Empty Nose Syndrome
Empty nose syndrome (ENS) is a debilitating, iatrogenic or paradoxical condition. Patients, usually after surgical reduction or removal of nasal turbinate tissue (inferior or middle turbinectomy, or other nasal surgery), report a sensation of nasal obstruction or "suffocation" despite a widely patent nasal airway on examination and imaging.
It is typically diagnosed months to years after surgery, with a latency of 1 month to many years. It occurs most commonly after total or subtotal inferior turbinectomy, in about 20 percent of such patients, and less often after partial resection or reduction. Milder forms occur after sinus surgery and septoplasty.
The incidence is uncertain (reported in 0.5 to 20 percent after aggressive turbinate surgery). It is also recognised in patients with atrophic rhinitis and after trauma or radiation.
The proposed mechanisms include:
- loss of nasal airflow sensation due to loss of mucosal thermoreceptors (cold sensitive TRPM8 receptors, and the trigeminal nerve endings)
- altered airflow dynamics (disordered laminar flow, loss of nasal resistance, changes to the nasal cycle and humidification)
- reduced mucosal surface area, drying and crusting
- damage to the trigeminal nerve fibres
- central maladaptive processes with psychological overlay (depression, anxiety and sleep disorders), though ENS is a real organic pathology
Patients with ENS have a high prevalence of depression, anxiety, insomnia and suicidal ideation, so mental health support is key.
ENS is classified as ENS-IT (inferior turbinate), ENS-MT (middle turbinate), ENS-both, and ENS-type with lesser tissue loss (ENS-type 1 to 4).
