What to know about empty nose syndrome?
Empty nose syndrome (ENS) is most common in people who have had nasal surgery, such as a turbinectomy.
The turbinates play a vital role in breathing, and altering them may bring about the symptoms of ENS.
Nasal passages may appear normal with empty nose syndrome.
A person who has had surgery on their nose or nasal passages may be at risk of developing ENS. Similarly, people who have had any kind of turbinectomy may have symptoms of ENS, though not every turbinectomy will lead to ENS.
A turbinectomy is the removal of part or all of the turbinate structures attached to the wall of the nose. The surgery is done to make the nasal passages bigger and make it easier to breathe.
Turbinectomy is necessary in cases where the nasal passages are too small for a person to breathe comfortably. Most people experience drastic improvements to their breathing after the surgery. A turbinectomy also allows people to rely less on medications to clear their nostrils.
A turbinectomy is seen as a quality of life improvement in most cases, but it can result in some people experiencing symptoms of ENS afterward.
As there is no direct cause or easy diagnosis of ENS, it remains relatively controversial. However, many people report similar symptoms to this condition after surgery, which makes ENS an important disorder to study and treat.
People with ENS experience a range of symptoms. Many people complain of feeling that they cannot inhale a complete breath through their nose.
The feeling of nasal obstruction, a headache, diminished taste, and nasal bleeding may be symptoms of empty nose syndrome.
Additional symptoms of empty nose syndrome include:
- feeling that inhaled air is too dry or too cold
- nasal obstruction, even though the passageways are clear
- nasal bleeding
- extreme dryness or crusting
- lack of the sensation of breathing
- feeling that too much air is entering the nose
- lack of mucus
- not being able to breathe
- inflammation and pain
- diminished sense of taste or smell
- sleep disorders, such as an inability to sleep or daytime sleepiness
People with ENS may also feel they have symptoms of suffocation, which can alter their sleep cycle and drastically reduce their quality of life.
They may also have co-occurring conditions, such as anxiety and depression, which can be present before surgery or show up at the same time as ENS. Persistent physical and mental health symptoms should be reported to a doctor immediately.
ENS and turbinate surgery
The turbinates are attached to two shelves of bone inside the nose. These shelves are divided by the septum, which is the section of bone and cartilage running along the middle of the nose.
These bony shelves help separate the sinuses from the nasal cavity, and the turbinates attach to the end of each one.
Turbinates are complex and perform several functions. Each side of the nose contains a low, middle, and high turbinate.
One of the primary functions of these turbines is to exchange heat rapidly as air is inhaled. This makes cold air feel warmer when it is inhaled through the nose.
Turbinates also play a role in making the inhaled air more or less humid, as necessary. Additionally, there is tissue in the turbinates that swells and shrinks to help regulate the airflow in the nasal passages.
These functions affect the air coming into the body, but they are equally as important for air going out of the body. The turbinates help control the amount of heat or liquid lost through exhaling.
Turbinates help the body keep heat, liquid, and oxygen levels stable in more extreme climates.
Given their complex roles, making changes to the turbinates and nerves connected to them may cause serious symptoms.
In many cases, turbinate surgery is successful in reducing the size of the turbinate and increasing the individual's airflow with no issue. However, even conservative turbinate surgeries may cause ENS symptoms. This is something both doctors and patients should be aware of before an operation.
Diagnosing ENS can be difficult. There is still no definitive diagnostic criteria or reliable tests for the syndrome.
There is no way to tell for certain if turbinate surgery will cause ENS symptoms. The surgery is successful most of the time and produces little to no long-term side effects. The symptoms of ENS may occur weeks, months, or years after surgery.
ENS is usually diagnosed by ruling out other conditions that can cause similar symptoms.
If a doctor suspects ENS, they may perform a cotton test. This is where a small piece of moist cotton is held where the turbinate would be. If it provides relief, the person may be suffering from ENS. However, the cotton test is not a recognized diagnostic tool, and it should not replace a full diagnosis.
Antibiotic nasal sprays may be recommended as a treatment, alongside saline flushes.
There is no straightforward treatment for ENS. Most treatments are aimed at relieving the symptoms temporarily.
Topical treatments such as saline sprays or saline gels can help moisturize the nose, but they can remove beneficial mucus and peptides in the nasal cavity. This unwanted consequence can leave room for dangerous bacteria to spread in the nose. Because of this risk, antibiotic nasal sprays and irrigations are often necessary alongside saline flushes.
In addition to sprays, other at-home treatment methods that may provide some relief include:
- sleeping with a humidifier
- sleeping with a CPAP machine that helps breathing
- living in warm, humid environments
- eating plenty of hot soups and liquids
Using a humidifier continuously can also relieve symptoms. Adding humidity to the air helps people breathe more easily and can let the body get more oxygen.
Although it may be unfeasible for many individuals, permanently moving to a warm, humid climate can also ease symptoms of ENS.
Some surgical options also exist for people with ENS. Surgery usually involves using implants of tissue or another material to increase the size of the remaining turbinate in the nose. If this is not possible, doctors may try to implant material in other areas of the nose.
These types of surgeries may help balance the airflow in the nasal passages. However, non-natural implants have little effect on the humidity or other functions of the turbinates. Additional surgical options are being researched, such as platelet-rich plasma injections.
Certain creams or oral medications can help with ENS symptoms. Estrogen creams and erectile dysfunction medications are thought to cause inflammation in the nasal mucosa, which may inflate any remaining turbinate tissue in the nose and relieve symptoms.
Cases of ENS can be difficult to diagnose and treat, and the outlook varies based on the individual. Moderate relief may be found through surgery or medication. Controlling symptoms as much as possible can help improve the person's quality of life.
Mental health can also play an important role in recovery for some people. Regular checkups can help relieve the mental stress and anxiety associated with the disorder.
There is currently no cure for ENS. Working with qualified ENT (ear, nose, and throat) specialists and mental health professionals gives a person the best chance of treating or reducing the symptoms of ENS.