Empty nose syndrome represents a postoperative condition in which the turbinates have been reduced too much or removed completely. As a result, the function of the turbinate, which is to moisten the inhaled air, can no longer be adequately performed. Obstruction of nasal breathing occurs despite an enlarged nasal cavity.
What is empty nose syndrome?
Empty nose syndrome is what is known as empty nose syndrome. It is a pathological condition that occurs after the turbinates are reduced in size or even removed. Despite enlarged nasal cavities, there is a feeling of a blocked nose. The reason for this is the lost ability of the nose to moisten the inhaled air. The air remains dry. Crusts form in the nose, which can also be the starting point for infections. In humans, there are three turbinates, which can be divided into upper, middle and lower turbinates. Between the individual turbinates are in turn the nasal passages, which are responsible for various functions. The superior nasal meatus is located between the superior and middle turbinates. It contains the olfactory organ and is therefore also called the olfactory duct. The nasal meatus, located between the middle and inferior turbinates, is known as the sinus meatus and ends in the paranasal sinuses. The inferior nasal meatus, which is found between the inferior turbinate and the palate, serves as the actual airway. It is responsible for nasal breathing and serves to humidify the air we breathe. In addition, the turbinates contain pressure sensors that signal the state of nasal breathing to the brain. If the turbinates are reduced in size or even completely removed during surgery, the signaling to the brain, the sensation of smell and taste, and, as mentioned earlier, the humidification of the air breathed will be impaired. This results in both physical and psychological symptomatology.
Causes
The cause of Empty Nose Syndrome is always a previous improper turbinate reduction. Such surgical procedures must be performed when chronic enlargement of the turbinates occurs. Enlarged turbinates obstruct the passage of air through the nose. Reasons for enlargement may be allergic reactions, inhalation of dusts, smoke or irritants, hormonal disorders, deviated septum or constant use of nasal drops with decongestant effect. During surgery, the nasal passage is widened to allow unobstructed nasal breathing. However, after these procedures, it was often observed that nasal breathing was still obstructed. Due to the empty nasal cavity, turbulent flows occur in the nose, resulting in flow resistance, which leads to a reduction in air transport through the nose. For this reason, the sensation of a stuffy nose occurs. Furthermore, due to the altered aerodynamic processes, the upper parts of the nose are less ventilated, which leads to the impairment of the sense of smell. The nasal mucosa contracts and produces much less mucus, so that inhaled pollutants are no longer removed and can therefore accumulate in the nasal cavities. Dry air causes crusts to form in the nasal cavity, which become targets for bacteria. A greasy coating can form in the nose, leading to the so-called stinky nose (ozaena). Unpleasant sweet and foul odors emanate from the stinky nose.
Symptoms, complaints and signs
Overall, Empty Nose Syndrome is characterized by a variety of physical and psychological symptoms. There is a subjective feeling of not getting enough air, although this is not objectively true. The inhaled air appears cold and dry. Furthermore, too little or, in some cases, too much mucus is produced. The nose may drip constantly, while thick mucus enters the pharynx in the posterior nasal cavity. Crusting of the nose is typical. The sense of smell is severely impaired. There is often pain and pressure in the sinuses, although sinusitis cannot be diagnosed. Impeded nasal breathing often interferes with sleep. A sweet, foul odor often emanates from the nose and mouth due to bacterial colonization of the crusting. Symptoms also include headaches or sometimes nosebleeds.Because of these impairments, secondary psychological symptoms such as depression, anxiety, difficulty concentrating, nervousness, constant fatigue, and exhaustion may develop.
Diagnosis
Empty nose syndrome is diagnosed based on symptoms that occur after surgical turbinate reduction.
Complications
In Empty Nose Syndrome, there is severe obstruction to breathing through the nose because the turbinates have been completely removed or greatly reduced in size. Usually, the patient can still breathe in the same amount of air through the nose as before the surgical procedure. However, sufferers may have the impression that the amount of air is too low and that the person is not getting enough air. Due to the missing nasal conchae, there is also the feeling that the air is cold and dry. As a result, sufferers often complain of a permanently runny nose and crusting around the nose. Sinusitis may also occur. Due to the feeling of not getting enough air, sleep disturbances and headaches occur in many cases. A sudden nosebleed may also occur. The symptoms severely limit the patient’s daily life and significantly reduce the quality of life. Depression and anxiety may also occur. Some patients also complain of nervousness. The treatment itself is carried out with the help of sprays, which can relieve the symptoms. However, to permanently combat Empty Nose Syndrome, surgical intervention is necessary. In this case, there are no complications.
When should you see a doctor?
