Radio Program on Rhinology and Empty Nose Syndrome in China

Introduction: Two years ago, when the second trial of the Wenling doctor-killing case opened, the defense lawyer of the defendant Lian Enqing mentioned the concept of "empty nose syndrome" for the first time in court. Because the public knows little about empty nose syndrome, some patients are believed to have mental illness, which has become a hidden pain for this patient group - the disease is always with them, but it is difficult to diagnose and is not understood. The audio file below is sourced from a Chinese radio channel that reads parts of the Beijing News article:

The Pain of Breathing for Patients with Empty Nose Syndrome

Original author: Luo Ting, Wang Jingyi
The audio file consists song Yu's selected readings from the mentioned article.The radio program was broadcasted 2016/11/30

In the embedded audio file below you will explore personal stories from individuals suffering from Empty Nose Syndrome after surgeons removed or reduced their Turbinates. In the radio program, they describe their difficulties with breathing, their mental health, and societal misunderstandings. Various medical perspectives are explored, including diagnoses, symptoms, and potential causes of the syndrome.

Additionally, the audio file touches on nasal anatomy, specifically focusing on the role of the turbinates in regulating airflow and maintaining nasal function. Throughout the article, personal anecdotes, medical insights, and scientific explanations are interwoven, providing a comprehensive overview of the condition Empty Nose Syndrome.

Below the embedded video, you can read a version where the Chinese audio file has been translated into English. The audio file includes embedded English subtitles. If you prefer other languages, you can select them by clicking on the settings icon in the video on YouTube.

 

Transcript of the audio file:

00:00

Welcome everyone to today's program. I am Song Yu. I am here today for everyone reading the article: The Pain of Breathing for patients with Empty Nose syndrome: This is from the New Beijing News two years ago. During the second trial of the Wenling murder case, the defendant Lian Enqing's lawyer first mentioned the concept of Empty Nose Syndrome in court. Because the public knows very little about Empty nose syndrome, some patients are believed to have mental illnesses…

00:40

This disease actually seems normal on the surface, but underneath it is truly terrifying. It's unbearable all the time, I've tried to commit suicide twice. My mother saved me both times... Some doctors don't understand this disease and tell you to go to a psychiatrist which means this has become a hidden pain for this patient group.

01:01

The disease follows like a shadow and is difficult to diagnose. Not well understood, only patients with the same condition can understand the suffering. Today we will talk about the pain of breathing for people with empty nose syndrome… Sun Su Lin could hardly wait to enter the shower room and turn on the hot water, steam quickly filled the entire small space.

1:30 am

She inhaled greedily, wishing she could breathe all the hot steam into her nose. This warmth and moisture in her nose means a lot to her and is really precious. Since the nose operation in 2013, breathing has become an exhausting task for Sun Sulin. Nasal congestion, pressure on the chest and even suffocation are now everyday experiences..

01:59

She once saw her badly damaged nasal mucosa on camera, it was pale, pale as a white dessert. According to several hospital diagnoses, she had Empty nose syndrome. Empty nose syndrome, a term never before seen in medical textbooks. Han Deming, an academician of the Chinese Academy of Engineering and a professor at the Tongren Hospital ENT Department, defines it as a post-surgical complication.

02:22

Studies show that with destructive nose surgery, 20% of patients may develop Empty Nose Syndrome, but Han Deming believes this number may be higher. The concept first entered the public consciousness two years ago during the second trial of the Wen Lingsha case, when the defendant Lian Enqing's defense lawyer brought up Empty nose syndrome. Since then, it began to enter the public consciousness, and more and more sufferers of Empty Nose Syndrome began to speak up.

02:50

This is a condition that is painful every second, every minute, because the nose is always like this. You have to breathe like this ¨every second, every minute. It is very unpleasant. I am now at home every day. After the surgery I was so stressed and never sat down, walked around and around and couldn't relax. It was so unpleasant that I just wanted to cry.

03:05

At the time I was thinking of taking a small lid and pinching it under my nose, but that method is really not scientific. As a person, I look normal on the surface, but in reality I'm horrible. The mental and emotional destruction is greatest. Because the public knows very little about Empty Nose Syndrome, some patients are thought to have mental illnesses.

03:32

This also becomes a hidden pain for this patient group. The disease follows them like a shadow, but their disease is difficult to diagnose and not well understood. Breathing, a simple and everyday task for most people, but for patients with Empty Nose Syndrome, this ordinary task becomes incredibly exhausting. Stay tuned to the show for more information on the breathing pain related to Empty Nose Syndrome.

04:08

Sun Su-lin is 45 years old, has a round face and smiling eyes. Some think she looks like the famous comedian Jia Ling. As a mid-level manager in a foreign company in Shanghai, her life used to be comfortable and pleasant. But a major turning point in life came because of a small choice. In December 2013, due to itching in her ear canal, Sun Su-lin went to the ENT department of a hospital in Shanghai.

04:37

An elderly female doctor examined her and said that the ear, nose and throat are connected. The ear infection was actually caused by the nose, and the nose needed treatment first. Sun Su-lin says she naively accepted nose treatment under the doctor's guidance. She remembers that the doctor said it was not a classic operation, nor was there a no-consent form for the operation.

04:53

A thin metal tube was inserted into her nose and passed back and forth. The process lasted about half an hour. The billing statement showed that Sun Su-lin underwent about ten procedures, including partial resections of the lower and middle turbinates. In the days following the operation, her wound gradually healed, but other discomforts began to appear.

05:11

Sun Su-lin began to feel that the air was too dry and cold, and she often experienced chest tightness and headaches, and sometimes even a vague feeling of suffocation. On March 26, 2014, while walking home from work, she was suddenly overwhelmed by a feeling of suffocation. Chest tightness, palpitations and shortness of breath.

05:34

She collapsed by the side of the road, terrified and wanted to cry, but there was no sound. She said it felt like a heavy stone was pressing on her chest, and she thought she was going to die. She struggled to get home and her mother performed basic CPR. The feeling of suffocation eased somewhat but did not go away.

05:51

From that day on, breathing became an exhausting task. She kept making strange noises, started purring and grunting. Breathing became a laborious task. She was always making strange, gurgling noises and her lips were turning purple from choking. Sun Sulin said that the air she breathed in was dry and cold, like a knife stabbing straight into the deepest part of her nasal cavity and shooting out into her head.

06:12

Headache, dizziness, insomnia and pneumonia appeared. People around her noticed that this normally fair-skinned Southern woman now had pores that turned faintly black. Her husband, Lao Tao, who was often on business trips, came home and found it strange that his wife always wore a mask and her voice had become weak. Later, Sun Sulin was diagnosed with: Empty Nose Syndrome in several hospitals.

06:35

According to media reports, the official name for the condition is Empty Nose Syndrome. It is an English name and abbreviated ENS. The condition was first discovered in 1945 by an American doctor named Kern... Dr. Tian Xingde of Jingzhou First People's Hospital has observed that the most common symptoms of Empty Nose Syndrome include paradoxical nasal obstruction, difficulty breathing, dry nasal mucosa, impaired sense of smell, and depression.

07:09

What exactly causes Empty Nose Syndrome? From the currently collected patient data and physician feedback, it appears that almost all patients with Empty Nose Syndrome developed the condition after undergoing surgery of the nasal turbinates. So what role do these organs play in our breathing?

This program will soon continue to discuss the breathing pain experienced by patients with Empty Nose Syndrome....

07:28

If we compare the human nasal cavity with an instrument, the producer must have deep understanding in beauty and design. Breathing, this seemingly simple act, is actually performed by a series of intricate parts working in perfect coordination in a predetermined program. According to relevant data, panting is repeated 10 times per minute by a quiet office worker, while a running athlete breathes more than 30 times per minute.

07:51

One of the parts involved is the Mussels. These bulging structures on the side walls of the nasal cavity, wrapped in mucous membranes, play a very important role. Professor Han Deming, an academician of the Chinese Academy of Engineering and an ENT specialist at Tongren Hospital, explained that a normal nose has three turbinates: the upper, middle and lower turbinates.

08:09

The lower turbinate helps to form the narrowest and softest passage in the nasal cavity. Here the air has the maximum contact surface with the nasal mucosa, which heats, humidifies and filters the air. To accomplish this, the air must meet some resistance after entering the nasal cavity. The narrow passage provided by the turbinates offers about half of this resistance which must be balanced with the power of the lungs.

08:29

When air enters the nasal cavity, the lungs need to expand to draw in the valuable air and this is facilitated by the resistance of the nose. If any part does not work, the function of the whole system will be affected.... Recalling the operation from two years ago, Sun Sulin's fellow patient Cheng Shunuo choked several times. Two years ago, at the age of 25, Cheng Shunuo from Hubei underwent a botched operation on his nasal turbinates at a hospital in Wuhan to treat rhinitis.

