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Understanding Empty Nose Syndrome

Okay. So. Empty nose syndrome. When you read about it on the internet – and I encourage you to read a little bit about it on the internet – there's a couple of incorrect things. For one thing, they say that it's a rare disease, and some ear nose and throat doctors are unsure if it really exists. Oh, it exists. There's no doubt it exists, and really, if an ear nose and throat doctor bothers to go to any rhinology meeting like the American Rhinology Society, which is fantastic. Plug for them. There's no one there who would tell you otherwise, so I wouldn't call it controversial in regards to its existence, but it's unclear why people get it. I can tell you some general terms that are general…

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 It started with a whistling sound in his nose. Then things got much worse.

ENS is not a well-understood disorder and is a somewhat controversial diagnosis because of its counterintuitive nature, since turbinate surgery is meant to improve breathing, not make it worse. It’s unclear why some patients experience breathing problems following turbinate surgery, while most do not. Some experts think that anatomical differences among patients may play a role. Regardless, “it’s real,” says Pryor Brenner, a D.C. otolaryngologist who has seen only two ENS cases in 24 years among the more than 2,000 nasal surgeries he’s performed. “I discuss the possibility of ENS with all my patients because it’s a major medical problem when it does occur,” he adds. “It can be incredibly impactful to their well-being, their quality of life, including to their mental health.”

Articles of Interest

Computational Fluid Dynamic analysis of aggressive turbinate reductions: Is it a culprit of Empty Nose Syndrome?

Empty nose syndrome (ENS) remains highly controversial, with aggressive inferior turbinate reduction (ITR) or mucocillia dysfunction frequently implicated. However, the appropriate degree of ITR is highly debatable.

Empty nose syndrome

Empty nose syndrome (ENS) is a rare, late complication of turbinate surgery. The most common clinical symptoms are paradoxical nasal obstruction, nasal dryness and crusting, and a persistent feeling of dyspnea.

Empty nose syndrome and atrophic rhinitis

The term ENS was first used by Eugene Kern and Monika Stenkvist at the Mayo Clinic in 1994. ENS as is currently used refers to a disorder associated with symptoms that arise from iatrogenic nasal tissue loss and often present radiologically with a paucity of normal nasal anatomical structures.

Empty nose syndrome: new insights from a CFD approach

Empty Nose Syndrome (ENS) is a debilitating condition which usually arises after aggressive turbinate reduction. However, objective tests to help in the diagnosis of this condition are lacking. Accurate diagnosis of ENS patients is critical for effective diagnosis and treatment.

Empty nose syndrome: When patients are left 'suffocating' after routine nasal surgery

Some of Dr Houser's patients even credit him with saving their lives. "I have to tell you, I've had 15 to 20 patients who have told me that my surgery kept them from committing suicide," he said. "I do a lot of sinus surgery … sleep apnoea and so forth, and those are surgeries that help people's quality of life … but a lot of times, the empty nose surgery that I do can actually save someone's life."

Empty Nose Syndrome: When the Nose Is Worse After Surgery

It is normal to have impaired mucociliary clearance after any nasal/sinus surgery. Despite cleansing and antibiotics, infections may occur. However, in the patients with unusual distress, complaints of insufficient air, being unable to breathe – consider ENS – Empty Nose Syndrome.

How can I avoid getting an “empty nose”?

By 1990 it was evident in the literature that the practice of removing part or all of these lower turbinates was not appropriate. Unfortunately there are still many ENT doctors and plastic surgeons that still do turbinate removal procedures. Many also remove other vital structures in the nose such as the middle turbinates and ethmoid sinus cavities which also may leave the patient with empty nose syndrome.

Inside my son’s ‘nasal cripple’ nightmare: ‘Felt like a plastic bag over his head’

Nearly 30 years after it was first identified, ENS is finally gaining greater recognition. The first medical textbook on the frightening condition was published this year by distinguished physician Dr. Eugene Kern, a professor of otorhinolaryngology at the University at Buffalo. In the early 1990s, while working at the Mayo Clinic, Kern was alarmed after two post-surgery patients from elsewhere told him they felt suffocation with every breath. Both later killed themselves.

Suicidal thoughts in patients with empty nose syndrome

Patients 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.

Resources

Empty Nose Syndrome Awareness

A group working to spread awareness of Empty Nose Syndrome - an iatrogenic disorder characterized by poor breathing after turbinate surgery.

NasalCripple.com

A collection of media mentions...