{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T05:23:20Z","timestamp":1788326600912,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,2,14]],"date-time":"2018-02-14T00:00:00Z","timestamp":1518566400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Empty nose syndrome (ENS) is a debilitating disorder thought to arise as a postsurgical phenomenon from excessive loss of nasal tissues. Affected patients often report a profound impact on all aspects of life, but the extent of this burden has not been quantified. We sought to determine the association of ENS with mental health and functional impairments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross\u2010sectional study was performed of individuals with ENS recruited from online ENS forums. ENS status was validated based on a positive 6\u2010item Empty Nose Syndrome Questionnaire (ENS6Q) score and sinus computed tomography imaging or supporting medical documentation. Subjects completed the ENS6Q, the 9\u2010item Patient Health Questionnaire (PHQ\u20109) for depression, the 7\u2010item Generalized Anxiety Disorder questionnaire (GAD\u20107), the Epworth Sleepiness Scale for daytime somnolence (ESS), the Work Productivity and Impairment questionnaire (WPAI), and the 5\u2010dimension EuroQol General Health State Survey (EQ\u20105D\u20105L). Pearson correlation analysis was performed with \u03b1 = 0.05 to determine significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010three ENS individuals were included in the study. Overall, participants reported symptoms consistent with moderate anxiety (\u03bc = 12.7; standard deviation [SD], 5.9) and moderately severe depression warranting treatment (\u03bc = 17.9; SD, 6.8). Participants also noted a 62% reduction in productivity at work (n = 24) and 65% in all other activities (n = 53). ENS6Q symptom severity was correlated with more severe depression (<jats:italic>p<\/jats:italic> &lt; 0.001), anxiety (<jats:italic>p<\/jats:italic> &lt; 0.001), overall pain\/discomfort (<jats:italic>p<\/jats:italic> = 0.002), and impairment in activities of daily living (<jats:italic>p<\/jats:italic> = 0.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ENS individuals carry a clinically significant psychological burden and experience marked difficulties with many activities of daily living. A multimodal approach to address the tissue loss with surgery and cognitive\u2010behavioral therapy for the psychological burden may provide the most optimal outcome.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22097","type":"journal-article","created":{"date-parts":[[2018,2,14]],"date-time":"2018-02-14T16:53:16Z","timestamp":1518627196000},"page":"707-712","source":"Crossref","is-referenced-by-count":68,"title":["The functional and psychological burden of empty nose syndrome"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3455-6790","authenticated-orcid":false,"given":"Jamil","family":"Manji","sequence":"first","affiliation":[{"name":"St Paul's Sinus Centre  Vancouver BC Canada"},{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Stanford University School of Medicine  Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Stanford University School of Medicine  Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Thamboo","sequence":"additional","affiliation":[{"name":"St Paul's Sinus Centre  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2009.02.001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24813"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21842"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.133.9.858"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2007.21.2987"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21774"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26549"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21633"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(03)00198-8"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318160d093"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2013.08.002"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3141"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599810391625"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/32.2.150"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0b013e31816ff3bf"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2869.2000.00177.x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-199304050-00006"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25054"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25814"},{"key":"e_1_2_7_22_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1176\/ps.2007.58.1.63","article-title":"Do Canada and the United States differ in prevalence of depression and utilization of services","volume":"58","author":"Vasiliadis HM","year":"2007","journal-title":"Psychiatr Serv"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1121189X00001421"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940711600703"},{"key":"e_1_2_7_25_1","first-page":"278","article-title":"Chronic tinnitus: an interdisciplinary challenge","volume":"110","author":"Kreuzer PM","year":"2013","journal-title":"Dtsch Arztebl Int"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21843"},{"key":"e_1_2_7_27_1","first-page":"15","article-title":"Relationship between the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in a sleep laboratory referral population","volume":"5","author":"Mondal P","year":"2013","journal-title":"Nat Sci Sleep"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2015.02.005"}],"container-title":["International Forum of Allergy &amp; 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