Evaluation of sinonasal-related quality of life of 49 patients undergoing endoscopic skull base surgery

Abstract Objective This study aimed to evaluate the sinonasal-related Quality of Life (QoL) in patients undergoing endoscopic skull base surgery. Methods A retrospective study was performed, including patients with benign and malignant tumors at a single institution. Each patient completed the 22-Item Sino-Nasal Outcome Test (SNOT-22) and the Empty Nose Syndrome 6 Item Questionnaires (ENS6Q) to assess their perceived QoL at least 2-months after treatment. Results Forty-nine patients were enrolled in this study. The average score was 25.1 (Stander Deviation [SD] 14.99) for SNOT-22 and 6.51 (SD = 5.58) for ENS6Q. Analysis of the overall results for the SNOT-22 showed that olfactory damage was the most serious syndrome. The most frequently reported high-severity sub-domains in SNOT-22 were nasal symptoms and sleep symptoms. Nasal crusting was the most severe item in ENS6Q according to the report. Nine patients (18.4%) had a score higher than 10.5 which indicates the high risk of Empty Nose Syndrome (ENS). SNOT-22 score was related to the history of radiotherapy (p < 0.05), while the ENS6Q score was not. Conclusions The possibility of patients suffering from ENS after nasal endoscopic skull base surgery is at a low level, although the nasal cavity structure is damaged to varying degrees. Meanwhile, patients undergoing endoscopic skull base surgery were likely to suffer nasal problems and sleep disorders. Patients who had received radiotherapy have a worse QoL than those without a history of radiotherapy. Level of evidence Level 3.

Efficacy and Safety of Autologous Stromal Vascular Fraction in the Treatment of Empty Nose Syndrome

OBJECTIVES: Regenerative treatment using stem cells may serve as treatment option for empty nose syndrome (ENS), which is caused by the lack of turbinate tissue and deranged nervous system in the nasal cavity. We aimed to assess the efficacy and safety of the autologous stromal vascular fraction (SVF) in the treatment of ENS. METHODS: In this prospective observational clinical study, we enrolled 10 ENS patients who volunteered to undergo treatment of ENS through the injection of autologous SVF. Data, including demographic data, pre- and postoperative Sino-Nasal Outcome Test-25 (SNOT-25) scores, overall patient satisfaction, and postoperative complications, were prospectively collected. Nasal secretion was assessed using the polyurethane foam absorption method, and the levels of biological markers were analyzed in both ENS group and control group using enzyme-linked immunosorbent assay. The SVF extracted from abdominal fat was diluted and injected into both inferior turbinates. RESULTS: Among the 10 initial patients, one was excluded from the study. Subjective satisfaction was rated as “much improved” in two and “no change” in seven. Among the improved patients, the mean preinjection SNOT-25 score was 55.0 and the score at 6 months after injection was 19.5. However, the average SNOT-25 score of nine participants at 6 months after injection (mean±standard deviation, 62.4±35.8) did not differ significantly from the baseline SNOT-25 score (70.1±24.7, P>0.05, respectively). Among the various inflammatory markers assessed, the levels of interleukin (IL)-1β, IL-8, and calcitonin gene-related peptide were significantly higher in ENS patients. Compared with preinjection secretion level, the nasal secretions from SVF-treated patients showed decreased expressions of IL-1β and IL-8 after injection. CONCLUSION: Although SVF treatment appears to decrease the inflammatory cytokine levels in the nasal mucosa, a single SVF injection was not effective in terms of symptom improvement and patient satisfaction. Further trials are needed to identify a more practical and useful regenerative treatment modality for patients with ENS.

Síndrome de nariz vacía / Empty nose syndrome

El síndrome de nariz vacía es una enfermedad de reciente descripción, que no tiene una definición clínica clara. Se puede originar como complicación de la cirugía de resección de cornetes, en especial del inferior. La fisiopatología no está del todo definida, pero es probable que posterior a la resección de cornetes se altere la permeabilidad nasal, interfiriendo con los mecanismos neurosensitivos y con las funciones de los cornetes. Su síntoma principal, es la obstrucción nasal paradójica. El diagnóstico es clínico, basado en los síntomas con los hallazgos de una cavidad nasal amplia posterior a la cirugía nasal. El tratamiento es difícil por lo subjetivo de los síntomas, prefiriendo en un comienzo el tratamiento médico y reservando la cirugía para casos más severos. Lo más importante es la prevención, realizando cirugías lo más conservadora posibles de la anatomía de la cavidad nasal.

