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Empty Nose Syndrome: Symptoms, Diagnosis & Solutions

Updated: 19 hours ago

Empty Nose Syndrome, or ENS, may sound strange, but it is a severe medical condition. Imagine your nose is wide open and air is flowing easily, yet you don't feel like you're receiving any Air.

Dealing with a persistent sense of nasal emptiness can be confusing, especially when your nose looks clear. This contradiction is the hallmark of empty nose syndrome (ENS), a potentially debilitating aftermath of some nasal surgeries.


Everyone, including persons with ENS, their families, and doctors, benefits from understanding the condition. Because it is frequently misunderstood, providing knowledge about it can aid suffering people.



Understanding and Overcoming the Empty Nose Syndrome





What Is Empty Nose Syndrome?


Imagine your nose is wide open and air flowing easily, yet you don't feel like you're receiving any Air. You feel like you are suffocating.


This condition can occur after nose surgery, making patients believe their nose is blocked when it is not.

Doctors first saw ENS in 1994 and were confused because it didn't match what nasal surgeries were supposed to do, which is to help you breathe easier.


Unfortunately, despite its significant impact on individuals’ well-being affected by ENS worldwide, awareness about this rare disorder remains low partly because it is often associated with complications arising from outdated surgical techniques.


As such, many otolaryngologists may still lack knowledge about this underreported condition.




What Causes Empty Nose Syndrome?


An image of a man's nose with showing Air flow

Empty nose syndrome (ENS) is a condition that arises from excessive removal of the inferior and/or middle turbinates or damage to the nasal septum during surgery.


It presents as a feeling of empty space in the nasal cavity, but its diagnosis can be challenging due to limited visible blockages on imaging scans.


Instead, it heavily relies on subjective symptoms reported by patients. To effectively treat ENS, thorough clinical evaluations are necessary, including standardized surveys and tests like the ‘cotton test’. Nasal obstruction may not always be the primary concern in ENS cases since each patient experiences empty nose syndrome differently.


Personalized treatment plans tailored to individual needs are crucial for managing this condition.



Why do Turbinates cause Empty Nose Syndrome (ENS)?

Mri scans of Empty Nose Syndrome

The primary cause of ENS is the removal of excessive nasal tissue during surgeries, which can lead to changes in air pressure and damage to receptors within the nasal passages.


This alteration in sensitivity and subsequent development of ENS is associated with a loss of ‘cool air’ receptors and nerve fibers responsible for detecting airflow during breathing through the nose.


Patients who have undergone specific surgical procedures, particularly those involving aggressive turbinate surgery, are at an increased risk for developing ENS.


Complete removal (total turbinectomy) of nasal turbinates poses significant risks, such as atrophic rhinitis, underscoring its role as a contributing factor in ENS cases.


Insufficient preoperative evaluation to determine the appropriate need and safe extent of turbinate surgery may also heighten one’s likelihood of acquiring EHS after undergoing nasal surgery.


Additionally, some individuals may be more predisposed than others due to variations in their specific structures or functions related to tumor surgery and thus require careful consideration before proceeding with the procedure.




Symptoms of Empty Nose Syndrome


A man with a headache due to Empty Nose Syndrome

Imagine feeling like your nose is blocked, but when you look, there's nothing there – that's ENS for you.


It's a tricky condition with many symptoms that can affect your body and mind. Here's the rundown on what those with ENS might go through:


Common Symptoms

  • Nasal Congestion: Despite clear nasal passages, patients often feel a sensation of blockage or congestion.


  • Nasal Dryness: Extreme dryness in the nasal cavity leads to discomfort and crusting.


  • Altered Breathing Perception: Patients may experience an altered sense of their breathing, feeling unable to breathe deeply despite improved airflow post-surgery.


  • Dizziness: Often accompanying the altered breathing perception, contributing to overall discomfort.


  • Decreased Mucus Production: A noticeable reduction in nasal mucus production is common.


  • Sensory Changes: Some individuals report a loss of taste or smell, affecting their enjoyment of food and overall quality of life.



Additional Symptoms

  • Headaches: Often associated with ENS, contributing to overall discomfort.


  • Sensation of Drowning: A disturbing symptom due to the altered perception of breathing.


  • Post-nasal Drip: This symptom can exacerbate the sensation of nasal congestion and discomfort.


  • Pain and Inflammation: Commonly experienced in the nasal area, adding to the physical distress.


  • Sleep Disturbances: Insomnia and fatigue are prevalent, impacting daily functioning and quality of life.


Diagnosing ENS


A Doctor doing an MRI woman to diagnose Empty Nose Syndrome

Diagnosing Empty Nose Syndrome (ENS) can be tricky due to its subjective symptoms and the lack of standard tests.


