Empty nose syndrome

Empty Nose Syndrome

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A CT scan showing the nasal cavity after partial bilateral turbinectomy, a procedure that can lead to Empty Nose Syndrome.

Empty Nose Syndrome (ENS) is a rare and controversial condition that occurs after surgical procedures on the nasal turbinates, such as turbinectomy or turbinate reduction. Patients with ENS often report a paradoxical sensation of nasal obstruction despite having an open nasal airway. This condition can significantly impact quality of life, leading to symptoms such as nasal dryness, crusting, and a sensation of suffocation.

• Pathophysiology

The nasal turbinates are structures within the nasal cavity that play a crucial role in humidifying, filtering, and directing airflow. When these structures are reduced or removed, it can disrupt the normal airflow dynamics and mucosal function, leading to the symptoms associated with ENS.

• 1. Symptoms

- Paradoxical nasal obstruction: Despite having a patent nasal airway, patients feel as though their nose is blocked. - Nasal dryness and crusting: Due to the loss of mucosal surface area and function. - Sensation of suffocation: Patients may feel they are not getting enough air, leading to anxiety and distress. - Reduced sense of smell: Also known as hyposmia or anosmia. - Nasal pain or discomfort: Often described as a burning sensation.

• Diagnosis

Diagnosis of ENS is primarily clinical, based on patient history and symptoms. Objective tests such as rhinomanometry or acoustic rhinometry may not correlate with the patient's subjective experience. Imaging studies, such as CT scans, can be used to assess the anatomical changes in the nasal cavity.

Histological image showing squamous metaplasia of the respiratory epithelium, a possible consequence of turbinate surgery.

• Treatment

Treatment of ENS is challenging and often requires a multidisciplinary approach. Options include:

- Saline irrigations: To maintain nasal moisture and reduce crusting. - Humidification: Using humidifiers to increase ambient moisture. - Surgical interventions: Such as implanting materials to restore nasal airflow dynamics. - Psychological support: To help manage the anxiety and distress associated with the condition.

• Prognosis

The prognosis for ENS varies. Some patients may experience improvement with conservative measures, while others may require surgical intervention. The condition can be chronic and significantly affect quality of life.

• Controversy

ENS is a controversial diagnosis, with some in the medical community questioning its validity. However, the symptoms experienced by patients are real and can be debilitating.

• Research

Ongoing research is focused on better understanding the pathophysiology of ENS and developing more effective treatments. Studies are exploring the role of nasal airflow dynamics and mucosal function in the development of symptoms.

Illustration of the nasal cavities, showing the location of the turbinates.

Also see

- Nasal turbinates - Turbinectomy - Nasal obstruction - Rhinoplasty - Chronic rhinosinusitis