Depression and anxiety in empty nose syndrome: A systematic review and Meta-analysis

Empty nose syndrome (ENS) is a condition characterized by a persistent feeling of nasal obstruction despite having a patent nasal airway. This study aims to understand prevalence of depression and anxiety in patients with ENS and the impact of augmentation procedures on psychological symptoms.

The literature was searched in accordance with PRISMA guidelines. Outcome measures were collected for mental health prevalences and patient-related outcome measures (PROMs).

Of 1056 abstracts identified, 11 studies (N = 401 patients) were included. Among patients with ENS, prevalences of depression and anxiety were 76.6% (95%CI: 61.0-89.1) and 77.0% (95% CI: 49.9-95.5). The prevalence of depression in patients with ENS was significantly increased compared to that of patients with chronic rhinosinusitis (CRS) (RR: 2.8 [95%CI: 1.5-5.2], p = 0.001) in studies which compared both conditions. In patients who underwent augmentation, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 showed no significant improvement at 6-month follow-up (5.39 [95%CI: -0.7-11.5], p = 0.08; 5.45 [95%CI: -2.8-13.7], p = 0.20) while Beck Depression Inventory-II and Beck Anxiety Inventory showed significant improvement at 6-month follow-up (11.94 [95%CI: 8.7-15.2], p < 0.00001; 10.83 [95%CI: 7.7-14.], p < 0.0001).

Depression and anxiety are common among patients with ENS, with a possible increased prevalence of depression in patients with ENS compared to those with CRS. Patients with ENS demonstrated inconsistent improvement in depression and anxiety scores following augmentation procedures depending on the PROMs utilized. As patients with ENS often have mental health comorbidities, further research should investigate whether anxiety and depression are true sequelae of ENS or factors contributing to its development.