Surgical management of Empty Nose Syndrome Using Inferior Meatus Volume Augmentation with Autologous Costal Cartilage: A Case Report

<title>Abstract</title> <p>Empty nose syndrome (ENS) is a clinical condition characterized by a paradoxical sensation of nasal obstruction despite the presence of patent nasal cavities, typically occurring as a consequence of extensive turbinate surgery. We present the case of a 50-year-old woman with a history of multiple nasal procedures, including partial inferior turbinectomy, who subsequently developed progressive nasal obstruction and significant deterioration in quality of life. Physical examination confirmed severe bilateral inferior turbinate atrophy. The preoperative scores were 16 on the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), 62 on the Sino-Nasal Outcome Test (SNOT-22), and 7 on a Visual Analog Scale (VAS) for nasal obstruction. The cotton test was positive, reducing the VAS score from 7 to 2. The patient underwent endoscopic reconstruction of the inferior meatus using autologous costal cartilage grafts. At 6 months of follow-up, nasal endoscopy demonstrated adequate graft integration and preservation of the reconstructed volume. Clinically, the patient experienced a significant symptomatic improvement, with ENS6Q scores decreasing from 16 to 8, SNOT-22 scores from 62 to 10, and VAS scores from 7 to 3, without major complications. This case supports endoscopic inferior meatus reconstruction with autologous costal cartilage grafts as a viable therapeutic option for selected patients with Empty Nose Syndrome refractory to conservative treatment.</p>