Medial Flap Turbinoplasty is Unlikely to Cause Empty Nose Syndrome

Background: Empty nose syndrome (ENS) is a poorly understood condition that affects a minority of patients who undergo inferior turbinate (IT) surgery. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) was validated to diagnose ENS following IT reduction, with an ENS6Q ≥ 11 being suggestive of ENS. Medial flap turbinoplasty (MFT) involves IT bone removal ± submucosal reduction (SMR) and is highly effective at surgically treating IT hypertrophy. This study's purpose was to determine the incidence of ENS following MFT by comparing ENS6Q scores preoperatively and postoperatively.

Methods: A retrospective cohort study was conducted on consecutive patients who underwent bilateral MFT with or without septoplasty to address nasal obstruction. Preoperative and postoperative nasal obstruction and septoplasty effectiveness (NOSE, 0-20) and ENS6Q (0-30) scores were compared at a minimum 12 months postoperatively.

Results: Of 100 patients, mean age was 48.9 years and 53% were male. Mean follow-up was 25.0 months (range: 12-66 months). Patients underwent MFT with SMR in 70% of cases, whereas 30% had bone removal only, and 79% had septoplasty. NOSE scores decreased significantly postoperatively (mean 9-point reduction, p < 0.0001). Mean preoperative and postoperative ENS6Qs were 8.5 and 3.0, respectively, with a mean 5.6-point decrease postoperatively (p < 0.0001). While some patients developed elevated ENS6Q scores mainly in the first 3 months postoperatively, no patients had ENS6Q scores ≥11 at final follow-up.

Conclusions: MFT ± septoplasty led to significant long-term reduction in nasal obstruction, with no patients ultimately developing ENS6Q ≥ 11 postoperatively. Therefore, MFT was unlikely to cause ENS.

Level of evidence: Level 4 Laryngoscope, 2024.