The Psychological Burden of Empty Nose Syndrome: A Systematic Review

<title>Abstract</title> <p>Empty Nose Syndrome (ENS) is a rare but debilitating iatrogenic condition arising post-turbinate surgery, characterized by paradoxical nasal obstruction despite a patent airway. While traditionally viewed as a structural disorder, emerging evidence points to a substantial psychological burden that may affect these patients. The objective of this paper is to systematically evaluate the prevalence, severity, and potential determinants of psychological comorbidities in ENS, and to assess the observed outcomes of both surgical and non-surgical interventions on mental health. A systematic review was conducted in accordance with PRISMA guidelines. Comprehensive searches of PubMed, Scopus, CINAHL, Cochrane Library, and PsycINFO identified studies published through March 2026. Eligible studies included ENS patients assessed for depression, anxiety, or suicidality using validated instruments (e.g., BDI-II, GAD-7, PHQ-9, SNOT-25). Study quality was appraised using CASP, ROBINS-E, and JBI tools. Due to heterogeneity, findings were synthesized qualitatively. Nine studies met inclusion criteria, encompassing over 400 patients. In the reviewed literature, ENS was strongly associated with high rates of psychological morbidity, including depression (~ 76%) and anxiety (~ 77%), with suicidal ideation reported in up to 37% of patients. Surgical interventions were linked to significant improvements in both psychological and sinonasal outcomes (p &lt; 0.001), though postoperative scores frequently remained elevated compared to controls. Non-surgical approaches, including cognitive behavioral therapy and antidepressants, also demonstrated meaningful reductions in symptom burden over time. Sex-stratified analysis suggested higher baseline depression and anxiety in females, with greater postoperative improvement compared to males. Risk of bias across studies was moderate, with confounding and measurement limitations noted. The gathered data suggest that ENS is strongly associated with significant psychological distress, underscoring the potential benefit of a multidisciplinary treatment approach that integrates both surgical and psychiatric care. While surgical reconstruction appears to improve symptoms, residual psychological burden frequently persists, highlighting the importance of addressing mental health pathways both pre- and post-operatively.</p>