Mental health burden of empty nose syndrome compared to chronic rhinosinusitis and chronic rhinitis

Int Forum Allergy Rhinol. 2022 Nov;12(11):1340-1349. doi: 10.1002/alr.22997. Epub 2022 Apr 7.


Background: Empty nose syndrome (ENS) is characterized by the paradoxical perception of nasal obstruction despite patent sinonasal anatomy after surgery. We investigated the relationship between ENS, and anxiety, depression, obsessive-compulsive disorder, and somatic symptom disorder (SSD) compared to individuals with chronic rhinitis (CR) and chronic rhinosinusitis (CRS).

Methods: This cross-sectional survey study compared ENS and CR and CRS patients. A total of 116 patients participated: 58 ENS patients from digital support groups, and 58 CRS and CR patients from tertiary rhinology clinics. Study participants completed four validated surveys: (1) Empty Nose Syndrome 6-Item Questionnaire, (2) Rhinosinusitis Disability Index (RSDI), (3) Obsessive Compulsive Inventory - Revised (OCI-R), and (4) PRIME MD Patient Health Questionnaire (PHQ).

Results: ENS patients exhibited a mean RSDI of 78.6, 95% confidence interval [CI] 72.8-84.5, compared to 25.2, 95% CI 18.6-31.8 for CRS/CR patients (p < 0.0001). This difference was seen across all subdomains. Using the PHQ, 53% of ENS patients met diagnostic thresholds for SSD compared to 14% of CRS patients (p < 0.0001). In relation to obsessive compulsive disorder (OCD), 18.37% of ENS patients compared to 8.62% of CRS/CR patients scored above the diagnostic threshold (>21) on the OCI-R questionnaire (p = 0.159).

Conclusion: ENS patients had diminished sinonasal quality of life and a higher prevalence of comorbid anxiety and depression, compared to CR and CRS. ENS patients were more likely to exceed thresholds for OCD and SSD compared to controls. Future studies are needed to assess the role of SSD in ENS to help optimize treatment for these complex patients.

Keywords: ENS6Q; OCI-R; PRIME-MD PHQ; RSDI; chronic rhinosinusitis; empty nose syndrome; somatoform disorders.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Chronic Disease
  • Cross-Sectional Studies
  • Humans
  • Mental Health
  • Quality of Life
  • Rhinitis* / diagnosis
  • Sinusitis* / epidemiology
  • Syndrome