måndag 3 juni 2024

Rhinoplasty & Turbinate reduction: Secondary atrophic rhinitis and the passing of Océane Flavigny

Océane Flavigny lived in Cambrai, France, and underwent two cosmetic surgeries. The first surgery did not go well, so she had it redone. When she consulted with the new surgeon, he informed her that the previous surgeon had also reduced her nasal turbinates. X-ray images revealed a large hole in the center of her left nasal turbinate. Additionally, a small perforation was visible between the left nostril and the left maxillary sinus. It is highly likely that her turbinate surgery was performed using a heat-based method such as radiofrequency or coblation. 

Two years after her first surgery, Océane started to experience issues with the mucous membrane in her nose; it became dry. She wrote that her mucosa had degenerated and she thought it might have started with a Covid infection. In some of her posts, she mentioned that she had secondary atrophic rhinitis and Empty Nose Syndrome, and she was a member of at least two Facebook groups for Empty Nose Syndrome. She once tried to contact the Italian doctor Fabio Piazza, but he never replied. Fabio Piazza is a doctor who helps people with Empty Nose Syndrome.


During a conversation with a friend, she mentioned that she wanted to undergo another surgery. They discussed whether Christophe Gaillard in Paris could be a good option. Her friend then wrote:


“Gaillard deletes bad Google reviews. The guy opened a new account to post something again. It is common practice. I would rather take it as a red flag.”


**** Embedded video about Océane Flavigny **** 


Eventually, Océane had a second surgery with the new surgeon, she chose Christophe Gaillard. She also wrote to her friend that the purpose of the surgery was to fix functional issues with her nose caused by the first surgeon, Marion Beuzeboc. The second surgery was performed on April 24, 2023.


Océane still had her turbinates remaining but suffered from nasal pain, dryness, crusting, bad odors emanating from the nasal mucosa, discomfort while breathing, insomnia, and nasal congestion. We are not aware of all the problems related to her surgery.


The first surgeon denied having performed a turbinate reduction, but the X-ray images clearly revealed this to be untrue.


The Information about Océane is quite limited. We know she sought help in several Empty Nose Syndrome support groups and wanted to try stem cell injections in her nose but lacked the funds. She also tried to improve her condition by taking various vitamins. Three to four weeks before her death, Océane posted a picture on her Facebook profile with the following text:


"For my funeral, I authorize someone to take a wreath of flowers and throw it backwards, to see who will be next."




















Translated with google translate app


She likely knew at that point that she was going to die. After speaking with a friend of Océane, it seems clear that her death was another suicide caused by nasal surgery and Turbinate reduction. 

First surgeon Marion Beuzeboc

First surgeon Marion Beuzeboc
The name of the first surgeon is Marion Beuzeboc, pictured on the left. She is active in Rennes, France. This is the surgeon who claimed she didn't touch the turbinate, but according to X-ray images, she did!

Twelve months and 26 days after Océane's second surgery, she passed away. Everything we found indicates it was another suicide due to complications and problems after rhinoplasty and turbinate reduction. Océane Flavigny left this world far too early at the age of 30. She passed away on May 20, 2024. Her facebook name was Océane Fly

Below, you can see Océane's nose before and after surgery 

The picture on the left shows the nose after the surgery, (to the right before) indicating that it has become significantly narrower. It is highly likely that the passage to the upper part of the nose has been partially blocked due to the reduction of the nasal vault. This could explain why Océane mentioned nasal congestion as one of her symptoms. She also wrote that her Septum had become twisted after the first surgery.

Océane's second surgeon is named Christophe Gaillard and is active in Paris. His clinic can be reached at the following site: https://rhinoplastie-paris.fr/dr-gaillard/. An image of this surgeon can be found further down.

We know Océane's first surgeon Marion Beuzeboc is still active today. She received no penalty or warning after the poorly performed surgery, and she has at least injured one more patient. I have spoken to this individual, a friend of Océane's, and she is experiencing very similar complications and problems after surgery as Océane did.

