Evaluation of Empty Nose Syndrome Scores in Patients Undergoing Extended Endoscopic Transnasal Sellar Surgery

Background: Several large series have established endoscopic transnasal sellar surgery as the procedure of choice for removal of tumors in the sellar area. Although this procedure provides a less invasive approach to the sella, it entails complications such as nasal bleeding, impaired olfactory function, atrophic rhinitis, synechiae, etc. No studies have yet reported potential morbidities such as empty nose syndrome (ENS), although patients have a relatively empty nasal cavity after surgery. Therefore, we sought to verify the percentage of patients who truly met the diagnostic criteria for ENS after endoscopic transnasal sellar surgery, determine the variation between pre- and postoperative scores in each Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) item, and further evaluate the symptoms that may affect the patients the most after surgery. Methods: Between March 2015 and January 2019, eventually 11 patients who underwent extended endoscopic transnasal sellar surgery in Shin Kong Wu Ho-Su Memorial Hospital, a tertiary referral medical center in Taipei, Taiwan, were enrolled. The patients completed the recently validated ENS6Q after surgery. Results: One patient met the objective diagnostic criteria for ENS (score ≥ 11 in ENS6Q). Significant differences were observed in the pre- and postoperative total ENS6Q scores. The pre- and postoperative scores of “nose feeling too open” and nasal crusting showed statistically significant differences. Further, compared with the other items, the postoperative score of nasal crusting increased most obviously, and it may be the most apparent operation-related symptom. Conclusion: This study is the first to report the possibility of developing ENS after endoscopic transnasal sellar surgery. Although the transnasal endoscopic approach is a safe and minimally invasive procedure for the treatment of sellar lesions, possible complications such as ENS should be considered.