Use of intranasal submucosal fillers as a transient implant to alter upper airway aerodynamics: implications for the assessment of empty nose syndrome
Nicole A. Borchard BA Sachi S. Dholakia BS Carol H. Yan MD David Zarabanda MD Andrew Thamboo MD, MHSc Jayakar V. Nayak MD, PhD
First published: 04 February 2019 https://doi.org/10.1002/alr.22299
Potential conflict of interest: None provided.
Presented orally at the Annual ARS Meeting on October 5‐6, 2018, in Atlanta, GA.
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Abstract
Background
Empty nose syndrome (ENS) is a debilitating condition associated with inferior turbinate tissue loss. Surgical augmentation of the inferior meatus has been proposed to treat ENS, although efficacy data with validated, disease‐specific questionnaires is limited. Instead we evaluated submucosal injection of a transient, resorbable filler into the inferior meatus to favorably alter nasal aerodynamics in ENS patients.
Methods
Patients with a history of inferior turbinate reduction, diagnosed with ENS via Empty Nose Syndrome 6‐Item Questionnaire (ENS6Q) and cotton testing, were enrolled and underwent submucosal injection of carboxymethylcellulose/glycerin gel (Prolaryn®) into the inferior meatuses between July 2014 and May 2018. This material likely resorbs over several months. Outcomes included comparisons of preinjection and postinjection symptoms at 1 week, 1 month, and 3 months using the ENS6Q, 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Generalized Anxiety Disorder 7‐item scale (GAD‐7), and Patient Health Questionnaire‐9 (PHQ‐9).
Results
Fourteen patients underwent injections. Mean ENS6Q scores significantly decreased from baseline at 1 week (20.8 vs 10.5; p < 0.0001), and remained reduced but upward‐trending at 1 month (13.7, p = 0.002) and 3 months (15.5, p > 0.05) following injections. Mean SNOT‐22 scores significantly decreased at 1 week (p = 0.01) and 1 month (p = 0.04), mean GAD‐7 at 1 month (p = 0.02) and 3 months (p = 0.02), and mean PHQ‐9 at 1 week (p = 0.01) and 1 month (p = 0.004) postinjection.
Conclusion
Transient, focal airway bulking via submucosal filler injection at sites of inferior turbinate tissue loss markedly benefits ENS patients, suggesting that aberrant nasal aerodynamics from inferior turbinate tissue loss contributes to (potentially reversible) ENS symptoms.
Nicole A. Borchard BA Sachi S. Dholakia BS Carol H. Yan MD David Zarabanda MD Andrew Thamboo MD, MHSc Jayakar V. Nayak MD, PhD
First published: 04 February 2019 https://doi.org/10.1002/alr.22299
Potential conflict of interest: None provided.
Presented orally at the Annual ARS Meeting on October 5‐6, 2018, in Atlanta, GA.
Read the full text
ePDFPDFTOOLS SHARE
Abstract
Background
Empty nose syndrome (ENS) is a debilitating condition associated with inferior turbinate tissue loss. Surgical augmentation of the inferior meatus has been proposed to treat ENS, although efficacy data with validated, disease‐specific questionnaires is limited. Instead we evaluated submucosal injection of a transient, resorbable filler into the inferior meatus to favorably alter nasal aerodynamics in ENS patients.
Methods
Patients with a history of inferior turbinate reduction, diagnosed with ENS via Empty Nose Syndrome 6‐Item Questionnaire (ENS6Q) and cotton testing, were enrolled and underwent submucosal injection of carboxymethylcellulose/glycerin gel (Prolaryn®) into the inferior meatuses between July 2014 and May 2018. This material likely resorbs over several months. Outcomes included comparisons of preinjection and postinjection symptoms at 1 week, 1 month, and 3 months using the ENS6Q, 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Generalized Anxiety Disorder 7‐item scale (GAD‐7), and Patient Health Questionnaire‐9 (PHQ‐9).
Results
Fourteen patients underwent injections. Mean ENS6Q scores significantly decreased from baseline at 1 week (20.8 vs 10.5; p < 0.0001), and remained reduced but upward‐trending at 1 month (13.7, p = 0.002) and 3 months (15.5, p > 0.05) following injections. Mean SNOT‐22 scores significantly decreased at 1 week (p = 0.01) and 1 month (p = 0.04), mean GAD‐7 at 1 month (p = 0.02) and 3 months (p = 0.02), and mean PHQ‐9 at 1 week (p = 0.01) and 1 month (p = 0.004) postinjection.
Conclusion
Transient, focal airway bulking via submucosal filler injection at sites of inferior turbinate tissue loss markedly benefits ENS patients, suggesting that aberrant nasal aerodynamics from inferior turbinate tissue loss contributes to (potentially reversible) ENS symptoms.
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