Bellow, you will find all the information we have gathered about her case. You can also see the hole in her left lower nasal Turbinate and the perforation into her left maxillary sinus. The document can be downloaded at the right bottom corner. 


söndag 2 juni 2024

Complications from Turbinate Reduction: ENS & Death. Interview with Charly Audes sister at Europe1

Interview with Laura: Sister to Charly Audes at the radio channel; Europe 1:  28th of May 2024.

Charly got Empty Nose Syndrome from Turbinate reduction and this led to his suicide.Translated from French speech to English text with Descript.com. Link to interview at Europe1 (in French) click at image below:


 

Olivier: Good evening. What's your name?

Laura: Laura

Olivier: And how old are you?

Laura: I am 35 years old, and I live in Normandy.

Olivier: Oh, you're in Normandy. Okay. 

Laura: Yes.

Olivier: What would you like to discuss, Laura?

Laura: I'd like to talk about Empty Nose Syndrome.

Olivier: What?

Laura: Empty Nose Syndrome! 

Olivier: This is the first time I've heard about this syndrome. I hope you'll forgive me. What exactly is Empty Nose Syndrome [ENS]?

Laura: It's my little brother who experienced this syndrome like many others in France and around the world. It's a condition that occurs after any nasal operation, whether it's a turbinate reduction, or people who are having their nose done again, or people who are having…… Oh, I'm sorry, I'm losing my words.

Olivier: Take your time, Laura. We have all the time in the world. I know it's one of the first times you're speaking about this, so we have plenty of time. 

Laura: So essentially, it's related to all the basic nasal problems. It can be a blocked nose, it can be for people who need revision surgery, so anything related to reconstruction, revision, etc.

Olivier: Okay. 

Laura: And then there are surgeries that ENT specialists propose. 

Olivier: Okay. 

Laura: So either initially treated with radiofrequency or other techniques. And in fact, these techniques result in ENS in about 20 percent of cases. There are approximately 1,800 cases (in France). 

Olivier: Okay, so let's talk about your little brother.

Laura: As you mentioned, Charlie's health issues started around 13 years ago, to be precise. At that time, Charlie was 17 years old. He was passionate about sports, all kinds of sports; he was a big sports enthusiast. When he decided to try boxing, he took a bad hit, a blow to his nose, and from that day on, he felt his nose was blocked.So these things often happen in boxing because we constantly take punches. Even if, I suppose, we have protective helmets; this injury is part of the risks.

Olivier: Did he take a big hit to the nose that day?

Laura: Well, I was there that day, and it didn't seem like a big blow to me. I think Charlie had a fragile nose, I don't believe all boxers have nasal congestion from these punches. At least, not to my knowledge. So maybe he already had a fragility in that area, and it wasn't the place he was supposed to be hit at.

Olivier: He might have had a frailty, you're right. But anyway, did he ever complain about his nose before? 

Laura: No, not before that. 

Olivier: Okay. What were the consequences of [this injury to] the nose? 

Laura: Well, Charly ends up with his nose blocked. As soon as the first night, you noticed that his nose was completely blocked when he was lying down.

There you go, that's it. It handicapped him during the day because, as a result, he couldn't sleep properly anymore; he was constantly tired. It was as if, as my little brother would say, he had a cold all year round. Yes, he woke up with a dry or pasty mouth, and then he was awakened several times during the night with a blocked nose, just like when we have a bad cold or something similar. But then, actually, it lasted for days and days, evidently. Well, it lasted for years. His nose didn't recover.

Olivier: Years, okay. What did Charly do during these years? Did he go to see doctors anyway?

Laura: Well, I guess he was 17 at the time. During those years, he found work; he worked!

Olivier: What did he do during these years? 

Laura: Charlie? Well, he tried to live with it by saying that his nose was blocked. He tried a first nose operation, but it only straightened the edge of his nose. One day, my little brother told me that his nasal septum was like an accordion. Everything was destroyed.

Olivier: So, did he see a specialist at the time?

Laura: Yes. 

Olivier: A real specialist? 

Laura: Well, an ENT operated on him but didn't straighten the right spot.

Olivier: Okay, but was it because he didn't find the deviation, or do you think he made a mistake?

Laura: Well, I don't know. In any case, he didn't straighten the nose at the right spot, and it didn't change anything for Charlie at all.

Olivier: Okay, so the first intervention was to straighten a deviated septum, and this intervention didn't achieve anything. 