09:24

Afterwards, he was diagnosed with Empty Nose Syndrome, the same condition that afflicted Sun Sulin. He suffered from a feeling of suffocation, weakness, insomnia, headache. This young man, in his early twenties, appeared exhausted and was already losing his hair. During the interview with the reporter, he often paused to take deep breaths... In order to maintain his image, he often went outside during the interview and leaned against the wall and made hissing noises similar to those Sun Sulin makes.

09:49

Wang Taili, a member of the famous group Chopsticks Brothers, is also a patient that Sun Sulin knows. He also suffers from Empty Nose Syndrome. In a media interview, he said that he underwent an operation to achieve nasal resonance for singing and that half of his lower turbinates were then cut off by a local doctor. This led to excessive ventilation and a constant feeling of dryness.

10:08 a.m

He paid a high price for an unattainable dream. When faced with an illness, celebrities do no better than ordinary people. Wang Taili told Sun Sulin that he had to tape one nostril to sleep. Otherwise he felt cold and dry air. He also tried treatments from several doctors, both domestic and international, with little or no success.

10:23

The inferior nasal turbinate reduction that Wang Taili underwent and the radiofrequency treatment that Cheng Shunuo had are both common procedures among patients with Empty Nose Syndrome. Many underwent just these types of surgeries before developing the condition. Dr. Das Subinoy, an American doctor dedicated to "researching" Empty Nose Syndrome, said in an email to Beijing News that almost all patients developed the condition due to previously performed surgery on the nasal turbinates.

10:43 am

Han Deming, an academician of the Chinese Academy and an ENT specialist at Tongren Hospital, explained that the turbinates and their mucous membranes are fundamental structures in the nasal cavity. They support nasal breathing, resonance, heating and filtration, provide sensations of air pressure and air temperature, and allow us to smell.

10:56 a.m

Regarding surgery for nasal congestion, Han Deming used an analogy: How we treat inflammation in the nose is like the situation in Shanghai with the Yangtze River. Treating the environment in Shanghai without addressing the pollution in the Yangtze River is like putting the cart before the horse. Breathing, resonance, heating, filtering, provides sensations of air flow, air pressure, cold and heat, and allows us to smell.

11:13

Han Deming explained that when the lower turbinates are damaged, the normally narrow and narrow airways become wider and nasal resistance is significantly reduced.

11:35

The ability of the lungs to expand is weakened and the decline in respiratory function can lead to a feeling of pressure on the chest and even suffocation. Low temperature, cryotherapy and plasma reduction of the turbinates are all operations that destroy the mucous membrane. The nasal mucosa is rich in nerve endings and can sense air flow.

11:51

Once damaged, you can no longer feel the airflow leading to a sensation similar to nasal congestion. Without the nasal mucosa, air cannot be heated and humidified sufficiently, which means that the air entering the nasal cavity feels very dry and cold. This irritates the nerve endings in the nasal cavity and causes headaches.

12:07 p.m

In addition, the air now lacks effective cleaning and filtration and now carries bacteria into the lungs, which can lead to lung infections... Many patients suffering from Empty nose syndrome are only understood by other affected patients. Outsiders cannot understand why they seem normal, but suffer so much. Within the medical community, there are differing opinions on Empty Nose Syndrome.

12:27 p.m

Many ENT doctors believe that the breathing problems ENS patients have is closely related to the patient's psychology. For over two years, Sun Sulin's breathing problems have increasingly limited her as a person. She says she can't die, but she can't live well either.

12:45 p.m

Previously, her mother and husband had to sleep on either side of her in the same bed, pinning her in the middle to prevent her sneaking into the kitchen at night to find a knife to end it all. This type of suffering can only be understood by Empty Nose Syndrome patients. Once she took many sleeping pills to end it, but her family intervened.

13:10

She constantly used things to pierce her throat and used other self-harming behaviors, and her family had to keep an eye open When her nose was first injured, she lost 14 kg in 20 days, and she could only sleep 10 minutes a day. And she couldn't even get out of bed. She also had nightmares and crawled out of bed to get up.

13:27

Every night she lived like this and tried to commit suicide twice. My mother saved me. Others do not understand your pain. Even when you tell your parents they say they know you had surgery but even after so many surgeries you are still not better. Who can you blame for that? Saying this to me, hearing these words makes me even more depressed.

13:46

Only fellow patients with the same condition can understand. Only we understand this disease, we comfort each other in online forums. When I really want to end my life, they tell me to wait. To try more treatment first. If they feel that way, I comfort them, we support each other. Because no one else understands, others don't understand your pain They know you are sad, but they don't know how much you suffer from physical and mental pain.

14:11

The situation is very bad for Empty Nose Syndrome patients, some say they would exchange an arm or a leg for a healthy nose. Losing a limb gives sympathy but for us there is no sympathy. In a 2013 Tencent video, a patient says he searched everywhere for a cure. When he found one, there was a risk that it could cause cancer. Then he said: Cancer, so what? As long as it cures my nose! So I think this condition is worse than cancer. Not being able to breathe, I'd rather have cancer! Patients with Empty Nose Syndrome are not understood.

2:33 p.m

A doctor once told a 25-year-old man from Hubei "You should see a psychiatrist, stop thinking about your nose" What hurt him the most was his mother's attitude. His parents divorced when he was young, and he lived with his mother. To support himself, he worked as a cleaner. After he got sick, he couldn't work. His mother was very angry about this and said he was lazy.

14:45

She forced him to get a job. Later he took advice from other patients moved to Hainan where the warm and humid air helped. He could not do heavy work, but could make a living. American doctor Das Subino said in an email that the first challenge for patients with Empty nose syndrome is getting the diagnosis because tests can come back normal.

15:51

More than one ENS patient has said that their local hospital was not familiar with this condition. The doctor could not understand why patients with wide nasal passages would experience a subjective feeling of difficulty breathing... When almost all indicators are normal, doctors believe that the patient has a mental problem.

16:12

At another hospital they said "Go to a psychiatrist, it's a neurological issue. You have good airflow. It looks like your nasal passage is quite wide. The doctor said that such wide passages shouldn't have any airflow problems. Go to a neurologist. They suspect that you have mental problems. In the medical community, there are different opinions about Empty Nose Syndrome. Several ENT doctors interviewed believe that the condition is closely related to the patient's mental state.

4:33 p.m

Zhou Bing, head of ENT at Beijing Tongren Hospital has analyzed patients he diagnosed with Empty Nose Syndrome. He found that these patients' turbinates appeared normal in shape and they had two turbinates that had never been operated on. He said all of these patients had undergone psychological evaluation before surgery.

16:58

There is a gap in understanding. Patients show varying levels of anxiety, depression and other psychological symptoms. Doctors at Beijing Anzheng Hospital understand the suffering of Empty Nose Syndrome patients. He believes that the problem is not only due to damage to the mucous membrane of the turbinates, but generally to the mucous membrane of the nose.

17:12

Some believe that it is the subjective feelings of some patients that are magnified but from the perspective of the patients, they feel a deep pain. However, the doctors make their own assessment and there is a gap in understanding between the two. This contradiction has given rise to confusion.

17:29

Although the medical community has clearly linked this symptom to surgery, there is a significant imbalance in the development of rhinology in different regions of China. But is surgery really the only treatment required for nasal congestion? Different hospitals have different options... The paper then goes on to highlight breathing pains in patients with Empty Nose Syndrome.

17:48

The doctors at the First People's Hospital in Jingzhou City, Hubei, cannot explain why some patients develop Empty Nose Syndrome after resection of the inferior turbinates while others do not. However, the pain of breathing in this condition is real. Doctor Tian Xingde of the First People's Hospital in Jingzhou City, Hubei, wrote in a research paper that he cannot explain why some patients develop Empty Nose Syndrome while others do not.

18:09

This is a confusion for most doctors today. But what he is sure of is that around 20% of patients will develop Empty nose syndrome after surgery on the lower turbinates. Professor Han Deming of the Chinese Academy of Engineering said that this figure could be even higher and that sometimes these operations are unnecessary.

18:23

Dr. Han Deming once wrote that the development of rhinology varies greatly between different regions of China. There is a lack of understanding and there is blind obedience in clinical practice. There is also a lack of understanding in clinical practice. He wrote, “Physicians who blindly perform surgery injure these structures (the turbinates) through ignorance.

18:51

Patients feel nasal congestion and doctors blindly cut off the turbinates. They are then left with an empty nasal feeling. Han Deming believes that the guideline for surgery should always be to preserve the basic structure of the turbinates.

