaryEmpty nose syndrome (ENS) is a clinical entity without consensual definition; it is a rare complication of nose or sinus surgery, and of inferior turbinectomy in particular. Physiopathology remains unclear, but probably involves disorder caused by excessive nasal permeability affecting neurosensitive receptors and inhaled air humidification and conditioning functions. Neuropsychological involvement is suspected. Symptomatology is variable and changeable, the most common sign being paradoxical nasal obstruction. Diagnosis is founded on: (1) a range of symptoms that need to be precisely collated; (2) broad post-surgical nasal permeability. Management is problematic, deploying the full range of simple nasal cavity hygiene and humidification techniques, with surgery reserved for the most severe cases; whatever the technique, surgery aims at partial filling of the nasal airway. Prevention is the most important strategy, and seeks (1) to check, before any surgery is envisaged, the reality of nasal dyspermeability resistant to medical treatment; and (2) to prefer the most conservative surgical techniques.