Laura: That's it, and we know by now that a crooked nose really can obstruct breathing. 

Olivier: Yes, yes, yes. 

Laura: Okay. Breathing is something we do every moment. It’s one of the most important [basic] things, so living with a blocked nose is practically hell, you know.

Olivier: Yes, yes, yes. During all these years, I suppose he accumulated stress from it? Did it impact his temperament? Did you notice any changes in him? 

Laura: Not particularly. Charlie was kind to others, always in a good mood, ready to party. He was very, very happy, but sometimes we could see that he was tired nonetheless, and he had a job in the morning and one in the afternoon, so he had to rest a lot anyway.

Olivier: But otherwise? 

Laura: No, his morale didn't seem affected; he was always pleasant. 

Olivier: So, it didn't impact his temperament in front of you! What did Charlie do in life during this period? What did he do for a living? 

Laura: Charlie worked in a logistics store. 

Olivier: Okay.

Laura: He was an order picker. 

Olivier: Okay. So he worked in the retail sector I suppose?

Laura: Yes. He worked in a large retail store.

Olivier: Okay. I think he also took care of... he has two little daughters, right? 

Laura: Yes, two princesses.

Olivier: Okay, so he met a young woman at some point.

Laura: Yes, he became a father very early, at the age of 18 and he had these two princesses. Well, he separated with his spouse, but always ensured he performed his role as a father very well.

So, there it is. The pale complexion, the dark circles under his eyes, the constant fatigue. In fact, he always felt like he never fully recovered, never got back in shape. And yet, he never showed it. He had enormous strength. And yet, Charlie was quite active. He did a lot of sports, ate balanced meals, and maintained perfect hygiene, you know.

Olivier: Yes, he was a very healthy young man. 

Laura: Yes, yes, his lifestyle hygiene, honestly, he was good. He partied like all young people, but he was still cautious. He was very careful about everything. Even though he partied, he was still responsible. He also experienced nocturnal awakenings. It was complicated. I also noticed that he had bleeding gums, and his teeth were falling apart. 

Olivier: Was it related to his damaged nose? 

Laura: Well, according to the doctors, no, but Charlie thought otherwise. 

Olivier: Hmm…. So, I think he tried everything to breathe through his nose. He tried a bunch of things, didn't he?

Laura: Yes, there was one time in 2022 when a spray worked for a night. He felt like he recovered a lot, but it was short-lived. Just one night. In 2022, he decided to make an appointment with an ENT specialist in [Le] Havre. This doctor confirmed his nasal deviation. He explained that it's difficult to correct a deviated septum with surgery. He suggested a different solution: radiofrequency treatment. It's a 15-minute operation aimed at reducing nasal obstruction. He saw this doctor without a prior consultation, just based on a colleague's recommendation. 

Olivier: He arrived on the day of the operation without any prior interaction with the doctor? Without any pre-consultation or anything?

Laura: Yes, without any preparation! 

Olivier: Hmm… So…. The operation lasted 15 minutes to reduce the obstruction and Charlie thought he could return to work the next day without any issues?

Laura: Yes, that's right. This operation aims to reduce the thickness of the mucous membrane. If not done carefully, it can cause irreversible damage. 

Olivier: So, what was the procedure like? 

Laura: Charlie asked the doctor if he had to remove a lot of tissue. The doctor said no, he would only treat the inner part of the mucous membrane to ensure proper airflow without causing damage. So, Charlie left after the operation. He had a bleeding nose, but it wasn't dramatic. That's all for now. And then, a week later, Charlie didn't notice any improvement from the operation.

It took about a month for him to feel the benefits. But then, Charlie began experiencing severe heart pain, palpitations, and sensations like his heart was going to stop. At the time, he didn't connect it to the operation.... So, he tried using a humidifier afterward, which helped with the dryness in his nose. But by the beginning of January, things took a turn for the worse. And there was absolutely nothing else that had happened, that could explain all these sensations he was experiencing.

Olivier: Hmm…. 

Laura: Charlie had learned a lot about nasal issues and had read testimonies about victims of Empty Nose Syndrome. So, in January 2023, the complications intensified. His condition worsened, and he complained of having too much air passage, which caused swelling in his nose.

