Cross-cultural adaptation and validation of the Empty Nose Syndrome 6-item Questionnaire (ENS6Q) into Arabic

Abstract Background Empty Nose Syndrome (ENS) is an iatrogenic condition characterized by a paradoxical sense of nasal blockage and various bothersome symptoms that can arise following turbinate procedures. The Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) is a validated, disease-specific screening instrument designed to aid in the identification of ENS. Objective This study seeks to translate, culturally adapt, and validate the Arabic version of the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q-A) for use in clinical practice among Arabic-speaking populations. Methods This prospective validation study was conducted over 16 months at a tertiary hospital. The ENS6Q was translated into Arabic following a standardized forward-backward translation process, and pilot tested for clarity. A total of 300 participants—100 ENS patients, 100 with chronic rhinosinusitis without nasal polyps (CRSsNP), and 100 healthy controls—completed the Arabic ENS6Q and SNOT-22 questionnaires. Reliability, validity, and diagnostic accuracy were evaluated. Results The ENS6Q-A showed excellent internal consistency (Cronbach’s α = 0.898) and test–retest reliability (ICC = 0.967). A strong correlation was observed with SNOT-22 (ρ = 0.758, P < 0.001). ENS6Q-A scores differed significantly between all groups ( P < 0.001). ROC analysis yielded an AUC of 1.000, with a cut-off value of 12.5 achieving 98.0% sensitivity and 100.0% specificity. Conclusion The ENS6Q-A is a reliable, valid, and diagnostically accurate tool for identifying ENS in Arabic-speaking populations. It offers a valuable supplement to endoscopic assessment for early diagnosis and monitoring of symptom severity.