Empty nose syndrome definitely requires medical evaluation and treatment. Difficulty breathing, disturbances in mucus production and a severely impaired sense of smell are typical complaints that need to be investigated. If ENS is diagnosed in the course of this, rapid treatment is required. In most cases, surgical intervention is performed, which is associated with a hospital stay of several days. After the end of the treatment, close monitoring is necessary, as this is the only way to rule out complications. If complaints such as a permanently runny nose, crusting or sinusitis occur, the nearest hospital should be visited. Also, with sudden nosebleeds, severe headaches, and sleep disturbances, it is best to seek medical advice immediately. Should depression or anxiety occur, a therapist may be consulted in consultation with the primary care physician. Empty nose syndrome mainly affects people who suffer from allergies, who breathe in a lot of dust, smoke or other irritants due to their job, or who have a deviated septum. Hormonal disorders and the regular use of nasal drops can also be triggers. At-risk patients with symptoms mentioned above should definitely consult a general practitioner.
Treatment and therapy
Therapeutically, two treatment options are available. Thus, both nonsurgical and surgical treatment methods are used. The nonoperative treatment methods aim at symptomatic therapy. However, only surgical correction of the turbinates promises permanent healing success. The non-surgical methods include daily nasal rinses, use of seawater nasal sprays, drinking plenty of fluids, use of air and room humidifiers, use of mucolytic agents, staying in areas with a sea climate, avoiding harmful environmental influences, building up a better bacterial flora in the nose with special nasal drops such as Symbioflor 1. Sleep masks with humidifiers are also used. In surgical treatment, the missing turbinates are replaced by appropriate implants. These implants are constructed from the body’s own bone and cartilage fragments or from artificial materials, among others. Hydroxyapatite cement, alloderm or silicone can be used as artificial material.
Outlook and prognosis
Unfortunately, to date, there is little prospect of cure for the Empty Nose symptom. The respiratory epithelium destroyed in previous surgeries cannot be replaced. At present, the only way to restore breathing through the nose is to perform another operation. However, even another operation carries the great risk of further irritating the mucous membranes. In addition, many doctors only operate in the case of very severe breathing restrictions with the Empty Nose symptom, as they do not want to cause further scarring.Sufferers can only relieve their symptoms, such as dry mucous membranes, difficulty breathing and itching, among other things. Nurturing saltwater nasal sprays can help here. But also warm nasal showers and ointments help to moisten the dry mucous membranes again in the short term. Particularly in the wintertime, with dry heating air, those affected must also perform their care routines several times a day. To facilitate breathing through the nose, special inhalations with ointments are useful. Without therapy for the highly stressed mucous membranes of the nose, the Empty Nose symptom can result in fine tears. These may be associated with initially only very mild, later more severe nosebleeds. Pathogens can now enter through the roughened and cracked mucosa of the nose, increasing the risks for chronic rhinosinusitis and other diseases of the nasal mucosa.
Prevention
Before a planned turbinate reduction, it should be checked whether there are other options for treatment. However, even if surgical reduction of the turbinates is necessary, there are ways to prevent empty nose syndrome. One of the ways this is done is through the use of minimally invasive nasal and sinus surgery, which is aided by the use of the latest technologies.
Follow-up
Empty nose syndrome is generally not considered a disease, but rather a condition resulting from surgical reduction of the nasal concha. Conventional therapy seeks to artificially moisten the nose, which sufferers say feels dried out. The dryness often leads to breathing problems and other discomfort in Empty Nose Syndrome. In the postoperative follow-up of Empty Nose Syndrome, patients can do a great deal for themselves. They should spend as much time as possible by the sea, where the salty aerosol at the water‘s edge moistens the nose. Daily nasal rinsing or inhalations with salt water are also helpful, especially during the heating season. There is much to be said against decongestant nasal sprays. Natural saline nasal sprays are a better alternative in Empty Nose Syndrome. In addition, ointments with depanthenol and special nasal oils can be used to counteract the perceived dryness. These agents also moisten the inside of the nose for a longer period of time. The fact that sufferers drink two to three liters of water a day protects the dried-out nasal mucosa in Empty Nose Syndrome from actually drying out. Humidifiers can be added during the heating season to ensure that the air in the room never drops below tolerable levels. What level of humidity does not lead to mold and is considered comfortable varies from individual to individual.
What you can do yourself
In Empty Nose Syndrome, the turbinate, usually due to surgery, is no longer able to properly moisten the air breathed in through the nose. The syndrome often occurs after cosmetic surgery, but it can also be the result of medically necessary corrections to the nose. The best self-help measure is prevention. In the case of cosmetic surgery, the patient should be fully informed about possible risks and consider whether he or she wishes to accept long-term damage such as Empty Nose Syndrome. If surgery is medically necessary, other forms of therapy can be tried first. If surgery is unavoidable, the patient should definitely seek an experienced specialist who is able to perform a minimally invasive procedure using the latest laser or radiofrequency surgical techniques. These surgical techniques preserve the functionality of the turbinate. The medical associations and the health insurance companies help in finding a qualified surgeon. Provided that Empty Nose Syndrome has already occurred, the patient can take a number of self-help measures to alleviate the symptoms. Permanent exposure to dry air should be avoided at all costs. In work rooms, a humidifier should be installed or at least regular ventilation should be provided. At night, it helps to sleep with the window open or to set up a humidifier in the bedroom. Nasal rinses with salt water and the use of seawater nasal sprays can also improve symptoms.
