Manji Jamil, Patel Vishal S, Nayak Jayakar V, Thamboo Andrew
1 St. Paul's Sinus Centre, Vancouver, BC, Canada.
2 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA, USA.
Ann Otol Rhinol Laryngol. 2019 Jul;128(7):601-607. doi: 10.1177/0003489419833714. Epub 2019 Feb 28.
Empty nose syndrome (ENS) is thought to have multiple etiologies, one of which is a postsurgical phenomenon resulting from excessive loss of nasal tissues, particularly the inferior turbinate. Given that the inferior turbinate is instrumental in maintaining nasal homeostasis in different environments, it is believed that ENS symptoms arise only in more arid regions of the world. The aim of this study was to recruit an international population of individuals with ENS to investigate the association of local climate factors on the incidence and severity of ENS-specific symptoms.
A cross-sectional study was performed of individuals from an international ENS database. ENS status was determined on the basis of a positive ENS questionnaire score (Empty Nose Syndrome 6-Item Questionnaire) and sinus computed tomographic imaging with supporting medical documentation. Participants completed a survey encompassing demographic, geographic, and symptom indicators. Climate variables were collected from global climate databases. Participant location was classified according to the Köppen-Geiger climate system. Pearson correlation analysis was performed using α = 0.05 to determine significance.
Fifty-three individuals with ENS were included. Participants were distributed across 5 continents and 15 countries (representing 4 distinct Köppen-Geiger zones). Although local climate factors varied significantly within this cohort, no significant association was found between Empty Nose Syndrome 6-Item Questionnaire symptom severity and these climate factors. However, most study participants reported exacerbation of their ENS symptoms in response to dry air (94%), air conditioning (64%), changes in season and weather (60%), and transitioning between indoors and outdoors (40%). This suggests that everyday local environmental factors may influence the well-being of these patients more than global, climate-level shifts.
ENS symptom severity does not appear to be related to climate or geographic factors. These findings deviate from the traditional dogma that ENS is experienced only in arid regions (or precluded in humid regions) and highlight the importance of recognizing this condition independent of geographic location.
空鼻综合征（ENS）被认为有多种病因，其中之一是术后现象，由鼻腔组织过度缺失，尤其是下鼻甲过度缺失引起。鉴于下鼻甲在维持不同环境下的鼻腔内环境稳定中起重要作用，人们认为ENS症状仅在世界上较为干旱的地区出现。本研究的目的是招募国际范围内的ENS患者群体，以调查当地气候因素与ENS特异性症状的发生率和严重程度之间的关联。
对来自国际ENS数据库的个体进行横断面研究。根据ENS问卷阳性评分（空鼻综合征6项问卷）以及鼻窦计算机断层扫描成像和辅助医疗记录来确定ENS状态。参与者完成了一项涵盖人口统计学、地理和症状指标的调查。气候变量从全球气候数据库中收集。根据柯本-盖格气候系统对参与者的位置进行分类。使用α = 0.05进行Pearson相关性分析以确定显著性。
纳入了53名ENS患者。参与者分布在5个大洲和15个国家（代表4个不同的柯本-盖格气候区）。尽管该队列中的当地气候因素差异显著，但未发现空鼻综合征6项问卷症状严重程度与这些气候因素之间存在显著关联。然而，大多数研究参与者报告称，干燥空气（94%）、空调（64%）、季节和天气变化（60%）以及室内外转换（40%）会使他们的ENS症状加重。这表明日常的当地环境因素可能比全球气候层面的变化对这些患者的健康影响更大。
ENS症状严重程度似乎与气候或地理因素无关。这些发现偏离了传统观念，即ENS仅在干旱地区出现（或在潮湿地区不会出现），并强调了认识到这种疾病与地理位置无关的重要性。
