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Use of intranasal submucosal fillers as a transient implant to alter upper airway aerodynamics: implications for the assessment of empty nose syndrome
Author(s) -
Borchard Nicole A.,
Dholakia Sachi S.,
Yan Carol H.,
Zarabanda David,
Thamboo Andrew,
Nayak Jayakar V.
Publication year - 2019
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22299
Subject(s) - medicine , nose , meatus , airway , implant , surgery
Background Empty nose syndrome (ENS) is a debilitating condition associated with inferior turbinate tissue loss. Surgical augmentation of the inferior meatus has been proposed to treat ENS, although efficacy data with validated, disease‐specific questionnaires is limited. Instead we evaluated submucosal injection of a transient, resorbable filler into the inferior meatus to favorably alter nasal aerodynamics in ENS patients. Methods Patients with a history of inferior turbinate reduction, diagnosed with ENS via Empty Nose Syndrome 6‐Item Questionnaire (ENS6Q) and cotton testing, were enrolled and underwent submucosal injection of carboxymethylcellulose/glycerin gel (Prolaryn®) into the inferior meatuses between July 2014 and May 2018. This material likely resorbs over several months. Outcomes included comparisons of preinjection and postinjection symptoms at 1 week, 1 month, and 3 months using the ENS6Q, 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Generalized Anxiety Disorder 7‐item scale (GAD‐7), and Patient Health Questionnaire‐9 (PHQ‐9). Results Fourteen patients underwent injections. Mean ENS6Q scores significantly decreased from baseline at 1 week (20.8 vs 10.5; p < 0.0001), and remained reduced but upward‐trending at 1 month (13.7, p = 0.002) and 3 months (15.5, p > 0.05) following injections. Mean SNOT‐22 scores significantly decreased at 1 week ( p = 0.01) and 1 month ( p = 0.04), mean GAD‐7 at 1 month ( p = 0.02) and 3 months ( p = 0.02), and mean PHQ‐9 at 1 week ( p = 0.01) and 1 month ( p = 0.004) postinjection. Conclusion Transient, focal airway bulking via submucosal filler injection at sites of inferior turbinate tissue loss markedly benefits ENS patients, suggesting that aberrant nasal aerodynamics from inferior turbinate tissue loss contributes to (potentially reversible) ENS symptoms.