목적: Empty nose syndrome (ENS) is a rare and controversial complication that emerges postoperatively due to the excessive loss of turbinate volume during turbinate surgery. Conservative treatment options are preferably used, but surgical treatments remain the mainstay of treatment for ENS. Although various materials have been used for augmentation, autologous cartilage is considered the most efficient material with fewer side effects. Herein, we aimed to assess the long- term clinical outcome of inferior meatus augmentation procedure (IMAP) with autologous costal cartilage. 방법:We conducted a retrospective review of medical records for 37 patients who were diagnosed with ENS and underwent the IMAP at Asan Medical Center from November 2015 to August 2023. Among them, 24 patients who underwent costal cartilage implantation and had a follow-up period more than 6 months were included in the analysis. Symptom improvement was assessed by measuring the change in Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) score before and after the surgery at their last follow-up. Additionally, postoperative complications, complaints and subsequent implant removal cases were investigated. 결과:The eligible 24 patients comprised 20 males and 4 females, with a mean age of 39.7 ± 11.7 years and a mean follow-up duration of 36.5 ± 29.0 months. All patients had a history of at least one instance of turbinate volume reduction, consisting of 14 turbinectomy (58.3%), 5 submucosal turbinoplasty (20.8%), and 7 radiofrequency ablation (29.2%). The average ENS6Q score before the surgery was 18.0 ± 5.2 and improved to 10.5 ± 7.0 after the surgery, revealing the mean reduction of 7.5 ± 6.9 (p < 0.001). Fourteen patients (58.3%) showed greater than 7-point improvement, which was considered a minimal clinically important difference (MCID). All specific items of ENS6Q showed statistically significant improvements, with the largest change in dryness (1.7 ± 1.6, p < 0.001), except for the crust formation (0.8 ± 2.1, p = 0.10). The most frequently reported surgical complication was ‘nasal obstruction’ (n = 9, 37.5%) due to excessive size of the implant, followed by ‘impossible to blow nose’ (n = 3, 12.5%), ‘costal wound pain’ (n =2, 8.3%), ‘excessive discharge’ (n=2, 8.3%), ‘frequent epistaxis’ (n=2, 8.3%), ‘headache’ (n = 2, 8.3%), ‘foreign body sensation’ (n = 1, 4.1%), and ‘nasal pain’ (n = 1, 4.1%). Three patients (12.5%) underwent subsequent implant removal due to nasal obstruction (n = 2) and headache (n = 1), which were relieved after the removal procedure. 결론:Our study suggests that the IMAP with autologous costal cartilage demonstrates a acceptable role as a definitive treatment option for ENS patients.