Assessment of Autonomic Dysfunction in Patients With Empty Nose Syndrome Using the Composite Autonomic Symptom...

Empty nose syndrome (ENS) can occur as a consequence of aggressive turbinate surgery. However, some patients with similar surgical histories do not develop ENS, suggesting that host-related factors may contribute to its onset. Dysregulation of the autonomic nervous system (ANS), which innervates the nasal mucosa, may play a role in triggering ENS. This study used the Composite Autonomic Symptom Scale-31 (COMPASS 31) questionnaire to compare ANS dysfunction between patients with ENS and asymptomatic controls.

Twenty-six patients with ENS and 43 control participants without nasal symptoms, rhinitis, or rhinosinusitis were enrolled. ENS diagnostic criteria included a history of turbinate surgery, reduced turbinate volume on endoscopy or computed tomography scan, and an Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) score of ≥11. ENS was also diagnosed in patients with an ENS6Q score ≤11 if clinical findings strongly suggested ENS and the cotton test was positive.

The ENS group showed significantly higher total COMPASS 31 scores than the controls. Although total ENS6Q and COMPASS 31 scores were not correlated, the crusting subscore was positively correlated with the total COMPASS 31 score (p=0.012).

Patients with ENS demonstrated markedly elevated total COMPASS 31 scores, and the crusting score in the ENS6Q was positively associated with total COMPASS 31 scores. These findings suggest that ANS dysfunction may contribute to ENS pathogenesis.