{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T03:57:49Z","timestamp":1784865469289,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T00:00:00Z","timestamp":1728259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Diagnosis of empty nose syndrome (ENS) relies on the ENS six\u2010item questionnaire (ENS6Q) with a score of \u226511, followed by a \u201cpositive\u201d cotton test yielding seven\u2010point reduction from baseline ENS6Q score via cotton placement to the inferior meatus (IM). Given the intricacies of diagnosing ENS and the propensity for false positives with the standard cotton test, we modified the classic single\u2010step cotton test into a four\u2010part Stepwise Empty Nose Syndrome Evaluation (SENSE) cotton test to reduce bias and evaluate the placebo effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Individuals diagnosed with ENS underwent the SENSE test, a single\u2010blinded, four\u2010step, office\u2010based cotton test, without topical anesthesia or decongestants. Conditions included: (1) placebo\/no cotton placed; (2) complete cotton\u2010blockade of nasal vestibule; (3) cotton placed medially against the nasal septum; and (4) cotton placed laterally in the IM (site of inferior turbinate tissue loss). With each condition, patients completed an ENS6Q.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010eight ENS patients were included. Twenty\u2010nine percent demonstrated a placebo effect (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), 40.4% had a positive response to complete cotton\u2010blockade (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), 64.4% to septum\u2010placed cotton, and 79.1% to IM\u2010placed cotton (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), corresponding to a mean ENS6Q reduction of 11.9 points (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Notably, the mean difference in ENS6Q scores between septum and IM placement was 1.7 (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The SENSE test offers further insight into subtleties of nasal breathing experienced by ENS patients. The placebo effect can be prominent and important to consider with individual patients. While most ENS patients prefer any intranasal cotton placement over baseline, blinded testing reveals these patients can accurately discriminate minimal changes in nasal aerodynamics.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.23442","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T14:48:10Z","timestamp":1728312490000},"page":"149-156","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Stepwise Empty Nose Syndrome Evaluation (SENSE) test\u2014A modified cotton test for reduced bias in office diagnosis of empty nose syndrome"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7075-8752","authenticated-orcid":false,"given":"Lirit","family":"Levi","sequence":"first","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"},{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Rabin Medical Center  Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esmond F.","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Ma","sequence":"additional","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachi S.","family":"Dholakia","sequence":"additional","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidya K.","family":"Rao","sequence":"additional","affiliation":[{"name":"Divisions of Cardiothoracic Anesthesiology and Critical Medicine Department of Anesthesiology Perioperative and Pain Medicine, Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Renteria","sequence":"additional","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueying","family":"Cao","sequence":"additional","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9519-5880","authenticated-orcid":false,"given":"Michael T.","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4454-0861","authenticated-orcid":false,"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Division of Rhinology Department of Otolaryngology\u2014Head and Neck Surgery Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2009.02.001"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21842"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22761"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.133.9.858"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26549"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/01945998211052919"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1945892419880642"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/acm.2010.0566"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cobeha.2018.10.008"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino13.086"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2011.25.3577"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-012-1955-1"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22299"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599819900263"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29593"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26769"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813491223"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26530"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22489"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26491"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24813"},{"key":"e_1_2_8_23_1","article-title":"Placebo interventions for all clinical conditions","volume":"2010","author":"Hr\u00f3bjartsson A","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22097"}],"container-title":["International Forum of Allergy &amp; Rhinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alr.23442","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T17:34:44Z","timestamp":1738344884000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/alr.23442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,7]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1002\/alr.23442"],"URL":"https:\/\/doi.org\/10.1002\/alr.23442","archive":["Portico"],"relation":{},"ISSN":["2042-6976","2042-6984"],"issn-type":[{"value":"2042-6976","type":"print"},{"value":"2042-6984","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,7]]},"assertion":[{"value":"2024-03-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}