Nasal Air-Jet Sensitivity Differentiates Empty Nose Syndrome and Turbinate Reduction Patients: A Pilot Study

Abnormal nasal mucosal function has been frequently implicated in the symptomatology of empty nose syndrome (ENS), yet with limited evidence. This prospective pilot study aims to compare nasal mucosal sensitivity to air-jet stimuli between ENS patients and patients who underwent septoplasty/turbinate reduction (septo-turb) surgery, but without ENS symptoms.

Seven ENS and seven septo-turb subjects were recruited through a sample of convenience (from 06/2023 to 09/2024) due to the rarity of ENS. A precise, 0.25 s air jet ranging from 0.5 to 5 L/min was delivered via a 25-gage microcannula, with a 0.4 × 1.6 mm side opening placed 2 mm from the mucosal surface at predetermined sites that include the medial and lateral side of the nasal valve, the head and the center of inferior turbinate and their opposing septum. Detection thresholds were determined using a single-staircase method in 0.5 L/min steps.

The ENS group had a significantly higher (less sensitive) threshold than the septo-turb group for the septum opposing the center of the inferior turbinate (ENS: 2.43 ± 1.37 L/min; septoplasty: 1.39 ± 1.27 L/min, p = 0.016); however, not for other sites. This regional threshold significantly correlated with all self-reported symptom scores (NOSE, SNOT-22, ENS6Q, VAS) (r = 0.45-0.54, all p < 0.05).

Significant regional differences in air-jet stimulus sensitivity between ENS and septoplasty patients were found that significantly correlated with symptom scores. A future larger sample size would make a more definitive conclusion.