Otolaryngology, Head and Neck Surgery (Ear, Nose, and Throat)
Empty Nose Syndrome (ENS)
Empty Nose Syndrome Defined
Empty Nose Syndrome is a term coined by Eugene Kern, MD, at the Mayo Clinic. It refers to the fact that a patient's CT scan looks empty, or devoid of normal tissue, following nasal surgery, specifically turbinate excision. The CT scan here depicts a typical view of a patient experiencing the symptoms of empty nose syndrome.
What Are Turbinates?
The nose has various normal projections into it called turbinates: inferior, middle, and superior (and sometimes even a supreme turbinate). These projections are important for a number of reasons:
- The turbinates provide surface area to allow particulate matter to strike them, entrapping the material in mucus, which is then swept into the pharynx to be harmlessly swallowed. This prevents the material from being inhaled and overtaxing the lung mucociliary clearance.
- The turbinates work to moisten and warm the air we breathe, so that by the time it reaches the lungs it is near 100 percent humidity and close to body temperature.
- The middle turbinate hoods over most of the sinuses and blocks the particulate matter from entering and setting up an infection, among other things.
- The upper turbinates may harbor cells of the olfactory system.
- The turbinates provide surface area/airway resistance to inform the brain that air is traversing the nose in a sufficient volume to sustain life. Without sufficient mucosa to sense the air, the person feels as though they are choking, despite fully adequate air intake.
Swelling of tubinates may unconsciously make us roll during sleep. While lying on one side, our turbinates swell, and when the nasal passageways are sufficiently blocked, the patient will roll to the other side without awakening. The natural nasal cycle may play a role in this process as well.
Symptoms of Empty Nose Syndrome
People with ENS feel as though their nose is always congested, and that they cannot take in sufficient air through their nose. They may report they feel as though they are suffocating. 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, though often chronic pain is a separate issue best treated by a pain specialist. The patient may also complain of crusting in their nose.
Can Nasal Surgery Cause Empty Nose Syndrome?
Most patients do not develop ENS after nasal surgery; it is a rarity. Those that do will initially encounter no breathing issues following surgery; the symptoms of ENS generally occur years later. Not everyone develops problems; people in moist climates may do better.
Treating Empty Nose Syndrome
Moisturizing is a vital element, most often through the use of a nasal spray. Saline jelly may also provide some relief. Estrogen drops from a pharmacy, or Breathe-ease from Hydromed may also be helpful.
A consult to evaluate and discuss your options is strongly encouraged and can be done over the phone. There is a charge for a phone consultation and it is typically not covered by insurance. Call MetroHealth at 216-778-8890 to request a phone consultation and ask for the current cost of the consult. A standard visit without a phone consult is also an option.