The first publication devoted entirely to management of this potentially devastating syndrome, Empty Nose Syndrome: Evidence Based Proposals for Inferior Turbinate Management takes a comprehensive, state-of-the-art look at ENS, serving as a valuable addition to the literature for physicians, surgeons, and trainees. ENS is a secondary atrophic rhinitis which is most often the result of excessive surgical removal of functioning turbinate tissue. In this timely reference, Drs. Eugene Barton Kern and Oren Friedman solidify the awareness of ENS, inform readers of the current state of knowledge on ENS, and provide detailed coverage of how to prevent or minimize it.



Provides comprehensive coverage of the entire problem of ENS, based on scientific research and including an extensive bibliography for further reading.


Addresses proper turbinate management during nasal surgery in detail, noting that ENS can be prevented in most instances.


Contains chapters on symptoms of ENS, key definitions, diagnosis, treatment options for ENS, and more, along with extensive coverage of every aspect of turbinate management


Consolidates today's available information on this timely topic into a single, convenient resource.



CHAPTER 1 THE SCOPE OF ENS

1.DEFINITION: WHAT IS THE EMPTY NOSE SYNDROME (ENS)?
2.SYMPTOMS OF ENS
3.EMPTY NOSE SYNDROME OR ATROPHIC RHINITIS? A DEFINITION OF TERMS
A. PRIMARY ATROPHIC RHINITIS
B. SECONDARY ATROPHIC RHINITIS
C. DIFFERENTIAL DIAGNOSIS OF NASAL ATROPHY
4. DIAGNOSIS OF ENS
5. IATROGENIC WONDERLAND-ETIOLOGY
A. MIDDLE AND INFERIOR TURBINATE SURGERY
B. NON-SURGICAL TURBINATE REDUCTION ADJUNCTIVE PROCEDURES (N-STRAP)
CHAPTER 2 NASAL PHYSIOLOGY AND PATHOPHYSIOLOGY OF ENS

1. ESSENTIAL FUNCTION
2. NASAL CYCLE
CHAPTER 3 TREATMENT OPTIONS FOR ENS

1. MEDICAL
2. SURGICAL
3. PREVENTING ENS
CHAPTER 4 BRIEF HISTORY OF EVIDENCE BASED MEDICINE (EBM)

CHAPTER 5 TURBINATE TREATMENT -HISTORICAL PERSPECTIVE

CHAPTER 6 TURBINATE ANATOMY

1. ANATOMY OF THE MIDDLE TURBINATE
2. ANATOMY OF THE INFERIOR TURBINATE
CHAPTER 7 TURBINATE CLASSIFICATION OF ENLARGEMENT (HYPERTROPHY)

CHAPTER 8 RHINOLOGIC EVALUATION WITH ASSESSMENT TESTS AND BIOPSY

CHAPTER 9 TURBINATE MANAGEMENT 2021

1. MIDDLE TURBINATE MANAGEMENT
2. INFERIOR TURBINATE MANAGEMENT
3. TURBINATE REDUCTION: SURGICAL AND NON-SURGICAL PROCEDURES
A. EPITHELIAL MUCOSAL DESTRUCTION (TRANS MUCOSAL APPROACH)
1. SURGICAL RESECTION-TURBINECTOMY (PARTIAL OR COMPLETE-TOTAL)
2. ELECTROCAUTERY
3. LASER THERAPY
4. CRYOTHERAPY
B. EPITHELIAL MUCOSAL PRESERVATION (SUB MUCOSAL APPROACH)
1.SUBMUCOSAL SOFT TISSUE SURGICAL REDUCTION (TURBINOPLASTY)
A. SUBMUCOSAL SOFT TISSUE REDUCTION ONLY
B. CONCHAL BONE REDUCTION ONLY
C. COMBINED: SOFT TISSUE AND CONCHAL BONE REDUCTION
2. MICRODEBRIDER
3. RADIOFREQUENCY
4. COBLATION
5. ULTRASOUND
6. ELECTROCAUTERY
C. COMPLIMENTARY OUT-FRACTURE (LATERALIZATION) TECHNIQUES
1. SOLITARY-ISOLATED INTERVENTION
2. COMBINED WITH OTHER PROCEDURES
CHAPTER 10 FINDING THE BEST METHOD FOR MANAGING INFERIOR TURBINATE ENLARGEMENT (HYPERTROPHY)

