Does Total Inferior and Middle Turbinectomy Always Lead to Empty Nose Syndrome?

Tuesday, October 14, 2025

8:30 AM - 8:36 AM EDT

Location: 125

Disclosure(s):

Nidhi Jha, Other:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Empty Nose Syndrome (ENS) is a rare and controversial complication often associated with aggressive turbinate reductions. Computational fluid dynamic (CFD) modeling has previously demonstrated that distorted nasal airflow patterns could contribute to ENS. However, no data has shown that aggressive turbinate reductions always lead to the development of ENS.

Methods: We retrospectively recruited 5 nasal obstruction patients who underwent turbinate reduction surgery. and virtually performed total inferior and total middle turbinectomies on all patients. We compared the CFD modeling results to the patients’ pre-surgical CT scans and 27 patients with confirmed ENS.

Results: As expected, the virtual turbinectomy significantly altered nasal cross-sectional area of the inferior and middle turbinate regions, more than that of actual surgery (inferior: 0.9±0.4 to1.8 ± 0.3 cm2,middle: 0.6±0.3 to 1.0 ± 0.3 cm2, all p< 0.01), however, it does not create the same distorted nasal airflow patterns as seen in ENS patients, with no significant difference in nasal resistance (actual surgery: 0.12±0.04; virtual surgery: 0.10±0.03; ENS: 0.11±0.04 Pa/ml*s, p>0.05) nor in regional wall shear force (WSF) distribution, an important indicator of air/mucosa stimulation (inferior turbinate WSF%: baseline 54.0±11.9, actual surgery: 51.5±15.1; virtual: 46.5±11.5, p>0.05), however all are significantly higher than that of ENS patients (WSF: 32.2%±12.5%, p< 0.001). There are also no significant differences in WSF distribution between inferior turbinectomy only vs inferior + middle turbinectomy.

Conclusions: ENS cannot be solely attributed to aggressive turbinate reduction surgeries since various factors may play a role in the disease process.

Presenting Author(s)

Nidhi Jha, Other

MD PhD student
The Ohio State University College of Medicine
Columbus, Ohio, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Jed A. Speers, BS

Medical Student
Wright State University Boonshoft School of Medicine
Fairborn, OH, United States

Disclosure information not submitted.
AO

Ahmad Odeh, Other

The Ohio State University College of Medicine, United States

Disclosure information not submitted.
ZW

Zhenxing Wu, PhD

Postdoctoral researcher
The Ohio State University
Columbus, OH, United States

Disclosure information not submitted.
JM

James Mihalich, HSD

The Ohio State University College of Medicine, United States

Disclosure information not submitted.
BH

Bradley Hittle, MS

Biomedical Informatics Consultant
The Ohio State Unviersity, United States

Disclosure information not submitted.
BO

Bradley Ia Otto, MD

Director, Division of Rhinology
The Ohio State University College of Medicine
Columbus, OH, United States

Disclosure information not submitted.
Kathleen M. Kelly, MD

Assistant Professor
Department of Otolaryngology Head & Neck Surgery, The Ohio State University Wexner Medical Center
Columbus, Ohio, United States

Disclosure information not submitted.
Gregory J. Wiet, MD

Professor
Nationwide Children's Hospital/The Ohio State University Department of Otolaryngology-Head and Neck Surgery
Columbus, OH, United States

Disclosure information not submitted.

Senior Author(s)

KZ

Kai Zhao, PhD

Professor
Department of Otolaryngology, The Ohio State University College of Medicine
Columbus, OH, United States

Disclosure information not submitted.