Empty Nose Syndrome (ENS) and Upper Airway Physiology

Our lab focuses on disorders of nasal physiology and nasal breathing, particularly with regard to the debilitating disease termed empty nose syndrome (ENS). Our practice of >100 patients with ENS has allowed the design and validation of what are now considered gold standard subjective (ENS6Q) and provocative (nasal cotton test) tests to more accurately identify patients suffering from ENS.

Our validation study of the ENS6Q questionnaire was named the Best Clinical Research Paper at the American Rhinologic Society at the 2016 national meeting, and the cotton test validation received cover article honors. Through international patient assessment, we have also measured the functional and psychological burden presented by empty nose syndrome and have assessed how the nasal mucosa remodels in ENS patients over time compared to controls using imaging. We are currently assessing the benefit/impact of candidate treatments for ENS patients using subjective and objective outcome measures.


Malik, Jennifer, Andrew Thamboo, Sachi Dholakia, Nicole A. Borchard, Sam McGhee, Chengyu Li, Kai Zhao, and Jayakar V. Nayak. “The Cotton Test Redistributes Nasal Airflow in Patients with Empty Nose Syndrome.” International Forum of Allergy & Rhinology 10, no. 4 (2020): 539–45. https://doi.org/10.1002/alr.22489.
Ibrahim, Nour, Matthew A. Tyler, Nicole A. Borchard, Aakanksha Rathor, and Jayakar V. Nayak. “Nasal Vestibular Body Treatment for Recalcitrant Nasal Obstruction.” International Forum of Allergy & Rhinology 10, no. 3 (2020): 388–94. https://doi.org/10.1002/alr.22463.
Thamboo, Andrew, Sachi S. Dholakia, Nicole A. Borchard, Vishal S. Patel, Navarat Tangbumrungtham, Nathalia Velasquez, Zhenxiao Huang, David Zarabanda, Tsuguhisa Nakayama, and Jayakar V. Nayak. “Inferior Meatus Augmentation Procedure (IMAP) to Treat Empty Nose Syndrome: A Pilot Study.” Otolaryngology–Head and Neck Surgery 162, no. 3 (2020): 382–85. https://doi.org/10.1177/0194599819900263.
Gill, Amarbir S., Mena Said, Travis T. Tollefson, E. Bradley Strong, Jayakar V. Nayak, and Toby O. Steele. “Patient-Reported Outcome Measures and Provocative Testing in the Workup of Empty Nose Syndrome—Advances in Diagnosis: A Systematic Review.” American Journal of Rhinology & Allergy 34, no. 1 (2020): 134–40. https://doi.org/10.1177/1945892419880642.
Talmadge, Jason, Jayakar V. Nayak, William Yao, and Martin J. Citardi. “Management of Postsurgical Empty Nose Syndrome.” Facial Plastic Surgery Clinics of North America 27, no. 4 (2019): 465–75. https://doi.org/10.1016/j.fsc.2019.07.005.
Williams, Ryan, Vishal Patel, Yu-Feng Chen, Navarat Tangbumrungtham, Andrew Thamboo, Sam P. Most, Jayakar V. Nayak, and Stanley Y. C. Liu. “The Upper Airway Nasal Complex: Structural Contribution to Persistent Nasal Obstruction.” Otolaryngology–Head and Neck Surgery 161, no. 1 (2019): 171–77. https://doi.org/10.1177/0194599819838262.
Manji, Jamil, Vishal S. Patel, Jayakar V. Nayak, and Andrew Thamboo. “Environmental Triggers Associated With Empty Nose Syndrome Symptoms: A Cross-Sectional Study.” Annals of Otology, Rhinology & Laryngology 128, no. 7 (2019): 601–7. https://doi.org/10.1177/0003489419833714.
Borchard, Nicole A., Sachi S. Dholakia, Carol H. Yan, David Zarabanda, Andrew Thamboo, and Jayakar V. Nayak. “Use of Intranasal Submucosal Fillers as a Transient Implant to Alter Upper Airway Aerodynamics: Implications for the Assessment of Empty Nose Syndrome.” International Forum of Allergy & Rhinology 9, no. 6 (2019): 681–87. https://doi.org/10.1002/alr.22299.
Manji, Jamil, Jayakar V. Nayak, and Andrew Thamboo. “The Functional and Psychological Burden of Empty Nose Syndrome: Burdens of ENS.” International Forum of Allergy & Rhinology 8, no. 6 (2018): 707–12. https://doi.org/10.1002/alr.22097.
Thamboo, Andrew, Nathalia Velasquez, Al-Rahim R. Habib, David Zarabanda, Hassan Paknezhad, and Jayakar V. Nayak. “Defining Surgical Criteria for Empty Nose Syndrome: Validation of the Office-Based Cotton Test and Clinical Interpretability of the Validated Empty Nose Syndrome 6-Item Questionnaire: Cotton Test Validation and ENS6Q MCID.” The Laryngoscope 127, no. 8 (2017): 1746–52. https://doi.org/10.1002/lary.26549.
Velasquez, Nathalia, Andrew Thamboo, Al-Rahim R. Habib, Zhenxiao Huang, and Jayakar V. Nayak. “The Empty Nose Syndrome 6-Item Questionnaire (ENS6Q): A Validated 6-Item Questionnaire as a Diagnostic Aid for Empty Nose Syndrome Patients: ENS6Q Diagnostic Aid for ENS.” International Forum of Allergy & Rhinology 7, no. 1 (2017): 64–71. https://doi.org/10.1002/alr.21842.
Thamboo, Andrew, Nathalia Velasquez, Noel Ayoub, and Jayakar V. Nayak. “Distinguishing Computed Tomography Findings in Patients with Empty Nose Syndrome: Radiologic Findings in ENS.” International Forum of Allergy & Rhinology 6, no. 10 (2016): 1075–82. https://doi.org/10.1002/alr.21774.
Locketz, Garrett D., Neville W. Teo, Evan Walgama, Ian M. Humphreys, and Jayakar V. Nayak. “The Nasal Vestibular Body: Anatomy, Clinical Features, and Treatment Considerations.” European Archives of Oto-Rhino-Laryngology 273, no. 3 (2016): 777–81. https://doi.org/10.1007/s00405-015-3868-2.
Velasquez, Nathalia, Zhenxiao Huang, Ian M. Humphreys, and Jayakar V. Nayak. “Inferior Turbinate Reconstruction Using Porcine Small Intestine Submucosal Xenograft Demonstrates Improved Quality of Life Outcomes in Patients with Empty Nose Syndrome: IT Submucosal Restoration Improves QOL in ENS.” International Forum of Allergy & Rhinology 5, no. 11 (2015): 1077–81. https://doi.org/10.1002/alr.21633.