1. BACKGROUND FOR FINDING THE "BEST METHOD": NEEDING RANDOMIZED CONTROLLED TRIALS (RCTS)
2. RANDOMIZED CONTROLLED TRIALS (RCTS) SEARCHING FOR THE "BEST METHOD" FROM
THE LITERATURE
3. FUTURE STUDIES - HOW TO DESIGN THE "BEST STUDY" FOR FINDING THE "BEST METHOD"
4. WHEN ARE RANDOMIZED CONTROLLED TRIALS RCTS NOT NEEDED?
5. ASKING ANSWERABLE QUESTIONS AND EMPIRICISM VERSUS RATIONALISM
6. ARE CONTROLLED TRIALS (RCTS) REALLY NEEDED? CAN THEY ACTUALLY BE ACCOMPLISHED IN SURGERY?
7. EVIDENCE FIRST BUT, WHAT TO DO WHEN RCT DATA IS LIMITED, INCOMPLETE,
INCONCLUSIVE, CONFLICTING OR STARKLY NON-EXISTENT?
8. WHAT ABOUT "PLACEBO" EFFECTS?
9. WHAT ARE THE ETHICS OF USING PLACEBOS IN MEDICINE?
10. WHAT ARE THE ETHICS OF USING PLACEBOS IN SURGERY?
11. "SHAM" SURGERY, IS THERE AN ETHICAL PLACE FOR RESEARCH SURGICAL TRIALS OR
IS IT FORBIDDEN?
12. WHAT ARE THE LIMITATIONS, IF ANY, TO THE DOCTRINE OF RANDOMIZED CONTROLLED
TRIALS (RCTS)?
13. IS THERE AN ETHICAL APPROACH TO SURGICAL AND INVASIVE PROCEDURES
WITHIN RANDOMIZED CONTROLLED TRIALS (RCTS)?
14. WHAT ARE THE OBLIGATIONS AND ACCOUNTABILITY TO OUR PATIENTS REGARDING
SURGICAL INNOVATIONS?
15. WHAT ARE THE CONSORT REQUIREMENTS AND WHAT'S THEIR IMPORTANCE
FOR RESEARCHERS AND JOURNALS?
16. WHAT IS PROPENSITY SCORE MATCHING (PSM) ALL ABOUT?
17. WHAT ABOUT USING CLINICAL PRACTICE GUIDELINES (CPG) AND ASSOCIATED CONFLICTS OF INTEREST (COI)?
18. WHAT ABOUT PRACTICE REPLACEMENT, REVERSAL AND THE NATURE OF MEDICAL PROGRESS
CHAPTER 11 CHILDREN AND INFERIOR TURBINATE REDUCTION

CHAPTER 12 MEDICAL JOURNALS: JUDGING THE EDITORIAL QUALITY AND PEER REVIEWERS

CHAPTER 13 SUMMARY AND CONCLUSIONS:

A. FOR MANAGING EMPTY NOSE SYNDROME (ENS) PATIENTS
1. EMPTY NOSE SYNDROME (ENS) EXISTS
2. PERTINENT NASAL PHYSIOLOGY
3. SYMPTOMS OF ENS
4. ETIOLOGY OF ENS
5. PREVENTING ENS
6 .MEDICAL TREATMENT OF ENS
7. SURGICAL TREATMENT OF ENS
B. EVIDENCE BASED MEDICINE (EBM) - DAVID SACKETT, MD
C. CONSORT
D. PROPENSITY SCORE MATCHING (PSM).
E. CLINICAL PRACTICE GUIDELINES (CPG)
F. REPLACEMENT REVERSAL
G. PROPOSALS FOR MANAGING MIDDLE TURBINATE ENLARGEMENT
H. EVIDENCE BASED PROPOSALS FOR MANAGING INFERIOR TURBINATE ENLARGEMENT ("HYPERTROPHY")
I. MEDICAL JOURNALS: JUDGING THE EDITORIAL QUALITY AND PEER REVIEWERS PLUS PLAGIARISM
J. REGARDING CHILDREN