The Serpentine Sign: A Reliable Endoscopic and Radiographic Finding in Empty Nose Syndrome.

Area of Science:

• Otolaryngology
• Radiology
• Pathology

Background:

• Empty Nose Syndrome (ENS) is a debilitating condition with significant diagnostic challenges.
• Objective clinical findings are needed to improve ENS diagnosis and patient quality of life.

Purpose of the Study:

• To identify objective clinical findings unique to ENS patients.
• To investigate the reliability of the
• Serpentine Sign
• as a radiographic manifestation of ENS.

Main Methods:

• Retrospective review of 34 ENS patients and 74 controls.
• Coronal CT imaging and endoscopic evaluation for the Serpentine Sign.
• Analysis of ENS6Q scores and histologic examination of nasal tissue.

Main Results:

• The Serpentine Sign was present in 52.9% of ENS patients versus 0% of controls (p < 0.0001).
• ENS patients with the Serpentine Sign had significantly lower ENS6Q scores (p = 0.033).
• Histology revealed disorganized subepithelium with seromucinous glands, similar to the nasal septum swell body.

Conclusions:

• The Serpentine Sign, characterized by compensatory mucosal hypertrophy of the nasal septum soft tissue, is specific to ENS patients.
• This radiographic and endoscopic finding can serve as a reliable diagnostic marker for Empty Nose Syndrome.