Here's a simplified look at how healthcare professionals tackle this challenge.



Endoscopic Exams and CT Scans


  • Endoscopic Exam: A vital test using a small, bendy tube with a camera to check the nose. It helps spot changes after surgery and signs of ENS.


  • CT scans: Special X-rays for clear nose pictures and finding issues or surgery changes linked to ENS symptoms.



Cotton Test


The cotton test is essential to diagnose Empty Nose Syndrome. It means placing cotton in your nose.


Surprisingly, patients often feel better when they do this.


Science, like Computational Fluid Dynamics (CFD), confirms it. CFD studies show that the cotton test changes how your nose works and helps with ENS symptoms.


So, it's a valuable tool for diagnosing ENS and finding the proper treatment.

Empty Nose syndrome Cotton Test


ENS6Q Questionnaire


The ENS6Q assesses ENS symptoms. It has six items, rating dryness, air sensation, suffocation, open nose, crusting, and burning on a scale from 0 (none) to 5 (severe).


The highest score is 30, showing symptom severity.


It helps healthcare providers measure ENS severity.


Testing Nasal Passage Airflow


To diagnose Empty Nose Syndrome (ENS), doctors must examine how air flows through the nose.


This helps spot unusual airflow patterns that might signal ENS. It's essential for those who've had nasal surgeries like septoplasty or turbinate reduction since these procedures can change airflow.


Ways to Measure Nasal Airflow:


  • Airflow Volume and Speed: There are various tools to measure how much air moves through the nose and how fast it goes. These measurements reveal airflow issues not visible during a physical exam.


  • Computational Fluid Dynamics (CFD): CFD is a complex method to study nasal airflow in detail. It shows how air behaves inside the nose, which can change after surgery.


One tool that helps with this analysis is  Flowgy. It's a medical device designed to enhance the diagnosis and management of nasal problems, including ENS.

Computational fluid dynamics Empty Nose Syndrome

It combines anatomical data from radiological sources to view nasal airflow dynamics.


How to treat Empty Nose Syndrome?


A man is putting a humidifier into a room.

Managing ENS is a difficult task as there is currently no cure. The main objective of treatment is to address the symptoms experienced by patients.


Different approaches may be used, such as at-home remedies, medications, and even reconstructive surgery in severe cases.


These methods aim to alleviate the uncomfortable effects of ENS on individuals affected by it.

Natural Remedies

  • Humidification: A humidifier adds moisture to the air, helping alleviate nasal dryness.


  • Avoiding Irritants: Reducing exposure to smoke, strong odors, and pollutants can help manage symptoms.


  • Nose Sprays: Nose sprays are crucial in managing Empty Nose Syndrome by moisturizing and soothing irritated nasal tissues, helping common symptoms like dryness and congestion.


A young woman is using a Nose Spray for her Nose


  • Nose Clip: The Super Nose Clip II from Arena is designed to prevent water from entering the nose by keeping the nostrils closed. While it's primarily for swimming, it might offer some relief by modifying airflow in the nasal passages.


Medications


Certain drugs, including estrogen creams and specific vasodilators, can enlarge nasal tissues, potentially reducing ENS symptoms.



Estrogen Creams

  • Topical Estrogen: Some studies suggest that topical estrogen applied to the nasal lining can help regenerate mucosal tissue, although its use is still under investigation.


  • Nasal Steroids: These can reduce inflammation in the nasal passages, although they should be used cautiously as they can sometimes worsen dryness.



Emerging Research


Platelet-rich plasma (PRP) injections


A doctor preparing Platelet-rich plasma

Platelet-rich plasma (PRP) injections have emerged as a promising, less invasive treatment for Empty Nose Syndrome (ENS).

PRP shots work because they use your body's natural healing power. Platelets in your blood contain growth factors and cytokines, which help repair tissue.


A study by Dong Woo Lee, Joo Yeon Kim, and Jae Hwan Kwon found PRP injections in the nose worked well for ENS, with improved exams and patient reports, offering a new way to treat it.

Arco-Palato-Uvular Flap (APUF)

The Arco-Palato-Uvular Flap (APUF) procedure, initially designed for snoring and sleep issues, is being studied as a possible treatment for Empty Nose Syndrome (ENS).


APUF may improve airflow and reduce unusual sensations in the nose, potentially relieving ENS.


However, more research is needed to confirm its effectiveness and safety in this context.



Hyaluronic acid (HA) gel injections


A syringe is being inserted into a syringe.

The hyaluronic acid gel helps treat Empty Nose Syndrome (ENS) after nasal surgeries.


It's injected into the nose to relieve dryness and nasal blockage.


The gel adds volume and moisture, compensating for tissue loss and improving airflow. This non-surgical option eases ENS symptoms, giving relief to patients.


