Reviews

Korean scientists identified 1,408 records from databases and registers, including PubMed, Embase, Scopus, the Cochrane Register of Controlled Trials, and Google Scholar. After removing duplicates and applying exclusion criteria (e.g., insufficient patient numbers or missing scales and scores for endoscopic findings), 28 studies were included: 24 on implant-based reconstruction and 4 on regenerative approaches.

The majority of the studies were case series and case-control studies, with only two being randomized controlled trials. The Cochrane Risk of Bias tool was used to assess the risk of bias in randomized controlled studies.

The results were summarized and described according to predefined criteria, including study design, number of patients, sex (male:female), age (years), cases/controls, country, previous surgical history, preoperative assessment, intervention, anesthesia, treatment location, treatment outcomes, results, and follow-up duration (months). More than a half of the reports utilized the cotton test for pretreatment evaluation.

The authors conclude that tissue regeneration techniques could be cautiously considered to support treatment in patients with ENS; however, further research is needed to clarify their potential, given the limited number of existing studies.

The authors conducted a comprehensive search using the term “Empty Nose Syndrome” across multiple databases, including PubMed, Embase, Google Scholar, ScienceDirect, and the Cochrane Database. In total, 287 articles were identified; after screening and applying eligibility criteria (excluding studies with irrelevant outcomes or those not focused on treatments, while limiting inclusion to English and French publications), 43 studies were included in the final review. The majority of included studies focused on implant-based treatments.

The authors assessed each study for potential bias and overall quality, following established guidelines. They used standard assessment tools (checklists to evaluate factors that could affect reliability, e.g. ROBINS-I tool). Furthermore, each selected article underwent analysis based on the 9 criteria such as heterogeneity of effects, certainty of evidence or how the results were described.

The results are presented in four tables, grouping studies by Injection Treatments, Synthetic Implants, Biological Implants, and Psychiatric/Psychological Treatments. Every publication in the treatment section was judged to have a high or critical risk of bias, with stem cell studies primarily assessed as being at critical risk.

The authors conclude that future investigations using robust methodological approaches are needed to evaluate the effectiveness of different treatments.

Atrophic rhinitis (AR) involves progressive atrophy of the nasal mucosa and bone, while empty nose syndrome (ENS) is often considered post-turbinectomy iatrogenic AR. Literature supports grouping AR and ENS as a single clinical, endoscopic, and radiological entity (AR), within which aetiology and history distinguish primary AR (ozaena) from secondary AR due to trauma, surgery, infection, systemic disease, or radiation.

Primary AR is diagnosed by nasal endoscopy, revealing enlarged nasal cavities and dry, dystrophic, atrophic mucosa that may be crusted or ulcerated. Microbiological testing may be useful when suppuration is present, with organisms including Klebsiella ozaenae, Corynebacterium diphtheriae, Staphylococcus aureus, Proteus mirabilis, and Escherichia coli.

Secondary forms of AR arise from a wide range of conditions such as surgery, granulomatous disease, autoimmune disorders, infections, toxic exposures, and malignancy. They typically present with mucosal atrophy, osteochondral loss, and structural nasal damage of varying severity. Endoscopic and radiological features are heterogeneous and closely linked to the underlying aetiology.