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Fu CH, Chen CC, Huang CC, Chang PH, Chen YW, Tang YC, Lee TJ. Morphology, Not Only Volume: A Study on Empty Nose Syndrome and Inferior Turbinates. Laryngoscope 2024; 134:3060-3066. [PMID: 38520707 DOI: 10.1002/lary.31328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/24/2023] [Accepted: 01/22/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Empty nose syndrome (ENS) is an underdiagnosed but burdensome clinical condition. Studies that have addressed the impact of remnant inferior turbinate volume (ITV) on ENS are scarce. We aimed to evaluate the impact of ITV and phenotyping on the severity and presentation of ENS. METHODS All the enrolled patients underwent the following subjective assessments: the ENS 6-Item Questionnaire (ENS6Q), Sino-Nasal Outcome Test-25 (SNOT-25), Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). The ITV was obtained from finely cut (1-mm-thick slices) sino-nasal computed tomography scan images and analyzed using ImageJ. The correlation between ITV, subjective measurements, and morphology of inferior turbinates was evaluated. ENS was categorized as torpedo type (balanced tissue volume) or pistol type (posterior dominance) based on the morphology. RESULTS Overall, 54 patients met the inclusion criteria. The ITV was positively correlated with the ENS6Q score and domain of ENS symptoms in SNOT-25. Neither BDI-II nor BAI scores had a significant correlation with ITV. Based on their morphological classification, the torpedo type exhibited diverse manifestations in the SNOT-25 analysis in response to changes in ITV, while the pistol type demonstrated an elevated rhinologic symptom burden and ENS-specific symptoms as their ITV increased. Nasal resistance did not correlate with the ITV in either type of ENS. CONCLUSIONS Symptoms were paradoxically worse in ENS patients with greater remnant ITV, and distinct morphological phenotypes in the nasal cavities may result in different presentations. Further investigation into the correlation between remnant inferior turbinates and nerve function is warranted. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3060-3066, 2024.
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Affiliation(s)
- Chia-Hsiang Fu
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Cheng Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chi-Che Huang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Chang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Wei Chen
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ya-Cheng Tang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ta-Jen Lee
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Pitsikas N. The role of nitric oxide (NO) modulators in obsessive-compulsive disorder (OCD). Nitric Oxide 2023; 134-135:38-43. [PMID: 37028750 DOI: 10.1016/j.niox.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
Obsessive-compulsive disorder (OCD) is as serious devastating anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs) are largely used for the treatment of this mental disease. This pharmacological approach presents consistent limitations including modest efficacy and important side effects. There is pressing need, therefore, to develop new molecules with higher efficacy and safety. Nitric oxide (NO) is an intra-and inter-cellular messenger in the brain. Its involvement in the pathogenesis of OCD has been proposed. In a series of preclinical studies, the anxiolytic profile of NO modulators has been emerged. In the present review I intended to critically evaluate advances in research of these molecules as potential novel agents for the treatment of OCD, comment their advantages over currently used pharmacological therapy as well remaining challenges. Up to now, few preclinical studies have been carried out to this end. Nonetheless, experimental evidence proposes a role for NO and its modulators in OCD. Additional research is mandatory aiming to definitively determine a role for NO modulators for the treatment of OCD. A note of caution, however, is needed on account of potential neurotoxicity and narrow therapeutic window of NO compounds.
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Fu CH, Chen HC, Huang CC, Chang PH, Lee TJ. Serum High-Sensitivity C-Reactive Protein Is Associated with Postoperative Psychiatric Status in Patients with Empty Nose Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11122388. [PMID: 34943627 PMCID: PMC8700485 DOI: 10.3390/diagnostics11122388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/05/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
Many patients diagnosed with empty nose syndrome (ENS) later develop mental illness. The literature addressing biomarkers associated with postoperative psychiatric status is limited. This study aimed to assess the association between high-sensitivity C-reactive protein (hs-CRP) and psychiatric status after surgery in ENS. We recruited patients with ENS undergoing endonasal submucosal implantation. Their pre- and postoperative psychiatric status was evaluated using the Beck depression inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Serum hs-CRP was analyzed one day before and one year after surgery. Of the 43 patients enrolled, all subjective measurements had improved (symptom scores decreased) significantly by the third month postoperatively and remained plateaued till 12 months. Those with preoperative hs-CRP levels > 2.02 mg/L were likely to remain depressive 1 year postoperatively. The regression model showed that a preoperative hs-CRP level > 2.02 mg/L was significantly correlated with postoperative depression in patients with ENS (odds ratio, 19.9). Hs-CRP level seems to be a feasible predictor of surgical outcome regarding improved depression in patients with ENS. Patients with higher preoperative hs-CRP levels should be monitored closely after surgery.
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Affiliation(s)
- Chia-Hsiang Fu
- Department of Otolaryngology—Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333604, Taiwan; (C.-H.F.); (H.-C.C.); (C.-C.H.); (P.-H.C.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333604, Taiwan
| | - Hung-Chin Chen
- Department of Otolaryngology—Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333604, Taiwan; (C.-H.F.); (H.-C.C.); (C.-C.H.); (P.-H.C.)
| | - Chi-Che Huang
- Department of Otolaryngology—Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333604, Taiwan; (C.-H.F.); (H.-C.C.); (C.-C.H.); (P.-H.C.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333604, Taiwan
| | - Po-Hung Chang
- Department of Otolaryngology—Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333604, Taiwan; (C.-H.F.); (H.-C.C.); (C.-C.H.); (P.-H.C.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333604, Taiwan
| | - Ta-Jen Lee
- Department of Otolaryngology—Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333604, Taiwan; (C.-H.F.); (H.-C.C.); (C.-C.H.); (P.-H.C.)
