Referred to by several patient associations, the Haute Autorité de Santé has just issued a series of recommendations for good practice on prevention, diagnosis and management of empty nose syndrome (source 1).

Empty nose syndrome (VSS) is characterized by the appearance of numerous nasal and/or extra-nasal symptoms which may have major psychological repercussions in the long term: depression, desocialization, agoraphobia, etc.

Symptoms appear within two years maximum after a turbinectomya surgical procedure offered to patients who suffer from persistent and debilitating nasal obstruction, such as chronic rhinitis or sinusitis.

Concretely, the turbinectomy consists in removing part of the small growths located in the nasal cavities (which are called the turbinates), indicates the HAS. And to specify: “It can be carried out alone or associated with other gestures on nasosinus structures”.

“The empty nose syndrome is always the consequence of an invasive surgical procedure on the lower, or even middle, turbinates of the nose and underlines in particular the importance of preventive actions to reduce the occurrence of this complication as much as possible”, indicates the Authority. Thus, it makes several recommendations:

• Only consider turbinectomy as a last resortin case of persistent and disabling nasal obstruction in failure of medical treatment and preserving the turbinates as much as possible.
• Inform patients well and favor the least risky surgical procedures occurrence of the syndrome.
• Carry out the interrogation scrupulously looking, in particular, for a previous turbinectomy.
• Perform a clinical and endoscopic examination of the nose to avoid complications.
• Perform a wet cotton test (by inserting a damp cotton ball into the nasal cavity to observe whether or not the symptoms improve) and imaging allowing the assessment of the residual volume of the turbinates.

Finally, the HAS recommends the multidisciplinary management of empty nose syndromeinvolving the ENT, the general practitioner and other professionals if necessary (psychiatrist, pulmonologist, speech therapist, physiotherapist, etc.).