Empty Nose Syndrome: An Update on Pathophysiology, Diagnosis, and Treatment

Empty nose syndrome (ENS) is a chronic sinonasal condition that typically results from overly aggressive turbinate reduction. It is characterized by nasal dryness, crusting, burning sensation, and a paradoxical perception of excessive airflow despite an anatomically wide nasal cavity, leading to significant impairment in quality of life. This narrative review summarized over 70 publications (PubMed, Embase, Google Scholar, and Cochrane Library; 2000-2026) to outline current diagnostic and therapeutic considerations for ENS. ENS most commonly develops following total or near-total inferior turbinectomy. Its pathophysiology involves transient receptor potential melastatin 8 cold receptor hypofunction, histopathological changes, autonomic nervous system dysfunction, and neuroinflammation. Diagnosis is based on the Empty Nose Syndrome 6-Item Questionnaire in combination with the cotton test, while the Standardized Empty Nose Syndrome Evaluation blinded protocol helps reduce placebo bias. The inferior meatus augmentation procedure is the most frequently reported surgical intervention, demonstrating clinically meaningful and sustained improvement in large meta-analyses; no single graft material has demonstrated consistent superiority. Non-surgical-including three-dimensional-printed nasal plugs, resorbable injectable fillers, intranasal trigeminal training, and cognitive behavioral therapy combined with selective serotonin reuptake inhibitors-serve as essential components of comprehensive management.