Clinical Efficacy of Topical Nitroglycerin Ointment for Patients With Empty Nose Syndrome

The objective of this study was to assess the clinical efficacy and safety of topical nitroglycerin ointment in patients diagnosed with empty nose syndrome (ENS).

ENS was diagnosed based on clinical history, nasal endoscopic findings, a positive cotton test, and an Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) score of ≥ 11. Patients who met the inclusion criteria were instructed to apply a topical nitroglycerin ointment (Rectogesic, glyceryl trinitrate 0.2%) three times daily. The mean age was 42.09 years, with a male-to-female ratio of 3:1. Pre- and posttreatment ENS6Q scores were compared, and subjective symptom improvement was analyzed.

The total ENS6Q score showed a significant improvement, dropping from 17.32 ± 4.34 to 12.52 ± 5.21 (p < 0.001). All six ENS6Q items showed significant improvements, with the greatest reduction observed in nasal dryness (4.16 to 2.86, p < 0.001). Sixteen patients (36.4%) showed moderate improvement (ΔENS6Q = 3 to 6). Fifteen patients (34.1%) showed marked improvement (ΔENS6Q > 6), exceeding the minimal clinically important difference. Subjective symptom improvement was reported by 27 patients (61.4%), who demonstrated significantly greater ENS6Q improvement than those without symptom improvement (ΔENS6Q 7.22 ± 4.99 vs. 0.94 ± 2.41, p < 0.001). Eleven patients (25.0%) reported adverse effects; mild headache was the most common symptom (n = 6, 54.5% of adverse effects). The presence of adverse effects did not have a significant impact on treatment duration.

Topical nitroglycerin showed promising preliminary results and may represent a potential conservative treatment option for ENS, an uncommon yet serious complication arising after turbinate volume reduction surgery.