Xiaopan went to a hospital because of sinus problems. The doctor said a minor operation was needed. After returning home, Xiaopan was contacted by the hospital to undergo surgery. When the surgery was done, he got Empty Nose Syndrome. During the interview, Xiaopan's nose was stuffed with cotton and his voice was weak, as if he was forcing his throat to speak.

19:27

Doctors from another hospital later examined his nose and said that this operation should not have been performed at all. In fact, many doctors currently urge caution when using surgery to reduce the turbinates, given its importance.

19:37

When interviewed, a doctor from a clinic in Beijing with a high-class positioning said that their clinic does not perform such destructive operations because they damage the physiological structure of the nasal cavity, although a short-term improvement can be achieved, the long-term consequences can be serious.

19:51

Han Deming said that Beijing Tongren Hospital has long since stopped performing destructive operations to reduce the turbinates.

20:03

He has personally repeatedly called for caution in such operations in various academic texts, but the situation in some small and medium-sized hospitals and private hospitals may be too optimistic. Chongqing Medical University and Affiliated Physician Yongchuan of the Department of Otolaryngology. Considers that for all diseases of the nasal cavity, the operation should be standardized where conservative treatment methods should first be used before the operation. The doctor at the hospital's otolaryngology department also believes that for all nasal conditions there should be one

20:20

conservative standard treatment that must first be undergone before resorting to surgery. And that surgery should only be considered when conservative treatment proves ineffective. Surgeons should also avoid unnecessary overexpansion of the nasal cavity during surgical procedures. ENT professionals should approach septal resection with caution and avoid excessive surgical intervention.

20:40

Experts say removal of nasal septal tissue should only be done in cases of severe trauma, bone exposure or tumor. But in reality, whether or not this surgery is performed differs between hospitals, methods of surgery also differ, and patients are offered different choices. Last winter, a Beijing News journalist visited an exclusive ear, nose and throat clinic in Beijing and interviewed a doctor named Liu.

21:01

He stated that their clinic does not perform destructive surgeries such as nasal septoplasty because it disrupts the physiological structure of the nasal cavity, although short-term improvements can be achieved, the long-term consequences can be severe. However, we had a journalist check out a private ear, nose and throat clinic in southeast Beijing, and here a female doctor suggested performing surgery on hypertrophic turbinates to improve symptoms of nasal congestion.

21:24

The cost of the operation of the turbinates would be RMB 20,000. Elsewhere, a "minimally invasive" approach was suggested even for our 70-year-old journalist. In response to concerns raised by the journalist about Empty Nose Syndrome, the doctor's response was: “You could be hit by a car.

When the journalist mentioned that he needed to consider whether or not to have surgery, the doctor quickly handed over a business card and suggested that he come directly to him in his adjacent consulting room, without even making an appointment. Yet another doctor at another clinic offered a similar treatment plan.

21:50

The medical community's understanding of this condition remains patchy... So for patients with Empty Nose Syndrome. How is there any hope for a cure? Considering the state of medical knowledge, the battle between Sun Sulin and Empty Nose Syndrome has been going on for over two years.

22:29

Almost every possible treatment plan has been tried. She has also written emails to the government of China, Taiwan, Japan, Germany, the United States and other research institutions. She has visited many experts in person but to no avail. Last August, Sun Sulin went to the United States for treatment, but it was still ineffective. For Sun Sulin, part of her nostrils are permanently lost, repairing it is not an easy task.

22:51

Theoretically, part of the turbinate on the opposite side can be removed and then implanted on the injured side, but whether the operated turbinate can survive, and to what extent, is unknown.

23:09

This is easy to say, but hard to do. So he suggests training is needed so doctors don't damage the structure. It is not entirely without hope. The Anthony Atala Research Institute at Wake Forest University in the United States told Sun Sulin that there is hope for successful research to cure Empty Nose Syndrome. however, the cost is staggering.

23:26

The first phase of animal testing costs about $500,000. Subsequent human experiments require about $800,000. Dr. Chang Shunuo, who has long studied Empty Nose Syndrome, wrote in an email, "The condition is difficult to cure. Currently available treatment methods are limited. He is currently researching a new treatment method, but it is still experimental.

23:42

Professor Han Deming's team is doing meaningful work, namely clinical observation and establishing a standardized diagnosis and treatment model across the country to prevent surgery from being abused. He believes that surgery of the turbinates will become less and less common. Professor further says that this generation is responsible for solving the problem of Empty Nose Syndrome. Instead, Han believes that drug treatment is expected to increase, which will reduce the number of operations performed on the nasal turbinates.

24:18

According to Professor Han, this trend suggests that the problem of Em,pty Nose Syndrome may soon become a thing of the past. The responsibility lies with this generation until a solution comes. Meanwhile, patients continue to struggle to breathe deeply. Cheng Shunuo now uses invisible nose plugs that she imported from the United States, these cost more than forty yuan.

24:44

They are small, with two silicone discs with a sponge filter in between. Each less than a centimeter in diameter, they are inserted into the nose to relieve excessively wide nasal passages due to the removal of the turbinates, creating a narrower airway. Some continue to wait while others have taken action. When Sun Sulin's appeal for help was posted on Tianya, it attracted a lot of attention.

25:06

Sun Sulin continues to be followed by many patients hoping to gain useful insights from her medical journey. Every day she receives letters filled with fear, anxiety, hope and despair from all over the world. In the midst of uncertainty, Sun Sulin remains a beacon of hope for those who are suffering. During the interview, her husband, Lao Tao, told a story from ten years ago.

25:26

Sun Sulin was sent by the company to a chemical factory in Shanghai to manage the construction of the new premises. Suddenly there was an explosion, and there was chaos with fire everywhere, things falling from the sky. Everyone ran out, but she took her safety helmet and ran into the factory. She wanted to see if their construction had caused it. Lao Tao said that his wife is such a brave person, so the pain she is enduring must be real. As her husband, he must accompany her through everything.

25:48

Listening friends, what you just heard is a selected reading from Beijing times magazine: and the article "The Pain of Breathing for Empty Nose Syndrome Patients." My name is Song Yu and I thank you for listening to today's program. This excerpt is from New Jingbao's "First-Person" program.

26:08

You can follow the public WeChat account of the magazine's featured reads. Taken from Xinjingbao "First-Person" program rebroadcast. Our WeChat ID is "baokanxuandu" Alternatively, log in to the Zanlanjin app Or listen to Himalaya FM. See you next time in the program!

Below you can print or download the entire document. 

Understanding the Severe Impact of Turbinate Reduction: Why Some Patients Struggle to Cope

Link to the original Chinese article   Download the translated article

I saw a news report: At the end of August 2016, a 27-year-old woman named Zhang Rui found a hospital in Urumqi through a Baidu search. She underwent a bilateral anterior ethmoid nerve block and nasal septum correction. Following the surgery, she developed psychological disorders and psychotic symptoms. Half a month later, she jumped to her death. Her family believes that the failed surgery caused Zhang Rui to suffer from "Empty Nose Syndrome." How painful is "Empty Nose Syndrome"? It seems that this suicide is not an isolated case.

Due to the interview titled "The Empty Nose Syndrome Group Behind the Bride-to-be's Death in a Fall, Where Breathing Felt Like Being Stabbed by a Knife," I recently came into contact with some patients and suspected patients of Empty Nose Syndrome who have not yet been diagnosed. Let me share my preliminary thoughts.

1. Rhinitis is not the same as Empty Nose Syndrome; the two concepts should not be confused.

2. Academician Han Demin, a domestic expert in the field of nasal treatment, stated that more than 20% of nasal surgeries result in Empty Nose Syndrome.

3. The treatment of Empty Nose Syndrome remains a global challenge, and there is no cure currently available.

4. Domestic tertiary hospitals have largely ceased performing local nasal excisions and similar surgeries. However, private hospitals, especially those in Putian, continue to perform these surgeries. Individuals who did not have Empty Nose Syndrome have developed it as a result. For example, Sun Sulin initially sought treatment for ear itching, but after surgery, developed Empty Nose Syndrome. Zhang Rui’s family reported that Zhang Rui was initially only treated for rhinitis, but the doctor irresponsibly performed nasal surgery. Following heavy bleeding and unbearable pain, she committed suicide by jumping off a building half a month later.

