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Go et al. Plast Aesthet Res 2024;11:11 Plastic and
DOI: 10.20517/2347-9264.2023.110
Aesthetic Research

Review Open Access

Empty nose syndrome

Beatrice C. Go, Emily C. Deane, Oren Friedman
Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA 19103, USA.
Correspondence to: Dr. Oren Friedman, Department of Otorhinolaryngology, University of Pennsylvania, 800 Walnut St 18th
Floor, Philadelphia, PA 19107, USA. E-mail: oren.friedman@pennmedicine.upenn.edu

How to cite this article: Go BC, Deane EC, Friedman O. Empty nose syndrome. Plast Aesthet Res 2024;11:11. https://dx.doi.org/
10.20517/2347-9264.2023.110

Received: 10 Nov 2023 First Decision: 11 Dec 2023 Revised: 7 Feb 2024 Accepted: 21 Feb 2024 Published: 29 Feb 2024

Academic Editor: Nan-Ze Yu Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Empty nose syndrome (ENS) is an iatrogenic condition that results from traumatic injury, often overresection, of
the turbinates during sinonasal surgery. The underlying etiology is not entirely understood but is thought to have
multifactorial contributions including alterations in the native nasal airway anatomy, abnormal mucosal and neural
healing, and decreased trigeminal sensitivity, among other possibilities and contributors. Patients typically present
with an intense fixation on their sensations of nasal obstruction and congestion despite an anatomically patent
airway on examination. Because many patients with ENS have been shown to have significant psychiatric
comorbidities, multidisciplinary specialist care including psychiatry and pain services is essential. Diagnosis is often
difficult due to the variability of presentation and severity of symptoms, but standard assessments exist including
the empty nose syndrome 6-item questionnaire (ENS6Q) and cotton test. Patients can be initially managed with
conservative measures through humidification, moisturization, and psychiatric testing/referral. Procedural
approaches to improve the nasal airway include submucosal implantation of temporary, semi-permanent, and
permanent materials. A realistic and empathetic approach to patient communication is necessary in order to help
manage patients with ENS, and all plastic surgeons performing septorhinoplasty should be aware of the risk and
treatment options of the disease.

Keywords: Empty nose syndrome, rhinoplasty, inferior turbinate, nasal obstruction

INTRODUCTION
Empty nose syndrome (ENS) is an iatrogenic condition associated with decreased quality of life with

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
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