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The use of expanded autologous Adipose-Derived Stem Cells (ADSCs) could overcome a common side effect of turbinate surgery, the so-called Empty Nose Syndrome (ENS). Research published to date suggests a greater efficiency than Stromal Vascular Fraction (SVF) treatment, confirming the superiority of expanded ADSCs over this adipose tissue-derived mix of cells.

Causes and symptoms of the empty nose syndrome

Empty nose syndrome is a common side effect of turbinate surgery, that is, the long, thin bones located in the inside walls of the nose. The layer of tissue that covers turbinates can swell, thus blocking airflow, because of allergic reactions or other nasal problems. Surgery can fix blocked airways and improve breathing. However, it can derange airflow dynamics, modify inspired air, compromise the nose’s innate defense mechanisms, and damage nerve endings.

In fact, the turbinates work by opposing physical resistance to inspired air, thus adjusting nasal cavity airflow. The mucosal layer that covers them is full of glands and receptors that heat, humidify, and clean the air. What is more, its epithelial and subepithelial layers play an important role in innate immunity.

Following turbinate surgery, the alteration of the airflow pattern (which is associated with reduced airflow resistance), the reduced mucosal area, the decreased humidification, and the increased warming, together with the neural damage and the loss of sensory, tactile, and thermal receptors, frequently lead to uncomfortable symptoms, in particular a paradoxical nasal obstruction, painful breathing, and inability to feel the inspired air. 20% of patients with inferior turbinate surgery develop ENS, complaining of reduced quality of life. Symptoms often occur several months or years after surgery.

Unfortunately, symptoms severity does not correlate with clinical examination results, potentially creating a conflict between patients and doctors. What is more, ENS understanding and knowledge about the most appropriate management are limited.

Empty nose syndrome: the treatments

To date, several empty nose syndrome treatments have been tried. Hydroxyapatite, autologous cartilage, Medpor, Gore-Tex, hyaluronic acid fillers, and acellular dermal tissue can help reconstruct turbinates, support the nasal mucosa and improve nasal resistance and ventilation. Unfortunately, several patients do not respond to currently available treatments, and even in the case of improvements there is only a partial response.

Stem cells can help regenerate lost tissues and restore their function. In particular, research demonstrated that the transplantation of expanded ADSCs combined with fat significantly improves nasal cavity status and mucosal function, and significantly reduces ENS-associated inflammation.

Stem cells for ENS treatment

Adipose tissue is a readily available stem cell source. It can be harvested in an outpatient setting, and only small volumes are needed to obtain useful amounts of stem cells; in fact, stem cells in adipose tissue samples can be expanded in the laboratory to obtain the needed quantity. Some approaches are based on the use of the SVF, that is a mix of cells obtained from the lipoaspirate. However, the presence of elements such as macrophages hinders the efficacy of SVF transplantation. For example, the use of SVF is frequently associated with injected fat resorption.

In fact, SVF injection does not effectively improve symptoms and patient satisfaction. On the contrary, the transplantation of fat plus ADSCs improves nasal mucosa moistening, decreases mucosa tension and breathing-associated nasal cavity pain, and ameliorates the quality of sleep. In some cases, nasal cavity dryness improves too. The only problem seems to remain excessive breathing, whereas no infection or allergy symptoms develop

How to undergo stem cell ENS treatment

For further information about stem cell treatments, please visit Bioscience Institute’s Regenerative Medicine webpage, contact us at info@bioinst.com, or call +971 (0)4 375 722. Our biologist will answer your questions without commitment on your part.

References

  • Gordiienko IM et al. Empty nose syndrome pathogenesis and cell-based biotechnology products as a new option for treatment. World J Stem Cells. 2021 Sep 26;13(9):1293-1306. doi: 10.4252/wjsc.v13.i9.1293
  • Kim DY et al. Efficacy and Safety of Autologous Stromal Vascular Fraction in the Treatment of Empty Nose Syndrome. Clin Exp Otorhinolaryngol. 2018 Dec;11(4):281-287. doi: 10.21053/ceo.2017.01634
  • MedlinePlus. Turbinate surgery. https://medlineplus.gov/ency/article/007563.htm. Last viewed 03/02/2022.
  • Xu X et al. The expansion of autologous adipose-derived stem cells in vitro for the functional reconstruction of nasal mucosal tissue. Cell Biosci. 2015 Sep 17;5:54. doi: 10.1186/s13578-015-0045-7
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