5. Empty Nose Syndrome patients appear physically normal, without missing limbs, but they are in constant pain.

"Every second feels like a knife stabbing into the brain," said Sun Sulin, an Empty Nose Syndrome patient. She particularly understands Zhang Rui's suicide. "I wanted to commit suicide every day for more than a year. If it weren't for my family watching me closely, I would have succeeded long ago." The key issue is that many people mistake them for being mentally ill. For example, Sun Sulin’s family initially treated her as a mental patient. Sun Sulin mentioned that another Empty Nose Syndrome patient left a suicide note before taking their life, which read, "Don’t think I am mentally ill; this is the greatest insult to me."

I want to clarify that many people who initially only had mild rhinitis, which could have been treated with medication, were instead operated on by some doctors at certain hospitals (I emphasize some, not the entire medical community). A small number of them (again, a small number) developed Empty Nose Syndrome, and eventually, some attempted or committed suicide. Therefore, I must emphasize again that we cannot generalize or make sweeping statements. These are just my rough thoughts; please feel free to criticize and correct me.

I am a patient with Empty Nose Syndrome, so I have some personal opinions on this matter:
Why did the rhinitis patient Zhang Rui commit suicide due to the unbearable consequences of a failed surgery? I believe we should start with understanding the nasal conchae.

What are the nasal conchae?
The lower conchae, which are covered with a layer of mucous membrane, have a layer of mucus on the surface, and some cilia that are invisible to the naked eye. Most nasal conchae removal surgeries are performed on the lower nasal conchae.

What is the function of the inferior turbinate?

Simply put, the inferior turbinate functions as a supercharger, humidifier, purifier, and air conditioner. It maintains nasal resistance, regulates airflow, adjusts the temperature and humidity of inhaled air, and filters and sterilizes it.

What are the consequences of surgery?
Once too much of the inferior turbinate is removed, the most immediate sensation is a lack of nasal resistance, difficulty breathing, and a reduced sense of smell. If the nasal mucosa, mucus, and cilia covering the turbinate are damaged, the patient may feel that the throat area becomes particularly dry and the airflow is imperceptible. The lack of effectively filtered air can cause reflex headaches, and insufficient oxygen can lead to fatigue. The resulting depression, neurasthenia, and poor sleep quality are just a few of the many symptoms. With so many side effects, you can imagine how torturous life is for patients with Empty Nose Syndrome. I have now forgotten what it feels like to feel refreshed. Now you should understand why patients with rhinitis might commit suicide after a failed surgery, right? I don’t know how long I can hold on, but who would choose death if they could live well?

Reply to everyone's question about how to treat rhinitis:

1. The most direct and effective method is to move to a place with good air quality.

2. Regularly flush the nasal cavity with physiological seawater, and avoid drugs containing hormones or other substances that can irritate the nasal mucosa.

3. For those who have tried other treatments with no success and whose quality of life is severely impacted, "inferior turbinate submucosal resection" may be carefully considered.

4. If you have a deviated nasal septum and it is severe enough to cause respiratory arrest at night, then consider septum deviation correction surgery.

5. Always choose a reputable public tertiary hospital for surgery, verify whether the department is outsourced, and ensure the doctor has a valid practicing license. Keep all medical records in case of a medical accident.

6. Don’t trust Baidu! Don’t trust the Putian system! Don’t trust all medical advertisements and recommendations from “relatives and friends”! Resist temptation and think critically!

Zhang Rui, 27 years old from Urumqi was planning to marry her boyfriend that year when she jumped from a bridge ending her life

A 27-year-old woman sought treatment for chronic rhinitis before getting engaged. She underwent surgery on the day of her initial diagnosis and fell to her death 19 days later. Her family filed a lawsuit against the hospital and Baidu.

Why did this happen?

Last night, Shandong TV's "Investigation" aired a report titled "The Mystery of the Bride-to-Be Falling to Her Death After Being Treated for Rhinitis." Let’s review it together——

The woman in question was Zhang Rui, 27 years old, who lived in Urumqi and was planning to marry her boyfriend that year. No one expected that a woman preparing to embrace a new life would suddenly jump from her 14-story home one night, leaving behind a series of unsolved mysteries.

Half a year has passed since Zhang Rui’s fall, yet there is still a large mark left in the green belt where she landed. The police investigation concluded that the cause of death was a fall from a height. Residents of the community mentioned that Zhang Rui had been behaving strangely prior to her death, but the reason she fell from the building was not what the residents guessed. Zhang Rui and her boyfriend had been dating for eight years, and neither was originally from Urumqi. They started a software company in Urumqi and worked hard for more than five years, with their lives and relationship improving steadily. That was until a small check-up before their wedding. Zhang Rui's rhinitis was not particularly severe, only flaring up when she had a cold, causing a lot of clear nasal discharge. In August, she searched on Baidu for treatments for rhinitis in Urumqi.

At the end of August 2016, Zhang Rui searched for the terms "Urumqi" and "rhinitis" on Baidu and was directed to the website of Urumqi Edward Hospital. After making an appointment online, she went to the hospital on the 27th to see a doctor named Hu Jiankui for rhinitis treatment. On the day of her first visit,

Zhang Rui was diagnosed with allergic rhinitis, hypertrophic rhinitis, sinusitis, and a deviated nasal septum. He underwent a bilateral anterior ethmoid nerve block, turbinate ablation, and nasal septum correction. The surgery cost Zhang Rui more than 4,000 yuan. In the week following the operation, he spent hundreds of yuan each day on follow-up treatments at the hospital. On the morning of the seventh day, Zhang Rui experienced heavy nosebleeds. On the tenth day after the surgery, he returned to Edward Hospital to have the gauze removed from his nose.

According to Xiao Yang, Zhang Rui's pain persisted continuously from that day onward. She was unable to work or lead a normal life and experienced hallucinations, feeling as though someone was trying to harm her. Seventeen days after the rhinitis surgery, and two days before her fall, Xiao Yang took Zhang Rui to the psychiatric department. The medical record noted symptoms including slowed response, confusion, irritability, impatience, difficulty sleeping, and poor work performance. An investigation revealed that Zhang Rui had weak emotional control. Zhang Rui's family believed her fall was related to the rhinitis surgery and subsequently filed a lawsuit against Edward Hospital. Notably, Zhang Rui's family also included Baidu as a defendant in the lawsuit.

Zhang Rui's family attorney, Hong Li, explained: "When you type 'Urumqi rhinitis' into Baidu, the top three results are all Edward Hospital, which can give ordinary users the impression that it is the best hospital, potentially misleading them." After representing Zhang Rui, Hong Li had the search results notarized. The notarization shows that in September 2016, searching for "Urumqi rhinitis" on Baidu yielded several results for Urumqi Edward Hospital, with the last line of the search results indicating "v" and "advertisement." The Shuimogou District People's Court of Urumqi accepted the case.

The suicide of an unmarried bride-to-be is indeed tragic and regrettable. But this raises a crucial question: why did Zhang Rui's family sue the hospital that performed the rhinitis surgery, and even Baidu? How could a rhinitis surgery alone lead to a patient's suicide? To address these questions, we first need to understand a term in otolaryngology: turbinate ablation.

Turbinate ablation involves the removal of part of the turbinate. Can this procedure make someone so uncomfortable that they might consider suicide? We found a rights protection group for Empty Nose Syndrome sufferers, many of whom have undergone turbinate ablation. We spoke with a patient named Sun Sulin, who, at the end of 2013, spent over 4,000 yuan on partial removal of the middle and lower turbinates at a hospital in Shanghai due to ear pain. A week after the operation, Sun Sulin's symptoms closely mirrored those described by Zhang Rui.

Sun Sulin reported to the media that for over three years, every breath she took felt like a knife was being driven into her brain and lungs. The air felt excessively dry and irritating. She explained, "I have to spray medicine constantly and carry it with me 24 hours a day. Despite this, it's only a temporary solution. The moisture is minimal, and it doesn't help with the issue. My nose has no sensation; I can't feel the airflow or breathing. Additionally, it has been aggravating my lungs and stomach. I constantly feel nauseous and have a cold stomach. My lungs are always coughing, and I frequently catch colds and have fevers. My immunity is compromised, allowing cold air and bacteria to go directly to my lungs. After the partial removal of the middle and lower turbinates, I suffered from stomach pain, headaches, shortness of breath, overall weakness, and lost my ability to work, requiring me to stay in bed for long periods. My husband had to resign from his job to take care of my diet and daily needs. I believe Zhang Rui committed suicide by jumping from a building because he could not endure the pain following his surgery."

Could partial removal of the middle and inferior turbinates lead to symptoms associated with Empty Nose Syndrome? What is the nature of this surgery in clinical practice? The reporter attempted to contact otolaryngology departments from hospitals in Beijing, Shandong, and other locations for clarification, but several experts declined the interview requests due to the lack of a clear national stance.

