Friday, July 3, 2009

The Empty Nose Syndrome

Patients who have too much tissue removed from their nose at the time of surgery will sometimes develop an empty nose syndrome. They will have a variety of symptoms including the sensation of too much air flowing through the nose, halitosis, lack of mucus, bleeding, lack of sense of smell, dryness, crusting, inflammation, dizziness, etc. Many patients are bothered severely by this and often become extremely preoccupied with it.

They may also have atrophic rhinitis which means that the the cells in the lining of the nose don't function normally and so doesn't produce enough mucus. Unfortunately as a person ages, the lining of the nose normally ages, so that many years after surgery, a patient may develop the empty nose syndrom due to development of atrophic rhinitis.

There is much debate about the cause of the empty nose syndrome. Most people think that the cause is due to having too much turbinate tissue removed at the time of surgery, but not everyone who has turbinate tissue removed will develop the empty nose syndrome.

Patients who have both the inferior turbinate and middle turbinate removed are more likely to develop the empty nose syndrome. Obviously they will have more tissue removed than someone who only had part of the middle turbinate removed.

In some cases it may be necessary to remove part of the middle turbinate in order to do surgery. Please note that the turbinate removal referred to here is not the same as the somnoplasty technique which is discussed below.

Adjunctive techniques such as irrigation, mucus thinners, and nasal sprays may be somewhat helpful. Increasing the humidity in the winter may also be helpful. The Mayo clinic uses glycerine solution topically to the lining of the nose. They will also use mineral oil flavored with rose geranium oil for bad breath. Some patients are helped by having cotton plugs or silicone plugs fashioned to reduce some of the nasal airflow. Unfortunately once the tissue is removed it cannot be replaced, although there are currently experimental technique to create artificial turbinates.

Tuesday, May 19, 2009



physical symptoms
Nose feels too empty/hollow/absent.
Diminished nasal airflow sensation feedback ('paradoxical obstruction').
Extreme sensation of dryness of the nasal cavities, with or without crusting.
Not enough moisture/mucus production.
Dryness of the pharynx, soft palate and back of the tongue ("dry pharyngitis" and "dry laryngitis"[5]).
Feeling of needing more nasal resistance (or nasal membrane responsiveness) to breathe.
Increased pulmonary sensitivity to air-borne irritants, strong scents and cold air. Causes much uneasiness in breathing and sometimes even long-periods (can last hours) of severe shortness of breath, depending on the degree of exposure.
Diminished sense of smell and/or taste. Can be confusing - because although there is diminished sense of smell there is also hyper-responsiveness to light and volatile airborne chemicals, fumes and irritants.
Difficulty projecting or resonating speech. The voice seems weak and requires some straining to sound loud and articulate well, which causes uneasiness in speech.
Feeling weak and depleted of energy.
Very poor quality of sleep. Not necessarily full sleep apnea, but shallow and dry breathing, which often switches entirely to mouth breathing only, waking up a lot very dry, with headaches, severe dizziness and very little REM sleep.
Relatively dry skin and eyes.

cognitive symptoms
Difficulty concentrating ('aprosexia nasalis').
Difficulty performing mental tasks.

emotional symptoms
Marked reduction in sense of self and very crippled sense of well-being.
Irritated and/or depressed mood. Often clinical depression.
Avoidance of social interactions.

other characteristic physical symptoms that many ENS patients develop
irritating sensation of thick stagnant mucus stuck at the back of the throat. Because of the dryness of the mucosa the mucus propelled to the throat (on the way to the stomach - the nasal mucociliary clearance that occurs in all humans) simply becomes too dry and sticks to the sides of the throat instead of sliding smoothly unfelt.
Chronic sinusitis.
Worsening of pre surgical nasal symptoms, such as allergic rhinitis, etc'.
Hardly any mucus production, or the opposite – episodes of excessive rhinoreah.
Foul smell from nasal cavities.
Gastroesophageal reflux (GERD).
Elevated levels of blood pressure.
Hormonal and metabolic imbalances.
Significant weight gain.


Monday, May 18, 2009


I have been to my Family Dr. many many times since my surgery for what I guessed was a sinus infection....many many times he has given me antibiotics... of course they never worked. I've tried ton's of different over the counter remedies some work better than others. I read about netti pots tried those seemed to help some......soooooo I thought what would work better.....a water pik with a nasal attachment....genius! Well when I turned that thing on......I thought I blew my eye right into the sink......other than the nasal surgery itself....that was the stupidest and most painful thing I had ever experienced. I really don't recommend it. Now I do use Netti Med Sinus's a nice little squeeze bottle....not near as painful. Just don't do it before bedtime......or your gonna end up with swimmers ear. Another product I like is Naso Med jell by simple squirt it up your nose a couple times a day.....then use the Ayr Jell for the inside of the tip of your nose.....I use a q-tip and smear it around pretty good in there......It seems to help me feel like there is something actually inside my nose instead of a cavern. Lastly I sleep with a cool mist humidifier blowing right on my face at night.....and I take one Tylenol Pm for good measures.
Issue # 4
DC Comics
April 1974
Featuring: Cain, Abel, Eve.
Cover Art: Basil Wolverton.
Regular Series
Issue Price: 20¢

Sunday, May 17, 2009

Empty Nose Syndrome

Please remember..... I am not a Doctor, I'm just trying to gather some information about ENS from the Internet, so people suffering from this can read without doing tons of time consuming of browsing.
Empty nose syndrome (ENS), is a condition that is caused when too much inner nasal mucus-producing tissues (the turbinates) are cut out of the nose, leaving the nasal cavities too empty and wide, with severely diminished capabilities to perform their functions of conducting and preparing the inhaled air to the lungs.

These operations, known as turbinate resections, turbinectomies, or nasal conchotomies, are performed by ear nose and throat surgeons or by plastic surgeons for different reasons. The most common reason to operate is chronic inflammation of the turbinates, which can block too much of the nasal airways. A condition called “turbinate hypertrophy" is a condition in which turbinates swell and over-grow. Among the most common causes for this condition are allergies, hormonal imbalance, too much exposure to dust, smoke and other airborne irritants, nasal structural deformities like a deviated septum and prolonged use of nasal decongesting medications.

An empty nose can have a huge impact on a person's quality of life, and it can cause depression, slow down and impair cognitive processes and inhibit sexual and social activities. It can also cause a person to feel weak and depleted of energy.

The term "empty nose syndrome" was originally coined in the 1990's by Dr. E.B. Kern who was at the time head of the ENT ward in the Mayo Clinic (Rochester Minn., USA). He and his colleagues began to notice that more and more patients that underwent turbinectomies seemed to developed symptoms of nasal obstruction even though their noses appeared to be wide open. Other symptoms were nasal dryness, shallow unrested sleep, difficulty concentrating, and quite often clinical depression. All the patients' CT scans showed that they had very wide and almost totally empty nasal cavities, thus they called it the "Empty Nose Syndrome".

What symptoms does a patient with Empty Nose Syndrome experience? They feel as though their nose is always congested, and that they cannot entrain sufficient air through their nose to breathe adequately. They may report they feel as though they are suffocating. Paradoxically, the individual may report that the only time that they feel as though they are breathing OK is when they have a cold. Pain may be an issue. The patient may also complain of crusting in their nose. These syptoms occur years after a turbinate excision.


professional nurse