Empty Nose Syndrome

Empty Nose Syndrome (ENS)

Empty Nose Syndrome (ENS) is a rare and complex iatrogenic condition arising post-nasal surgery, particularly following procedures aimed at reducing or resecting the nasal turbinates. Turbinates play a crucial role in humidifying, warming, and filtering inhaled air. ENS is characterized by a paradoxical sensation of nasal obstruction despite an objectively patent nasal airway, leading to significant morbidity.

ENS is most commonly associated with:

Turbinectomy or Turbinoplasty: Surgical interventions to alleviate nasal obstruction or improve airflow that result in excessive resection of the nasal turbinates.

Septoplasty: Corrective surgery for a deviated septum, which may inadvertently impact the turbinate structures.

Other Nasal Surgeries: Any surgical modification of the nasal cavity that significantly alters nasal anatomy and airflow dynamics.

Patients with ENS typically present with the following symptoms:

1. Paradoxical Nasal Obstruction: Subjective sensation of nasal blockage despite a widely patent nasal cavity.
2. Nasal Dryness: Reduced mucosal secretion leading to xeromycteria.
Crusting: Formation of crusts within the nasal passages secondary to dryness.
3. Burning Sensation: Sensation of irritation and burning within the nasal cavity.
4. Impaired Airflow Sensation: Diminished or absent sensation of airflow through the nasal passages.
5. Dyspnea: Difficulty in breathing or a sensation of insufficient air intake.
Nasal and Facial Pain: Persistent discomfort or pain localized to the nasal and facial regions.
6. Sleep Disturbances: Insomnia or disrupted sleep patterns secondary to breathing difficulties.
7. Psychological Distress: Significant anxiety, depression, and overall decline in quality of life due to chronic symptoms.

The diagnosis of ENS involves a multifaceted approach:

Detailed Patient History: Comprehensive history with emphasis on prior nasal surgeries and symptom onset.

Clinical Examination: Nasal endoscopy to evaluate mucosal integrity, residual turbinate tissue, and presence of crusting.

Imaging Modalities: High-resolution CT or MRI scans to assess structural alterations within the nasal cavity.

Symptomatology Questionnaires: ENS-specific validated questionnaires to assess symptom severity and impact on patient’s life.

Treatment of ENS requires a multidisciplinary strategy:

Nasal Moisturization: Application of saline sprays, gels, or emollients to maintain mucosal hydration.

Environmental Humidification: Use of humidifiers to ensure ambient moisture.

Topical Medications: Use of topical antibiotics for secondary infections or anti-inflammatory agents as needed.

Surgical Reconstruction: Consideration of surgical options such as submucosal implants, tissue grafting, or the insertion of bio-compatible materials to restore nasal volume and function.

Psychological Support: Cognitive-behavioral therapy (CBT) and other forms of psychological support to address the mental health impacts of ENS.

Lifestyle Adjustments: Recommendations to avoid dry environments, nasal irritants, and to maintain optimal nasal hygiene.

Some patients experiencing significant symptomatic relief through conservative measures while others may require surgical intervention. Continuous research is imperative to enhance understanding and treatment of ENS. Regular follow-up with an otolaryngologist is crucial for ongoing management and monitoring of the condition.

At the MedFirst ENT Centre, we offer you the latest and best ENT care in an ethical and efficient manner.

Dr (Major) Rajesh Bhardwaj who heads the Centre served in the Army for Fifteen years and brings the ethos of the Army into his practice.
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