Empty Nose Syndrome: Symptoms, Causes, Treatment

What are the symptoms of empty nose syndrome?

Empty nose syndrome (ENS) is a rare condition that can occur after surgical procedures, such as turbinate reduction or sinus surgery, particularly when too much nasal tissue is removed. It is characterized by a range of symptoms related to a sensation of nasal obstruction or airflow limitation, despite there being a clear nasal passage. Some common symptoms of empty nose syndrome include:

1. Nasal obstruction: Despite having a clear nasal passage, individuals with ENS often feel as though their nose is blocked or congested.
2. Difficulty breathing: A sensation of difficulty breathing through the nose, even when there are no physical obstructions present.
3. Dryness and crusting: The nasal passages may feel excessively dry, leading to crusting and discomfort.
4. Nasal pain or discomfort: Some individuals with ENS may experience pain or discomfort in the nasal passages, which can be exacerbated by changes in humidity or temperature.
5. Nasal drainage: While not always present, some individuals may experience increased nasal drainage, particularly if the nasal mucosa becomes irritated.
6. Nasal bleeding: In severe cases, ENS may be associated with nasal bleeding, especially if the nasal mucosa becomes excessively dry and fragile.
7. Difficulty sleeping: The sensation of nasal obstruction or airflow limitation can make it difficult to breathe comfortably while lying down, leading to disrupted sleep patterns.

It’s important to note that the symptoms of ENS can vary widely from person to person, and some individuals may experience more severe symptoms than others. If you have undergone nasal surgery and are experiencing persistent nasal symptoms that are not improving with time, it’s important to seek evaluation from an otolaryngologist (ear, nose, and throat specialist) who is familiar with ENS.

What are the causes of empty nose syndrome?

Empty nose syndrome (ENS) is a condition where there is a sensation of difficulty breathing despite there being no physical obstruction in the nose. It is thought to be caused by excessive surgical removal of nasal tissues, particularly during nasal turbinate reduction surgery. The turbinates are structures inside the nose that help regulate airflow and humidify the air we breathe. When too much tissue is removed, it can disrupt airflow and lead to the sensation of “empty” nasal passages. Other potential causes or factors that may contribute to ENS include:

1. Nasal Surgery: Procedures such as turbinectomy, septoplasty, or sinus surgery, especially when too much tissue is removed or the surgery is not done correctly.
2. Nasal Trauma: Injury to the nose or nasal tissues that disrupts normal airflow patterns.
3. Chronic Sinusitis: Ongoing inflammation and swelling of the nasal passages that can lead to changes in nasal anatomy and function.
4. Environmental Factors: Exposure to dry or irritant air, such as in arid climates or from certain occupations (e.g., working in air-conditioned environments).
5. Neuropathy: Damage or dysfunction of the nerves that control sensation in the nose, which can occur due to various factors.

ENS is a complex condition, and the exact causes and mechanisms are not fully understood. Treatment often focuses on managing symptoms and improving nasal airflow, which may include saline nasal sprays, humidifiers, and in some cases, surgical intervention to reconstruct the nasal passages.

How is empty nose syndrome diagnosed?

Diagnosing empty nose syndrome (ENS) can be challenging because it is primarily based on the patient’s symptoms and medical history, as there is no specific test for ENS. However, certain signs and symptoms may suggest the presence of ENS, including:

1. Persistent nasal obstruction or congestion, despite a clear nasal passage
2. Difficulty breathing through the nose, especially when lying down or during exercise
3. Sensation of dryness, crusting, or irritation in the nose
4. Reduced ability to detect airflow through the nose (nasal airflow sensation)
5. Psychological distress related to nasal symptoms, such as anxiety or depression

To diagnose ENS, a healthcare provider will typically:

1. Review the patient’s medical history, including any previous nasal surgeries or trauma
2. Perform a physical examination of the nose and nasal passages
3. Assess nasal airflow using tools such as a rhinomanometry or acoustic rhinometry, although these tests are not specific for ENS
4. Consider other possible causes of nasal symptoms, such as allergies, chronic sinusitis, or nasal polyps

In some cases, imaging studies such as a CT scan of the sinuses may be performed to evaluate the nasal anatomy and rule out other conditions. A diagnosis of ENS is often made based on the combination of symptoms, medical history, and physical examination findings.

What is the treatment for empty nose syndrome?

The treatment for empty nose syndrome (ENS) aims to improve nasal airflow and alleviate symptoms. The approach to treatment can vary depending on the severity of symptoms and the underlying cause, but it often includes a combination of medical and surgical interventions. Here are some common treatment options:

1. Nasal Moisturization: Using saline nasal sprays or irrigation can help moisten the nasal passages and reduce dryness and crusting.
2. Nasal Ointments: Applying nasal ointments or gels can help moisturize and protect the nasal mucosa.
3. Avoiding Irritants: Avoiding environmental factors that can worsen symptoms, such as dry air, irritants, and allergens.
4. Nasal Dilators: Using external nasal dilators or nasal strips can help improve nasal airflow by opening the nasal passages.
5. Surgical Interventions: In some cases, surgical procedures may be considered to reconstruct the nasal passages and restore normal airflow. These procedures can include turbinate repositioning, cartilage grafting, or nasal implants.
6. Psychological Support: Some patients with ENS may benefit from psychological support to help cope with the psychological distress associated with their symptoms.
7. Medications: In some cases, medications such as corticosteroids or antihistamines may be prescribed to reduce inflammation and improve nasal symptoms.

It’s important for individuals with ENS to work closely with their healthcare provider to develop a treatment plan that addresses their specific symptoms and needs.