Impact of Psychologic Burden on Surgical Outcome in Empty Nose Syndrome

Objectives /Hypothesis Empty nose syndrome (ENS) is a complicated condition currently thought to be caused by excessive surgical resection of turbinate tissue. Patients with ENS experienced significant psychological symptoms, such as depression and anxiety. This study aimed to evaluate the impact of the psychological burden on the surgical outcome of ENS. Study Design Prospective case series in a tertiary medical center. Methods Patients with ENS were prospectively recruited between 2015 and 2018. Validated instruments including the Sinonasal Outcome Test-25 (SNOT-25), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) were used to evaluate patients with ENS prior to and 3, 6, and 12 months after nasal reconstruction surgery with submucosal Medpor implantation. Results A total of 54 ENS patients were enrolled during the study period. All three evaluations revealed significant improvement, and symptoms stabilized 3 months after surgery. Six months post-operatively, SNOT-25 scores were significantly associated with the pre-operative BDI-II and BAI scores (beta = 0.64 and 0.87;P= .006 and <.001, respectively). Multivariate regression model revealed that only BAI scores were significantly associated with the six-month post-operative SNOT-25 scores (adjusted beta = 0.49,P= .036). Moreover, Spearman's correlation found close relationships between the post-operative SNOT-25 and the post-operative BDI-II and BAI scores (r(s)= 0.751 and 0.884, bothP< .001). Conclusions Psychological evaluation can help predict surgical outcomes and identify patients with residual disease. These findings emphasize the importance of screening for psychological symptoms and structuring care by including psychological therapy in addition to surgery. Level of Evidence 4.Laryngoscope, 2020

Automated summary

This study found that psychological symptoms, especially anxiety, significantly impact the surgical outcomes of ENS patients after nasal reconstruction surgery. It is suggested to conduct psychological evaluation before surgery and incorporate psychological therapy into the treatment plan.