- Department of Otolaryngology—Head and Neck Surgery, Xiamen Chang Gung Memorial Hospital, Xiamen 361000, China
- Correspondence:
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Kanjanawasee D, Campbell RG, Rimmer J, Alvarado R, Kanjanaumporn J, Snidvongs K, Kalish L, Harvey RJ, Sacks R. Empty Nose Syndrome Pathophysiology: A Systematic Review. Otolaryngol Head Neck Surg 2021; 167:434-451. [PMID: 34665687 DOI: 10.1177/01945998211052919] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The pathophysiology of empty nose syndrome (ENS) remains unclear despite significant research. The pathophysiologic mechanism of ENS was systematically reviewed. DATA SOURCES MEDLINE and Embase. REVIEW METHODS Data were systematically reviewed for studies that provided original data on pathophysiology. RESULTS A total of 2476 studies were screened, and 19 met the inclusion criteria: 13 case-control and 6 cross-sectional. Nine pathophysiologic themes were identified.• Demographics: ENS symptoms had no relationship with climatic factors.• Symptomatology: ENS patients demonstrated high symptom severity.• Mental health: Anxiety and depression including hyperventilation were reported in >50% of ENS patients and correlated with ENS symptom severity.• Anatomic features: Structural changes in response to turbinate surgery were similar between ENS and non-ENS patients.• Airflow analysis: Airflow parameters were similar between ENS and non-ENS patients after turbinate surgery. On computational fluid dynamic analysis, differences were found on multiple outcomes.• Diagnostic testing: The menthol detection test was impaired in ENS, and cotton placement in the airway improved ENS symptoms.• Cognitive function: Functional magnetic resonance imaging showed activation in emotional processing area during breathing.• Olfactory function: Subjective impairment was reported in ENS, but quantitative measures were similar to non-ENS patients.• Mucosal physiology/innate immunity: Turbinate histopathology in ENS showed a tissue-remodeling pattern. Nasal nitric oxide level was lower in ENS patients. CONCLUSION There is evidence of high comorbid mental health disorders in ENS patients. An abnormal trigeminal-thermoreceptor response may be present in some patients. The influence of altered airflow and the evidence of surgery as the cause for ENS are unclear.
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Affiliation(s)
- Dichapong Kanjanawasee
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Raewyn G Campbell
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Otorhinolaryngology-Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Woolcock Institute, University of Sydney, Sydney, Australia.,Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Jesada Kanjanaumporn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Larry Kalish
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Richard J Harvey
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Raymond Sacks
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia
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Jeong JH. Nasal Nitric Oxide in the Upper Airway Inflammatory Diseases. JOURNAL OF RHINOLOGY 2021. [DOI: 10.18787/jr.2021.00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Exhaled nitric oxide (eNO) from the lower respiratory tract is used commonly in diagnosis and treatment monitoring of asthma patients. However, nasal nitric oxide (nNO) has not been widely used in patients with upper airway inflammatory diseases due to its lack of standardized measurement methods. Nasal nitric oxide is produced mainly by the paranasal sinus mucosa and partially by the nasal mucosa and increases with inflammation. Nasal nitric oxide not only locally supports the defensive mechanism of the upper respiratory tract, but also remotely controls pulmonary function by acting as an aerocrine. Nasal NO can be affected by various physiologic and pathologic factors of the upper respiratory tract. This article will review the origin of nNO, its function, various measurement methods, and difference in presentation among upper respiratory tract inflammatory diseases such as allergic rhinitis, upper respiratory tract infection, nasal polyp, rhinosinusitis, primary ciliary dyskinesia, cystic fibrosis, Young’s syndrome, diffuse panbronchiolitis, empty nose syndrome, and obstructive sleep apnea. Future studies should identify the mechanism of action of nNO in various upper respiratory tract inflammatory diseases and obtain highly reproducible normal values of nNO based on a standardized measurement method with a deeper understanding of factors affecting nNO. Then, nNO will be useful for more rapid and simpler diagnosis of various upper respiratory tract diseases and for monitoring their treatment.
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Outcomes of olfaction in patients with empty nose syndrome after submucosal implantation. Am J Otolaryngol 2021; 42:102989. [PMID: 33676069 DOI: 10.1016/j.amjoto.2021.102989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Olfactory dysfunction, such as hyposmia, is a significant symptom of empty nose syndrome (ENS). The efficacy of surgical intervention in olfaction improvements for ENS has not been investigated extensively. OBJECTIVE The aim of this study was to evaluate changes in olfaction after surgical treatment for ENS. METHODS This prospective cohort study at a tertiary medical center enrolled patients with ENS indicated for surgical treatment between June 2015 and June 2019. The Sniffin' Sticks 12-items odor identification test (SS-12) and subjective olfaction rating were completed by patients before and after surgery to assess olfaction. RESULTS A total of 40 patients completed the survey both before and after surgical treatment. Prior to surgery, 25% of the patients had olfactory dysfunction detected by SS-12, whereas 80% of the patients reported a reduction in olfactory function by subjective rating. The degree of olfactory dysfunction by both assessments significantly improved following surgery. The age was a significant predictor of postoperative improvement. CONCLUSION Surgical treatment is helpful in improving olfaction in patients with ENS who commonly suffer from olfactory dysfunction. Younger patients may benefit more from surgical intervention in aspect of olfaction.
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