Olivier: What does that mean? That his nose ended up being completely blocked? 

Laura: Well, the air goes directly into his throat. There's no more mucous membrane, it's probably been reduced too much. And now, there's no protection…. When our noses function properly, there's a filter that prevents…. I don't know what it's called... but it prevents air from rushing into our lungs. So, now air rushes completely in. When we saw the doctor from Paris, he explained to us that it's like living while holding our breath. 

Olivier: Oh, okay. 

Laura: Constantly feeling like living while holding our breath. 

Olivier: So, this sensation of an empty void space in the nose, is it the result of having too much air flow in the nose?

Laura: Yes, exactly... It's a sensation that feels suffocating. Suddenly, there's an influx of air, and it's overwhelming. There's nothing to regulate it. So, it leads to other symptoms because the body becomes exhausted when something isn't functioning properly. 

Olivier: Hmm…. And what were the consequences for him?

Laura: Again, he experiences nocturnal awakenings where he feels suffocated. Superficial sleep where it seems like he's dreaming all night. He experiences an increased heart rate, memory loss, difficulty concentrating, heart palpitations, constant headaches, and digestive issues…. And, in fact, it's more than just words on paper. We witnessed my little brother completely deteriorate. 

Olivier: So, he expressed to you that it's an inexplicable sensation... He wrote something for you, or he told you something to remember, all those quotes you sent to my colleague?

Laura: Yes, yes, yes. 

Olivier: What did he write? Was it like a personal journal? 

Laura: No, he left us a 7-page report on this illness because Charlie doesn't want anyone else to experience it. 

Olivier: Okay, okay. So, in these 7 pages, he described it as an indescribable sensation for those who haven't experienced it, the feeling of being constantly trapped in a dream that never ends, a nightmare even.

Laura: Yes. A living hell, as they say. 

Olivier: Your mother mentioned that Charlie told her he had a pounding heart. Very intense. What caused it? Was it the fear of suffocating from the excess air?

Laura: This suffocation triggered this empty nose syndrome, precisely… Well, actually, I don't think we can even comprehend it ourselves. Unless we've experienced something like that yourself, I think it's inexplicable. And I think about all those people who suffer from it…. 

Olivier: Well, it's truly awful. 

Laura: My life feels reduced now also due to my loss.

Olivier: Did he ever think of blocking his nose occasionally with a plug when he had too much air? Did he try that?

Laura: Yes, he tried nasal vents, he tried cotton, wet cotton placed in the back of the nose, but it didn't work. We even consulted a doctor specialized in this [empty nose] syndrome in Paris, who then discovered that Charlie had 50 percent of his nasal septum destroyed.

He offered three solutions. The first was vitamin supplements in hopes of natural remedy, but Charlie had already tried it without success. The second was a PRP injection, where blood is drawn, separated, and then reinjected to give volume to the septum.

And the third was bone graft implants to reconstruct the septum. 

So, Charlie opted for the PRP solution, which unfortunately didn't work. 

Olivier: Okay. So it was unsuccessful again. 

Laura: Then he returned to the ENT who performed the surgery, who dismissed the idea of Empty Nose Syndrome [ENS], claiming his nasal lining had healed perfectly. He saw no issue with it. No regrets, no... 

Olivier: Okay. Did he know about this ENS mentioned by the other ENT? 

Laura: We discussed it during the doctor's visit, so Yes. And I don't know, we can't really do much because Charlie had his surgery on December 6th, 2022, and HRS's law came out on December 15th, 2022, just 9 days later. 

Olivier: The HRS law, what is that?

Laura: It's the Haute Autorité de Santé. They didn't ban this type of operation, but they said it needed to be monitored more closely.

Ah yes, they needed to monitor this operation more closely. There were increasing problems with the syndrome. I believe the cases almost reached 20 percent. So it's significant. 

Olivier: Mm hmm. Nowadays, that seems substantial. So it's best to avoid this type of operation when it's not fully mastered.

When I listen to you, it seems better to avoid this type of operation, considering the consequences it had on your brother, which were dramatic… The ENT who operated on your brother finally admitted on October 17, 2023, that your brother had Empty Nose Syndrome!?