The Xinjiang Yunxiang Judicial Appraisal Institute conducted a forensic clinical assessment based on Zhang Rui's medical records from Edward Hospital and the mental health clinic records provided by her family. The assessment found that Edward Hospital committed medical errors in Zhang Rui's diagnosis and treatment, including insufficient clinical basis, violations of treatment principles and standards, failure to provide informed consent, and neglect of necessary precautions. The report stated: "In this case, the medical team should have adopted a step-by-step treatment approach. Instead, the patient underwent surgery with an expanded scope of operation. Therefore, the medical team committed errors that violated treatment principles and norms." The report also estimated that the hospital's medical faults contributed 25% to Zhang Rui's death. Edward Hospital's attorney responded by stating that they could not comment before the court trial.

Whether turbinate ablation causes suffering severe enough to be considered worse than death is a medical question that needs to be addressed by the authoritative medical community. Determining whether the surgery on Zhang Rui was appropriate and whether the hospital's treatment adhered to regulations are legal matters to be resolved by the court. This case bears similarities to the Wei Zexi incident, which attracted significant attention last year.

Last spring, Wei Zexi's name was frequently in the headlines, raising widespread concern about issues like outsourcing of public hospital departments and search engine bidding rankings. In Zhang Rui's family's lawsuit, Baidu was named as a secondary defendant, alleging that Zhang Rui was misled by Edward Hospital's paid search rankings for rhinitis on Baidu.

The reporter observed that Baidu's search engine now clearly marks commercial promotions and provides risk warnings. Zhang Rui used the search engine in August of last year, after these changes were implemented. Will Baidu still be held responsible?

Zhu Wei, a professor at China University of Political Science and Law, argues that internet users should be aware of advertisements in search results when using search engines like Baidu. He views this as common knowledge. If Baidu has reviewed the qualifications of those paying for search services and clearly marked these as advertisements, then under the Advertising Law, it should not be held responsible. Advertisements in search results should not exceed 30%, and if a website engages in false advertising, search engines like Baidu are obligated to verify and remove such links. Zhu Wei believes that even if hospitals engage in false advertising on their official websites, search engines like Baidu might not necessarily be held accountable.

The subpoena obtained by Zhang Rui's family indicates that the court will open the case on April 24, two weeks from now. However, the reporter has learned that the court might need to postpone the case due to the defendant’s objection to jurisdiction. The responsibilities of the hospital and Baidu in this case will ultimately be determined by the court. A year has passed since Wei Zexi’s death. We have seen that the country has taken a series of measures, and we hope that medical and internet advertising practices will become increasingly standardized, ensuring effective protection of patients' rights.

I had a nasal septum correction surgery at Shenzhen Peace Hospital in 2012. Before the surgery, the doctor described my symptoms as very severe, warning that without the surgery, a large number of nasal polyps would grow, making them difficult to treat later and potentially causing fungal sinusitis and other issues. In reality, I had suffered from rhinitis (primarily hypertrophy of the inferior turbinate) for many years. Aside from nasal blockage, I had never experienced other symptoms. The main goal of the nasal septum surgery was to alleviate facial pain and improve my quality of life.

When the doctor explained the surgical plan, he mentioned that removing part of the inferior turbinate would make the nasal mucosa unnecessary. The contact information and mobile phone number provided by the doctor who performed my surgery turned out to be false, and I was unable to reach him a month after the surgery. I received local anesthesia, and the doctor’s attitude was very casual and indifferent. During the operation, the doctor removed one-third of my right inferior turbinate. I also asked the doctor why he removed the right inferior turbinate when my nasal septum was deviated to the left. The doctor replied that it was "common practice."

After the surgery, the packing in my nasal cavity was removed within two days. However, there was significant bleeding after the packing was removed, and it had to be replaced. I contacted the surgeon at the time, but his response was very dismissive and impatient. He said it was normal and handed me a tissue to manage the bleeding.

It wasn’t until I went to a tertiary hospital and received hemostatic drugs that the situation improved. After being discharged, my nasal cavity felt constantly dry, and I experienced over-ventilation. My throat was always filled with dust. When winter arrived, my throat felt extremely cold, and I kept retching. No matter what I did, it didn’t get better. Initially, I thought it was just part of the recovery process, so I didn’t pay much attention. I continued using saline to rinse my nose, but two years later, not only did my nasal symptoms not improve, but my lung discomfort worsened gradually. I began to experience difficulty breathing and suffocation, even feeling labored when climbing stairs. My eyes were always filled with stars, and every breath felt like a knife in my lungs, as if they were burned by fire. I could hardly concentrate on my work, and my work efficiency was consistently low.

It wasn’t until 2015, when I learned about the term "empty nose syndrome," that I discovered the truth. It turned out that the doctor had removed one-third of the front end of my inferior turbinate, causing significant damage to my nasal mucosa. There were large scars left in my nasal cavity after the removal of the inferior turbinate. My nasal cavity lost its ability to filter small dust particles from the air, and the discomfort and pain in my lungs were due to inhaling excessive dust. I wanted to sue Shenzhen Heping Hospital, which turned out to be a "black hospital," but by the time I went there, it had been shut down. Specific link: http://sz.house.qq.com/a/20131222/002313.htm

Here are a few things I want to say to all citizens:

1. Do not trust any non-Grade 3A hospital for surgery, and be cautious with Armed Police Hospitals or PLA Hospitals.

2. Empty nose syndrome is real, but the medical community has not yet clearly defined the condition. Although doctors abroad have researched it, the effectiveness of current treatments is uncertain.

3. Although empty nose syndrome is very distressing, you should not reject nasal surgery altogether. When considering nasal surgery, it is best to discuss with the doctor whether they recognize empty nose syndrome. If they do, they will try their best to protect the nasal tissues during the operation to avoid this condition.

4. Nasal diseases can lead to many mental problems, but patients with empty nose syndrome are not "mentally ill." They are individuals who suffer from a condition that others often do not understand. Their emotional struggles and impulses are caused by the disease that torments them, not by any inherent "mental illness."

To those who dismiss empty nose syndrome as a psychological issue without scientific basis: you are truly unworthy of your titles. To put it bluntly, you are not suited to study medicine, a field that requires objectivity and rigor.

Causes of Empty Nose Syndrome

The seemingly advanced technologies such as "laser" and "low-temperature plasma," combined with the promise of a "one-time cure," have given many patients with nasal diseases a false sense of hope. However, the reality can be harsh. After a brief period of symptom relief, many patients end up paying a heavy price: dry nose, nasal congestion, headaches, increased nasal discharge, and nasal reflux.

Are laser and low-temperature plasma technologies beneficial for patients with nasal diseases, or are they leading them into a deeper problem? To unravel this, we must first understand the treatment principles behind these technologies. Laser therapy employs the photothermal effect of stimulated radiation light on tissues. The treatment temperature is high (over 150°C), and it ablates the nasal mucosa by destroying its epithelial layer. Low-temperature plasma therapy uses high-frequency electromagnetic waves to ablate tissues at lower temperatures (around 40-70°C). A highly concentrated plasma zone forms around the electrode through a conductive medium, crushing the organic molecular chains in the tissue, reducing tissue volume, and causing targeted ablation. This method is often used to destroy the subepithelial layer of the nasal mucosa, with the advantage of less heat penetration.

Both treatments focus on the nasal mucosa, which is crucial for the nasal cavity's physiological function. The mucosal surface not only houses an important ciliary transport system that clears secretions and dust but also contains glands that secrete fluids to keep the nasal cavity moist. Additionally, various receptors in the mucosa respond to whether the nasal cavity is clear and the temperature is appropriate. Ablating the nasal mucosa and shrinking the nasal concha with laser and low-temperature plasma treatments inevitably impacts the function of the nasal mucosa, potentially leading to counterproductive results. While some believe that low-temperature plasma affects only the subepithelial layer and not the epithelial layer, thereby causing less trauma, the reality is that the mucosa's damage cannot be ignored.

Currently, laser and low-temperature plasma technologies are commonly used to treat inferior turbinate hypertrophy caused by rhinitis. The goal is to improve nasal ventilation by ablating the inferior turbinate. However, there are two primary types of inferior turbinate hypertrophy due to rhinitis: bony hypertrophy, caused by bone hyperplasia of the inferior turbinate, and mucosal hypertrophy, caused by mucosal hyperplasia. Bony hypertrophy of the inferior turbinate is unsuitable for treatment with laser and low-temperature plasma, which explains why many patients experience no improvement or even discomfort after such treatments. For patients with mucosal hypertrophy, a period of regular treatment with nasal hormones and other medications is generally effective, and they should avoid destructive mucosal treatments.

