AbstractObjectivesPatients with empty nose syndrome (ENS) suffer from paradoxical nasal obstruction with a patent objective nasal airway. ENS may result from the excessive surgical reduction of the turbinate tissue. ENS patients also experience significant psychological symptoms such as anxiety and depression. In this study, we aimed to evaluate the prevalence of suicidal thoughts in ENS patients and to characterize these patients for early identification.Study DesignProspective case series.MethodsPatients with ENS were prospectively recruited for this study. The Sino‐Nasal Outcome Test‐25 (SNOT‐25), Empty Nose Syndrome 6‐item Questionnaire (ENS6Q), Beck Anxiety Inventory (BAI), and Beck Depression Inventory‐II (BDI‐II) were used to assess ENS patients before and 6 months after nasal reconstruction surgery.ResultsSixty‐two patients with ENS were enrolled. Suicidal thoughts were identified in 23 ENS patients preoperatively and in four patients postoperatively. ENS patients with suicidal thoughts rated significantly higher in the SNOT‐25, ENS6Q, BDI‐II, and BAI total scores than those without suicidal thoughts (all P < .05). “Nose feels too open” was the item in ENS6Q that was significantly more severe in ENS patients with suicidal thoughts than those without suicidal thoughts (P < .001).ConclusionsSuicidal thoughts are frequently identified in patients with ENS. ENS patients with suicidal thoughts experienced significantly more severe symptoms, impaired quality of life, and psychological burden than those without suicidal thoughts. Recognizing individuals who may carry suicidal thoughts and provide appropriate psychological interventions is critical to prevent tragedy.Level of Evidence4