Laura: Yes. Yes, with the report from the doctor we saw in Paris.

Olivier: Okay…. So, he recommended Charly to see a psychologist. 

Laura: Yes, because that’s the current solution. They make you sick and then suggest you see a psychologist and take antidepressants, it doesn’t work. 

Olivier: Mm hmm…. From your perspective, this Empty Nose Syndrome (ENS), which obviously affects sleep and causes fatigue... Can it create a psychological imbalance or at least anxieties that can amplify the feelings your brother had?

Laura: As my brother said, it was the illness that made him anxious. It wasn’t him. My brother had never been sick or anything. He wasn’t like that at all. And I think that if you take away a person's sleep, their ability to breathe properly, and everything that makes them function normally, it will eventually break them down.

Olivier: Oh yes, I struggle to fully grasp this condition but the effect of it must be terrible. It clearly had a severe impact on your brother’s health and morale. So much so that two and a half months later, in January 2024, he……

Laura: Yes. In the last lines of his story, he calls for a ban on nasal surgeries except in cases of extreme necessity like cancer. It’s a tragic decision that Charlie made, but we could feel that he couldn’t take it anymore.

Olivier: I’m sorry... Thank you. Sandrine, along with your sisters Laura and Mélanie, you decided to take up the case with your brother and raise public awareness about this [empty nose] syndrome and the risks of turbinoplasties... You want Charlie's story to reach as many people as possible and to prohibit this surgical operation [surgical procedure]. In any case, to warn people about this surgical operation, I think it’s incredible what you’ve been through. 

You didn’t expect it at all. You didn’t see it coming? You didn’t feel that it was over for Charlie? 

Laura: Yes, we felt it but we always hoped it would work. And that it would get better... It's hard when you see people who are dear to you slowly destroying themselves. He had lost his taste for everything. He didn't want to see anyone anymore. He shut himself in and stopped working.

Olivier: Ah, he had stopped working, okay. 

Laura: Yes. And actually, just before. He had an appointment with security who asked him to resume work, but Charlie could not resume work, and that was it. 

Olivier: Do you think Charlie started out well and then fell into a serious depression? 

Laura: Psychologically, no. But physically, he couldn't continue; his body couldn't take it anymore.

Olivier: Okay... Your mom supported him a lot, I think…. Did he ever share with her his desire to end everything, to end his life? 

Laura: Well, there were some things to read between the lines, but not clearly said... Once, he told me, “if I continue like this, it's not possible for me”. It's obviously very unpleasant to hear... You know what, I’m currently shooting a film about his suicide, and I’m personally very concerned about this issue.

Olivier: Okay. And it’s true that we never believe. We never believe that the beings we love and who love us can finally make this gesture. It's undoubtedly in a state of total despair... Did you feel that he was desperate? at the end?

Laura: Yes... He held on, I think, for a very long time… I have suffered a lot as a mother, for my daughters, and for myself. I have suffered too much.

Olivier: Yes, yes. It's crazy that no doctor, in a time where there are so many advancements, could help him by installing something in his nose that could reduce this [empty nose] syndrome a little bit.

Have you found out if there are people who get treated for Empty Nose Syndrome [ENS]? 

Laura: Yes, but unfortunately, in France…. well, even in the whole world, it's experimental treatments. Some are trying fat injections; there are several trials… I am speaking with a group on Facebook, and I have spoken directly with a few people. I have the impression that, in fact, healing is almost impossible. And that’s why they have to stop that. People have to pay attention to their ENT specialists and what they offer as a solution. Things like that shouldn’t happen again. 

A turbinate reduction with coblation or radiofrequency lasts only 15 minutes, from those 15 minutes, so much damage occurs. We can imagine how powerful the tools used must be to reduce the mucous membrane to nothing. It’s visibly destroying it

Olivier: Well, of course, it destroyed 50%. 

Laura: Oh, yes. Oh, yes. 

Olivier: How old was he exactly? 

Laura: He was thirty-one. 

Olivier: You have created an association, right? 

Laura: As of now, no…  it’s been five months since Charlie’s gone… In fact, our goal is rather to raise awareness right now, so that people are as aware and don’t go through it. And to make people pay attention to what they’re doing. And to make ENT specialists be confident and be sure of the procedures they want to perform. That’s mostly what we want, that people protect themselves. 

