Empty Nose Syndrome Treated by Autologous Auricular Cartilage

Empty Nose Syndrome Treated by Autologous Auricular Cartilage Turbinate Augmentation— Case Report 新光吳火獅紀念醫院 耳鼻喉科 光吳火獅紀念醫院 醫學美容中心 3 台大醫院 耳鼻喉部 吳子宜 1 邱昱勳 1，2，3

Patient Profile • • Sex : Female Age : 63 Occupation : Retired shop keeper Past medical history: • Medical: denied systemic disease history • Surgical: underwent multiple nasal and turbinate surgeries in the past 10 years at different hospitals, including radiofrequency surgery, laser turbinoplasty, septomeatoplasty, and inferior turbinectomy

Chief Complaint • Persistent nasal obstruction sensation in the left nose for years • Associated with burning sensation and post-nasal drip sensation • Symptoms did not improve after latest surgery (Septomeatoplasty about 5 years ago)

Local finding Left nose: • Large, patent nasal fossae, with absence of inferior turbinate

Work-up • Cotton test: subjective improvement of symptoms noted in her left nose • Sinus CT: lack of left inferior turbinate

Impression Empty Nose Syndrome, secondary to inferior turbinectomy Treatment Conservative: Nasal lavage and topical corticosteroids were tried for 2 weeks, but were ineffective. Surgical: left inferior turbinate reconstruction with autologous concha cartilage implantation

Inferior turbinate reconstruction with autologous concha cartilage implant Post-OP 2 weeks

Inferior turbinate reconstruction with autologous concha cartilage implant Post-OP 4 weeks Symptoms mostly alleviated

Discussion Treatment of Empty nose syndrome Picture from Empty Nose Syndrome International Association

Empty Nose Syndrome • First coined by Kern and Stenkvist in 1994 • a recognized complication of turbinate surgery, most frequently total turbinate excision • A diagnosis of exclusion; no reliable objective tests Picture from Empty Nose Syndrome International Association

Treatment Nasal implantation • First described by Houser et al • 8 patients with ENS symptoms having submucosal implantation of acellular dermis. • All reported subjective improvement (Mean SNOT-25: 58 38) • Placement should ideally simulate the natural nasal airflow

Review paper of 8 studies, 128 patients in total (2000/01 – 2014/06) All SNOT subdomains improved following surgery Extrusion of implant occurred in 6 cases (all biomaterial)

Comparing effects of lateral or inferior nasal wall implantation in terms of clinical benefits and improvements in quality of life. Implant: porous, high-density polyethylene implant (Medpor; Porex Surgical, Inc. )

30 patients, with at least 1 year follow-up. Post-OP SNOT-22 scores improved significantly in both groups. Lateral wall group showed more significant improvements in rhinologic symptoms and sleep function.