The Empty Nose Syndrome is a recently described disease, which has no clear clinical definition. It is a rare complication of turbinate surgery especially in the inferior turbinectomy. The pathophysiology is unclear, but after turbinectomy the nasal patency could be affected and this can interfere with neurosensory mechanisms and functions of the turbinates. The most common symptom is the paradoxical nasal obstruction. The diagnosis is clinical, based on symptoms with the discovery of a wide nasal cavity after nasal surgery. Treatment is difficult because of the subjective symptoms, initially preferring medical treatment and surgery is reserved for more severe cases. Most important is the prevention, being as conservative as possible with the nasal cavity.

Clinical studies on the ex-vivo expansion of autologous adipose derived stem cells for the functional reconstruction of mucous membrane in empty nose syndrome / 解放军医学杂志

Objective To analyze and evaluate the feasibility and effectiveness of using autologous adipose derived stem cells (ASCs) for rebuilding the function of nasal mucosa in patients with empty nose syndrome (ENS). Methods Autologous adipose tissue 15-20ml were obtained from each of 5 ENS patients admitted from Aug. 2013 to Feb. 2014, and from which stem cells were isolated, cultured and expanded in vitro. The phenotype, differentiation, and genetic stability of the third generation of amplified stem cells were identified. For the patients with rudimental turbinate (n=3), ASCs were injected into the damaged nasal mucosa for 4 times (once every 10 days). For the patients with no rudimental turbinate (n=2), autologous pure fat granules 1-5ml were extracted after 3 times of ASCs injection into the damaged nasal mucosa, and mixed with the 3rd-6th generation of ASCs for inferior or middle nasal turbinate angioplasty. Nasal endoscopic examination was performed before treatment and 3, 6 and 9 months after treatment for comparison, and the data of SNOT-20 questionnaire, nasality resistance and nasal mucociliary clearance action were statistically analyzed.  Results With injection transplantation of the 3rd-6th generation of ASCs in 2 patients with no rudimental turbinate, and 3, 6 and 9 months after the combined ASCs and fat granules transplantation in 3 patients with rudimental turbinate, nasal endoscopy showed that no obvious absorption in conchoplasty, nasal mucosa was improved significantly, and same as SNOT-20 scores, with statistically significant difference (P0.05). Conclusions Te reconstruction of mucosa function by nasal turbinate angioplasty combined with adipose derived stem cells and autologous adipose transplantation may signifcantly improve the symptoms in patients with ENS with lasting effects. It is a new procedure which is helpful for the mucosal repair in patients with ENS.

A Case of Treatment of Empty Nose Syndrome Using Auricular Conchal Cartilage and Filler / 대한이비인후과학회지

Empty nose syndrome (ENS) is a rare complication of nose or sinus surgery, and of inferior turbinectomy in particular. Symptomatology is variable and changeable, the most common sign being paradoxical nasal obstruction. Treatments include moistening nasal cavity by local irrigation, humidification, applying ointment or narrowing of the nasal cavity. We report a 61-year-old male patient who suffered from dryness, nasal obstruction and crusting in the nose after sinus surgery and turbinate reduction. We harvested auricular conchal cartilage and implanted on both side of the caudal part of cartilaginous septum. Calcium hydroxylapatite filler (Radiesse(R), Merz aesthetics Inc., San Mateo, CA, USA) was injected in the anterior end of both inferior turbinates, submucosally. The patient achieved a significant symptom improvement without any complications. We experienced a case of ENS and report successful treatment using an auricular conchal cartilage and filler.

Rinitis atrófica como causa del síndrome de nariz vacía: reporte de caso / Atrophic rhinitis as cause of the empty nose syndrome: case report

La rinitis atrófica es una de las causas del Síndrome de nariz vacía, la cual está relacionada con colonización por gérmenes, inflamación crónica y posterior atrofia progresiva de la mucosa nasal. Típicamente produce síntomas obstructivos nasales, rinorrea y costras fétidas. Se presenta el caso en imágenes endoscópicas, tomográficas y de cultivo en una paciente femenina en la cual por sus comorbilidades el manejo fue exclusivamente médico.

Atrophic rhinitis is one of the causes of the empty nose syndrome that is related to colonization by germs, chronic inflammation and subsequent progressive atrophy of the nasal mucosa. Typically produces nasal obstructive symptoms, runny nose and fetid crusts. Endoscopy, tomography and culture images of a female patient is presented in which by her co-morbidities associated the treatment was medical exclusively.