Laser and low-temperature plasma technologies do have their place in treating nasal diseases, but their indications should be approached with caution. For patients with severe mucosal hypertrophy of the inferior turbinate who have not responded to regular drug treatments, these technologies can be used to ablate the hypertrophic mucosa of the posterior segment of the inferior turbinate (but not excessively). They can also be used to block the anterior ethmoid nerve in cases of allergic rhinitis to temporarily reduce nerve sensitivity and improve symptoms. However, these technologies do not provide a radical cure. Additionally, they are effective in treating epistaxis, with bleeding points being closed with the aid of nasal endoscopes. Post-surgery, patients should rinse their nasal cavity with normal saline and use oily drops to keep the nasal cavity clean and moist, promoting mucosal recovery.

Patients who have undergone laser or low-temperature plasma treatments and experience symptoms such as nasal congestion, dry nose, excessive nasal discharge, or nosebleeds should use normal saline to rinse their nasal cavity regularly and consider medications that promote mucosal recovery and thin mucus, such as standard myrtle essential oil (Ginoton), to restore nasal mucosa function. Ultimately, patients should exercise caution when considering laser and low-temperature plasma treatments and consult a nasal specialist at a reputable medical institution before proceeding.

In 2012, I had mild chronic rhinitis. I searched for rhinitis hospitals on Baidu and clicked on the top result, Shanghai Fuda Hospital (a Putian hospital). The doctor there performed bilateral middle and lower turbinate ablation on me in the outpatient clinic. Later, I consulted Dr. Yu Hongmeng of Shanghai Otorhinolaryngology Hospital. He said that due to this operation, my nose could not be cured and expressed his concern. Nearly two or three years later, I began to experience symptoms of empty nose syndrome. Despite numerous visits to top hospitals in Shanghai and spending over 100,000 yuan on Chinese medicine, my condition did not improve. A minor rhinitis surgery had led to empty nose syndrome. It is crucial to approach rhinitis surgery with caution.

We must work together to raise awareness of empty nose syndrome, push for its recognition by national health authorities, include it in disease catalogs and medical textbooks, and encourage national research institutions to study its treatment methods. Ultimately, our goal is to find a cure for empty nose syndrome!

Actually, there are surgeries that are not related to rhinitis. However, I was misled into believing that ear issues were caused by nasal problems. I experienced discomfort in my ears whenever I heard a noise. Despite consulting numerous hospitals, they found nothing wrong with my ears. Eventually, I went to a private hospital where the doctor claimed my ear issues were related to my nose, and I believed him because I had studied ears but not noses.

The doctor recommended surgery that same day, and the invoice indicated unilateral ablation. However, during the local anesthesia, I realized both nasal conchae were ablated. After the surgery, there was edema for a while, and once the swelling subsided, my nose felt more ventilated. I started using cotton for a long time to manage it. While my body tolerated it somewhat, I could only sleep with my head down due to excessive ventilation. Every morning, my nose felt uncomfortable, and my ear issues remained unresolved.

I later discovered that the hospital had been involved in false advertising and did not have an official hospital grade. I went to another hospital, where the doctor informed me that I didn’t need surgery and that my nasal mucosa was eroded.

Doctor-killing incident in Wenling

Following the doctor-killing incident in Wenling, Zhejiang, empty nose syndrome, previously considered a mysterious condition, began to attract public attention. Lian Enqing, the perpetrator, was suspected to be suffering from empty nose syndrome. After a series of unsuccessful attempts to seek medical help and assert his rights, he attacked the doctor.

Before this incident, empty nose syndrome had been "avoided" by the medical community due to its association with sensitive issues like "over-medicalization." Furthermore, with no definitive treatment available globally, some desperate patients either committed suicide or harmed their doctors. Empty nose syndrome has thus evolved from a medical problem to a societal issue.

Otolaryngology: The Most Affected Area for Medical Injuries
After the Wenling incident, which led to nationwide protests by doctors, the doctor-killer Lian Enqing was quickly identified as a patient with empty nose syndrome by his peers.

Long before the Wenling incident, a group of empty nose syndrome patients had already formed in China. Due to the lack of epidemiological statistics, the exact number of affected individuals remains unknown.

Wang Xianzhong, a former otolaryngologist at Beijing Tongren Hospital, has studied empty nose syndrome and conducted exploratory surgical treatments on some patients. To date, he has diagnosed over 100 patients with empty nose syndrome, and his patient group includes more than 260 individuals. "The empty nose syndrome patients we know about are just the tip of the iceberg; we don’t know the full extent of the group," Wang Xianzhong estimated, suggesting there may be more than 10,000 cases.

Wang Xianzhong’s diagnosis is primarily based on CT scans showing significant loss of the inferior turbinate, along with symptoms such as a dry and cold nasal cavity, hyperventilation, chest tightness, insomnia, and depression. The most crucial factor is evidence of destructive surgery on the inferior turbinate.

For many years, these surgeries have been regarded as convenient and effective means of treating rhinitis. However, the potential side effects of these procedures have often been underestimated. In a sense, empty nose syndrome represents a concentrated manifestation of these possible side effects.

According to media reports, Wang Xianzhong is not entirely certain that Lian Enqing also suffered from empty nose syndrome. However, he believes that the 2012 incident in Beijing, where a patient attacked doctors, is related to empty nose syndrome. On April 13, 2012, a patient named Lv Fuke stabbed Professor Xing Zhimin of the Department of Otolaryngology at Peking University People's Hospital, and a doctor at Beijing Aerospace General Hospital on the same day. Lv Fuke had undergone nasal surgery in Tianjin and sought a certificate from Xing Zhimin to claim compensation from the hospital. Wang Xianzhong noted that in the past three years, there have been at least ten violent incidents in ENT departments, with many perpetrators being patients with empty nose syndrome. Besides these violent incidents, there are countless other medical disputes. Wang Xianzhong argues that the rising number of empty nose syndrome patients has made the ENT department, which is generally a small department in hospitals, a "severely affected area" for doctor-patient conflicts.

A Southern Weekend reporter discovered that the medical assault at Shenzhen Pengcheng Hospital on September 4, 2012, which injured four people, also occurred in the ENT department and involved a rhinitis patient. However, since hospitals often handle such cases discreetly, the specifics of these incidents and their connection to empty nose syndrome are largely unknown to the public.

Incomprehensible Pain

According to a Southern Weekend reporter, "empty nose syndrome" is not yet officially recognized as a disease within the domestic otolaryngology community. The term "empty nose syndrome" (ENS) was first introduced by American doctor Kern et al. in 1994 to describe symptoms resulting from the loss of nasal tissue and normal anatomical structure. The condition is named "empty nose" because the nasal cavity becomes excessively spacious due to tissue loss.

Wang Xianzhong began studying empty nose syndrome in 2009. He observed that some patients who had undergone inferior turbinate surgery, especially those where the turbinate was excessively removed, experienced a peculiar symptom: their nasal passages became wider post-surgery, yet they still felt stuffy. This symptom, known as "paradoxical nasal congestion," is common in empty nose syndrome patients and is particularly distressing.

This was the case with the doctor who committed violence in Wenling. In March 2012, Lian Enqing had a "bilateral inferior turbinate submucosal resection" at the First People's Hospital of Wenling City due to hypertrophic rhinitis. Despite examinations showing that his nasal cavity was noticeably open, Lian Enqing continued to experience nasal congestion and frequently had to use clips or cotton swabs to open his nostrils to breathe. He also suffered from severe insomnia. Previously gentle, Lian Enqing became irritable post-surgery, feeling that "the whole world is only the nose."

Wang Xianzhong attributes the "paradoxical nasal congestion" in empty nose syndrome patients to inappropriate physical damage to the inferior turbinate, which disrupts the normal respiratory tissue structure of the nasal cavity. This disruption leads to deviations from the normal physiological state of nasal breathing, resulting in a series of respiratory system disorders and a lack of normal breathing perception.

Yu Hongmeng, an otolaryngologist in Shanghai, notes that the nasal mucosa contains various receptors that respond to nasal obstruction and temperature. Thus, treating rhinitis solely through mucosal ablation or shrinkage can have counterproductive effects.

Not all surgeries that excessively remove the inferior turbinate lead to empty nose syndrome. Some laryngeal cancer patients do not develop empty nose syndrome despite their nasal cavities being surgically hollowed out. Additionally, some empty nose syndrome patients do not require special treatment one or two years after surgery and recover on their own due to the body's compensatory mechanisms.

Patients with empty nose syndrome exhibit various "quirks." Some need to insert cotton in their noses to feel comfortable, others frequently rinse their nasal cavities, and some use hot water to "steam" their nostrils. A patient treated by Wang Xianzhong had to "chase air" for a period—every time he exhaled, he had to chase it forward to avoid discomfort.