Stem Cells


This new method mainly uses adult stem cells, which could heal damaged mucosal tissues and turn them into surface cells, reducing ENS dryness.


This shift to stem cell therapy aims to renew physical structures and vital nasal function elements.

Empty Nose syndrome Testimonial Stem Cell injections

For more insights and discussions on Empty Nose Syndrome and stem cell therapy, join this Facebook group: Empty Nose Syndrome and Stem Cell Therapy Group.


Risk and Dangerous of ENS



Bacterias


When you have ENS because of nasal surgery like septoplasty or turbinate reduction, it can reduce mucus. The mucus keeps the nose's bacterial balance healthy. It acts as a natural shield, catching and removing harmful germs. Less mucus means weaker protection, possibly causing too many harmful bacteria to grow.

Harmful bacteria that can thrive include Staphylococcus aureus, which causes sinus infections, and Pseudomonas aeruginosa. These bacteria worsen ENS symptoms, causing more inflammation, irritation, and nasal problems.


Psychological and Emotional Impact


Mental Health effects

  • Anxiety and Depression: Chronic ENS symptoms often lead to heightened anxiety and depression as patients struggle with ongoing discomfort and uncertainty about their condition.


  • Stress Disorders: The persistent nature of ENS can trigger stress-related disorders, exacerbating the psychological burden of the syndrome.


Facebook post by a girl with Empty Nose Syndrome, sharing her personal story about how her life has changed since being diagnosed with the condition. The post reflects her challenges and adaptations in daily life due to ENS.


Quality of Life Deterioration

  • Daily Activities Disruption: ENS symptoms can interfere with routine tasks, reducing productivity and causing frustration.


  • Social Interaction Challenges: The discomfort and self-consciousness associated with ENS can hinder social engagement, leading to isolation.


  • Overall Mental Well-Being: The cumulative effect of these challenges can significantly diminish overall mental well-being, impacting happiness and life satisfaction.


Facebook post by a girl discussing her life changes due to Empty Nose Syndrome, highlighting her struggles and adjustments.

Suicidal Thoughts for People with Empty Nose Syndrome



ENS extends beyond physical symptoms, significantly impacting mental health.


The persistent discomfort and breathing difficulties can lead to increased levels of anxiety and depression.


This psychological impact can exacerbate the physical symptoms, creating a cycle of deteriorating health.




Michael Jackson and Empty Nose Syndrome



Michael Jackson, the famous singer, may have had Empty Nose Syndrome (ENS).


Jackson's changing nose has been widely discussed. It's thought that his numerous nose surgeries could have harmed his breathing.


Another idea is that Jackson had ENS, causing his breathing issues and the need for multiple nose surgeries.


Jackson had turbinate reduction surgery in the 1990s, often done with rhinoplasty. This surgery can lead to ENS in some cases.


ENS symptoms can be severe, including headaches, loss of smell or taste, dry nose, and constant breathlessness. These symptoms match some of Jackson's reported health problems. ENS might have played a big part in his health issues.


Living with ENS can disrupt daily life and breathing. Nasal discomfort makes everyday activities hard, affecting work and personal life.


ENS also takes a toll on emotions. Dealing with symptoms can lead to frustration, helplessness, anxiety, and depression. Treating ENS must address both physical and mental health.




Conclusion



Empty Nose Syndrome (ENS): It's clear this condition, which is not well known, dramatically affects those it touches. ENS emerges post-nasal surgeries, causing a strange paradox: clear nose but constant discomfort.


ENS goes beyond physical issues; it's entwined with daily life, mental health, and social interactions. Living with ENS is a tough emotional journey marked by resilience and a quest for relief.


Evolving treatments, like regenerative therapies and research, offer hope. As ENS knowledge grows, so does support for those facing this condition.


In short, Empty Nose Syndrome, though often in medical shadows, is real.


It's a tale of hidden struggles and emerging hope.


Frequently Asked Questions about Empty Nose Syndrome

What Exactly is Empty Nose Syndrome (ENS)?

ENS is a rare condition often occurring after nasal surgeries like turbinate reduction. It involves symptoms like a constant feeling of a blocked nose, dryness, and difficulty breathing despite clear nasal passages.

Can Anyone Get ENS or Are Certain People More at Risk?

What Does Empty Nose Syndrome Feel Like?

How to Avoid Empty Nose Syndrome?

How to Sleep with Empty Nose Syndrome?

How to Cope with Empty Nose Syndrome?

Doctors Who Treat Empty Nose Syndrome

How Often Does ENS Occur After Turbinate Reduction?

Is There a Cure for Empty Nose Syndrome?

How Many Cases of ENS Have Been Documented?


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