Many patients have expressed a willingness to trade limbs or other organs for a healthy nose. Fan Qiu (a pseudonym), a Guangzhou patient with empty nose syndrome, told a Southern Weekend reporter, "It hurts, but we can’t show it. Unlike those with broken limbs who receive sympathy, we look normal but are in intense pain. No one believes us; they think I’m exaggerating."

Psychological pain often surpasses physical pain. The unexplained "paradoxical nasal congestion" leads many patients to be suspected of mental issues by doctors and advised to see a psychiatrist. Family members also struggle to understand the patients' suffering.

Some patients direct their frustration towards doctors. Yu Hongmeng believes that patients with empty nose syndrome often had certain mental disorders before surgery, and the surgery exacerbates their emotional responses. "Without surgery, they feel uncomfortable; with surgery, they feel worse. If surgery is performed, they desperately blame it for their problems," he explains. Therefore, he is cautious about performing surgery on such patients, even if they persistently request it.

It is noteworthy that some patients who develop empty nose syndrome due to inappropriate surgery become increasingly fixated on further surgeries, hoping to use new procedures to treat the condition caused by previous surgeries. Since 2012, a patient in Zaozhuang, Shandong, has undergone six surgeries, including inferior turbinate surgery, spending over 100,000 yuan, yet continues to seek treatment. On December 2, 2013, a patient named Liu, whose symptoms had improved through his own compensatory mechanisms, insisted on another operation from Wang Xianzhong due to discomfort in other nasal areas.

Diseases That Are Avoided

Xianzhong had undergone "low-temperature plasma" surgery, a popular treatment for chronic rhinitis in recent years. Compared to conservative treatments and other surgeries, it is very appealing to rhinitis patients due to its lack of bleeding, low cost, and no need for hospitalization. After the Wenling incident, some hospitals discontinued this surgery.

Yu Hongmeng believes that the benefits of low-temperature plasma surgery for chronic rhinitis have been exaggerated and often abused. In clinical practice, he found that while many patients experience short-term improvement in nasal ventilation, they later pay an irreparable price.

An anonymous otolaryngologist told Southern Weekend that the popularity of surgical treatments for rhinitis has deep-rooted causes. In his view, smaller hospitals, unable to perform major surgeries, rely on minor surgeries like low-temperature plasma for income. Revenue targets are set for departments and doctors, leading to "over-medicalization." With public hospitals implementing a zero-price difference policy for drugs, surgery has become more important.

A paper published in the Chinese Journal of Otolaryngology in 2001 reported that empty nose syndrome was identified in China as early as 1996. The authors warned that excessive turbinate resection with ENS is a serious and challenging iatrogenic complication, urging otolaryngologists to avoid unnecessary resection or damage to nasal mucosa and structures.

Empty nose syndrome has been included in China’s authoritative medical textbook, Otorhinolaryngology Head and Neck Surgery, published by the People's Medical Publishing House, since at least 2005, under the official name "iatrogenic atrophic rhinitis." The textbook emphasizes that this condition "should attract attention" due to the lack of specific treatments.

However, due to significant financial interests and the discipline's image, empty nose syndrome has not received adequate attention in the industry. As one otolaryngologist put it, the domestic otolaryngology community tends to "avoid" the disease, leading to stagnation in academic research on empty nose syndrome.

Unrecognized Pain and the Challenges of Empty Nose Syndrome
Patients who have undergone inferior turbinate surgery often experience symptoms similar to those of empty nose syndrome, yet they may be unaware of this condition. Doctors usually avoid providing a clear diagnosis in medical records, opting instead for vague descriptions.

Since 2011, Wang Xianzhong has attempted to treat patients with empty nose syndrome using "filling" surgery, having treated more than 20 cases to date. According to him, two patients were cured, some showed improvement, and others experienced no effect. The controversial nature of the treatment has led to disputes with some patients. Despite this, Wang Xianzhong is not fearful of violent retaliation from patients with empty nose syndrome, as he ensures they are fully informed about the potential outcomes and risks of the surgery.

Yu Hongmeng remains pessimistic about the treatment prospects for empty nose syndrome. Nevertheless, he is favored by many patients because he honestly communicates the potential risks of inferior turbinate surgery.

Many patients with empty nose syndrome have reported that prior to their surgery, surgeons focused solely on the benefits and failed to mention possible side effects. "Regardless of whether there were issues with the surgery, our right to be informed was not respected," said Yu Jia, a patient from Wujiang, Jiangsu, in an interview with Southern Weekend. In October 2012, Yu Jia underwent bilateral turbinate cryotherapy for allergic rhinitis. The surgery altered the size of his nostrils, and he soon developed symptoms consistent with empty nose syndrome. Although he was convinced he had the condition, it was not confirmed by a doctor. Recently, due to persistent pain, Yu Jia had to quit his job and rest at home.

Southern Weekend reporters attempted to contact several otolaryngologists for interviews about empty nose syndrome, but most declined. One doctor stated that, following the Wenling incident, the hospital had explicitly instructed doctors not to accept interviews with reporters. Some patients with empty nose syndrome confessed to Southern Weekend reporters that they harbored intense anger towards doctors and felt urges to harm them.

Desperate Patients
"Destructive surgeries targeting the inferior turbinate are not exclusive to China; they are also performed in developed countries in Europe and America. Why don’t doctors resort to violence in those countries?" Wang Xianzhong asked during an interview. He attributed the violence in China to a lack of fairness in the medical system.

"Hospitals are places to treat illnesses, not to resolve disputes," Wang Xianzhong said. "Courts are the proper venues for such matters, but patients often distrust the judicial system." Many patients with empty nose syndrome have considered suing hospitals to seek justice, but most have abandoned the idea, believing that they would not prevail. Nevertheless, their resentment towards doctors remains strong. “Almost all ENS patients feel they have been treated unfairly,” Wang noted. “They feel abandoned by society and their families, which intensifies their despair and anger.”

Six months after undergoing partial inferior turbinate removal surgery, Lian Enqing began experiencing discomfort. He embarked on a prolonged quest for medical treatment and to assert his rights. Zheng Bijian, assistant to the director of Wenling First People's Hospital, recounted that at the end of December 2012, Lian Enqing approached him, complaining that "the surgery was ineffective." The hospital’s ENT department director reviewed the case and found no issues with the surgery. About ten days later, Lian Enqing returned to the hospital, requesting another surgery to alleviate his pain. However, after a departmental consultation, it was concluded that further surgery was unnecessary. Zheng Bijian admitted that Lian Enqing appeared extremely distressed during his visit, even kneeling in desperation. Dr. Wang Yunjie, who was later killed by Lian Enqing, was not the surgeon for Lian Enqing’s operation but had been involved in mediating the medical dispute.

Lian Enqing was convinced he had empty nose syndrome. During his inferior turbinate surgery, he also had "nasal septum correction surgery" at Wenling’s First People's Hospital. He believed something had gone wrong, thinking that the right side should have been operated on, but the left side was treated instead, according to his sister, Lian Chao. Zheng Bijian informed Southern Weekend reporters that the hospital had sought advice from Tang Jianguo, vice chairman of the Zhejiang Provincial Otolaryngology and Head and Neck Surgery Society, regarding Lian Enqing's case. The reporter attempted to verify this with Tang, but Tang declined an interview.

A deputy director of the Wenling Municipal Health Bureau admitted that Lian Enqing had also contacted the Health Bureau about the controversy surrounding his nasal surgery. According to his sister Lian Chao, in early 2013, she accompanied Lian Enqing to several tertiary hospitals in Hangzhou’s ENT departments, where doctors found no issues with his nose. By August 2013, they visited a top hospital in Shanghai, where doctors again found no problems. This led Lian Chao to suspect mental issues and she admitted her brother to the Shanghai Mental Health Center. “My brother didn’t want to go, and he attacked me and smashed my phone,” Lian Chao said.

Medical records show that on October 24, the day before the murder, and nine days after being removed from the Shanghai Mental Health Center by his family, Lian Enqing went for his final nose check. He saw Zhang Zhaohui, an otolaryngologist at Taizhou Municipal Hospital, and used a pseudonym on the patient registration form, suspecting collusion among doctors.

Southern Weekend reporters later sought an interview with Zhang Zhaohui about Lian Enqing’s treatment, but Zhang declined, stating that the interview required hospital approval. The hospital’s vice president also said that approval from higher authorities was necessary. The following day, Lian Enqing, a suspected empty nose syndrome patient, went to Wenling First People's Hospital armed with a knife and hammer.

The Broader Implications of Unaddressed Pain
The pain associated with empty nose syndrome is difficult for others to understand, as evidenced by the doctor-killing incident in Harbin.

Several years ago, I experienced rhinitis due to overwork and late nights. I sought treatment at the First Affiliated Hospital, where anti-inflammatory and expectorant drugs initially cured me. However, the symptoms recurred within half a month and eventually progressed to frontal sinusitis. I later went to the Second Affiliated Hospital, where the situation seemed to improve. But as I aged and my health declined, the nightmare began anew—weather changes, nasal congestion, frequent runny nose, severe throat infections, coughing, and breathing difficulties. After extensive research, I discovered that 80%-90% of those who undergo surgery face such sequelae, which are often incurable. Doctors attribute this to individual resistance.

Reflecting on this experience, my advice is as follows: unless absolutely necessary, avoid surgery. Rely on your body’s natural resistance unless it is a life-threatening situation. Diseases fall into three categories: incurable, self-curable, and treatable. Seek out the right doctor—those who rely solely on surgery may not offer the best solutions. You must become an expert in your own health.

There are many quack doctors and charlatans today; it’s essential to use your own judgment.

1. Chinese medicine’s claim of omnipotence: Reflect on whether any disease is truly incurable.

2. Medicine’s progress: What were once considered the best solutions may be replaced by better ones due to adverse events. Medicine is not infallible; self-care and resistance are crucial.

3. Complexity of organisms: Individual differences necessitate precision medicine, highlighting our limited understanding of biological mechanisms. Advances are still needed.

4. Impact on medical staff: While 60% of medical staff are dedicated and life-saving, they also need to support their families. Tolerance and patience are necessary, and we await improvements in the medical insurance system to address growing needs.

The Hidden Struggle of Empty Nose Syndrome: Sun Sulin's Story

SHANGHAI — Three months after his wife, Sun Sulin, underwent a simple sinus surgery in 2013, Tao Jie received a call from her, saying that she was dying. He rushed home to find Sun lying in bed with her face swollen and red, crying and screaming that she couldn’t breathe. Suddenly, she jumped out of bed and dashed toward the window.

Tao was quick enough to stop her that night, but since then, Sun’s attempts at self-harm have become a daily occurrence. Sun’s family has had to hide all the knives and scissors in the house. At night, family members sleep next to Sun to prevent her from trying to take her own life.

At first, Tao struggled to understand: How could a supposedly routine nasal procedure destroy his wife’s will to live?

Desperate for answers, Sun turned to the internet and consulted doctors in both China and the U.S. Why did she feel like she was suffocating even though her nasal passages were wide open? An American doctor finally came back with a diagnosis: Sun had empty nose syndrome (ENS).

ENS is a rare condition that can occur following surgery on nasal turbinates, thin bony structures that run along the nasal passage to help warm and moisturize air as it flows through the nose. “Turbinates are critical for survival,” Dr. Subinoy Das, medical director of the U.S. Institute for Advanced Sinus Care and Research, told Sixth Tone in an email.

"Sometimes I just want to grab a knife and slash my throat to feel the air again" Sun Sulin ENS Sufferer

Doctors may recommend turbinate surgery in patients who suffer from allergies and chronic sinus infections, which can lead to enlarged turbinates and symptoms of nasal obstruction. While most people who undergo turbinate surgery do not experience any complications, for a small group of patients, turbinate resection can lead to a paradoxical sensation of being suffocated even though their nasal cavities are clear. People with ENS also often complain of nasal dryness, fatigue, anxiety, and insomnia.

Han Demin, a leading ear, nose, and throat (ENT) doctor at Beijing Tongren Hospital, estimated that around 20 percent of patients who receive turbinate reduction surgery in China experience ENS after the procedure.

In 2013, Sun, a project manager at a chemical engineering institute, complained of an itchy, stuffy nose and itchy ear. She was diagnosed with allergic rhinitis and inflammation of the ear canal, and — after an online search for the best ENT hospital in Shanghai — she underwent a simple surgery at the 85th Hospital of the People’s Liberation Army. She recalls lying in a hospital bed and feeling a long metal probe inside her nose during surgery, but she didn’t suspect that anything was amiss at the time.

Shortly afterward, Sun started to feel pain when she breathed. The sensation of suffocation occupied her every waking moment. When her condition was at its worst, her husband had to press down on her chest to help her feel the airflow in her lungs. “Sometimes I just want to grab a knife and slash my throat to feel the air again,” Sun told Sixth Tone.

When she reported her symptoms, her doctor denied that there was anything wrong with her. How could she feel suffocated if her nasal passage was clearly open? If anything, Sun felt pain because she had not followed the proper recovery procedures, the doctor said. Tormented by her condition, Sun sought help at another hospital. It was there that she learned a large portion of her inferior turbinate had been removed without her knowledge. Since then, several doctors have diagnosed her as having “suspected ENS.”

With no established diagnostic criteria, ENS remains a controversial syndrome. While some physicians simply deny the existence of ENS, a handful of ENT specialists have devoted their lives to studying it. Dr. Jayakar Nayak, an assistant professor of otolaryngology at Stanford University School of Medicine, developed the first six-item questionnaire to help diagnose ENS, though it is not widely used in China. According to Nayak, when ENS sufferers experience psychological symptoms, they are typically a secondary result of the physical nasal issues.

Four years later, Sun now spends most of her days in bed, too exhausted to work. At night, she uses a combination of sleeping pills and cottons swabs in her nose to help her fall asleep. For many people with ENS, the hardest part is not the physical pain but the emotional despair, as doctors accuse them of fabricating their symptoms. Sun once kneeled in front of a doctor, crying hysterically and begging for relief from her pain. The doctor’s only recommendation was that she see a psychiatrist.

"There are only three types of people in my life now: other people with ENS, doctors, and scientists" Sun Sulin ENS Sufferer

Even family members can find it difficult to believe ENS sufferers, especially when their claims contradict a doctor’s assessment. For a long time, Sun’s parents and Tao believed that Sun’s pain was all in her head. On the recommendation of a priest, Tao would kneel at a designated site in the countryside in the middle of the night, begging local deities to exorcise the “evil energy” from Sun. But after doing his own research on the syndrome, Tao began to stand by his wife. Had he not, “perhaps the grass in front of her grave would now be several meters tall,” he said.

Sun eventually sued the hospital that performed her surgery, and the lawsuit is ongoing. However, because ENS is not recognized as a disability in China, it cannot be considered a consequence of medical malpractice. According to medical lawyer Li Qiang, the most that a plaintiff with ENS can get from suing a hospital is compensation for lost income and medical fees incurred.

There are currently no organizations in China that provide counseling or other support to people with ENS. Seeking solace, Sun joined several ENS chat groups online; she often reads angry and desperate posts calling on fellow ENS sufferers to kill doctors or take their own lives together. Sun remembers one woman with ENS whom she met online, a poet from Beijing, who killed herself last April. She left behind a letter: “My nose feels dead, but I’m still alive to suffer. I am scared of death, and I don’t want to leave. But I can’t go on any longer. I am only dragging my family down.”

In a high-profile case in the winter of 2013, ENS sufferer Lian Enqing barged into a hospital in Wenling, eastern China’s Zhejiang province, killing the head of the ENT department and injuring two others with a knife and hammer. Lian had been suffering from nasal obstruction, headaches, and insomnia following nasal surgery. Repeated examinations, however, showed that nothing was wrong.

Sun and Tao are working to raise awareness about ENS, regularly attending protests and advocacy events in hopes of preventing others from suffering a similar fate. “After going through these struggles, we don’t want others to end up in the same miserable situation,” Tao said.

A quick scan of the couple’s 55-square-meter apartment in a Shanghai suburb reveals piles of books and articles about medical lawsuits. Boxes of medication are scattered around the house, along with suitcases from the pair’s frequent travels for treatments and advocacy activities. The electric fan and humidifier are always switched on — even in the winter — to help Sun breathe.

The family’s finances have also suffered, and they sold their house in 2015 to help pay for the many medical procedures they’ve tried. Sun rarely sees her 22-year-old daughter, as she does not want the young woman to be involved in her mother’s “mess.” Sun’s social network has also shrunk. “There are only three types of people in my life now: other people with ENS, doctors, and scientists,” Sun said.

As Sun and Tao continue to hope for increased recognition of ENS in the medical field, their greatest wish is to find an affordable way to alleviate Sun’s pain and cope with the feelings of powerlessness, which can be overwhelming. On the wall facing the couple’s bed, a painting of an open window and two green plants on the windowsill offer a modicum of cheer on dark days. “ENS has totally changed how I see the world,” Sun said. “I was living an easy life. But now, I realize there are places that sunlight does not reach.”