Olivier: Yes, yes. You who are listening to us, if you have ENT problems related to the nose or ears. I hope you have heard and analyzed Laura’s testimony and Charlie’s tragic misadventure because it all started with a punch to the nose, taken in a boxing match. It's crazy. It's crazy. 

Laura: Yes. And so, no doubt, this punch caused a blow to the nose.

Olivier: I hope you eventually find ease in what happened. Thank you very much for your testimony tonight on Europe 1, Laura. Maybe you’re going to create an Instagram page, or something, at least as support, because, as you say, I understand that all of this is still very, very tough.

Laura: The pain is still very intense. 

Olivier: And this is normal, because Charlie left you just 5 months ago. You’ll need support from your sisters and parents from time to time. But I really wish from the bottom of my heart that you all manage to get through it, and that you can fight for Charlie as he deserves it. Thank you for your testimony tonight on Europe 1, Laura, and good luck to you. 

Laura: Thank you, it's me who should be thanking you for the help you are giving us.. 

Olivier: You’re welcome. Thank you very much. Good evening. Goodbye. 

Laura: Goodbye.


Bellow is the same text to print or download, click at the right bottom corner

tisdag 28 maj 2024

Recommendations on Turbinate reduction and Empty Nose Syndrome by HAS: French National Authority for Health

New Recommendations for the Prevention and Management of Empty Nose Syndrome Issued by Haute Autorite de Sante (HAS) French National Authority for Health. PRESS RELEASE - Posted online on December 15, 2022. Translated with chat GPT from French to English May 5th 2024. The English translation of the whole document from HAS can be found at the bottom of this post!

Following a request from patient associations, HAS (Haute Autorité de Santé) has developed a good practice recommendation on the prevention, diagnosis, and management of Empty Nose Syndrome (ENS). This syndrome, often poorly tolerated by sufferers, is one of the possible complications of nasal surgery performed on patients with persistent nasal obstruction (turbinectomy). It is characterized by the onset of a range of nasal and extra-nasal symptoms, with potentially significant psychological repercussions: depression, social withdrawal, agoraphobia, etc.

Prompted by the French Federation of Respiratory Insufficient or Disabled Patients' Associations (FFAAIR) and the Empty Nose Syndrome France association, HAS has developed recommendations on this syndrome. It causes multiple nasal and extra-nasal symptoms that occur within a variable period not exceeding two years after a turbinectomy, of which it is a complication. This surgical procedure is offered to patients suffering from persistent and disabling nasal obstruction, such as chronic rhinitis or sinusitis. It involves removing part of the small growths located in the nasal cavities (known as turbinates). It can be performed alone or combined with other procedures on the nasosinusal structures.

HAS reminds that Empty Nose Syndrome is always the consequence of an invasive surgical act on the lower, or even middle, nasal turbinates and highlights the importance of preventive actions to minimize the occurrence of this complication.

HAS specifically recommends favoring the least risky surgical procedures for the occurrence of the syndrome, considering turbinectomy only as a last resort in cases of persistent and disabling nasal obstruction that fails medical treatment, and preserving the turbinates as much as possible. It emphasizes the importance of a shared decision with the patient regarding this intervention after properly informing them of the risk of Empty Nose Syndrome.

In addition to a thorough patient history, especially investigating any previous turbinectomy, the clinical and endoscopic examination of the nose is essential for diagnosing this complication. Additionally, HAS recommends performing the moist cotton test (inserting a moist cotton ball into the nasal cavity to observe symptom improvement) and imaging to assess the residual volume of the turbinates.

Finally, HAS recommends a multidisciplinary approach to managing Empty Nose Syndrome, involving ENT specialists, general practitioners, and other professionals if necessary (psychiatrists, pulmonologists, speech therapists, physiotherapists, etc.).

Find the complete good practice recommendation on the HAS website. 

https://www.has-sante.fr/jcms/p_3395700/fr/prevention-diagnostic-et-prise-en-charge-du-syndrome-du-nez-vide

Link to the article 

https://www.has-sante.fr/jcms/p_3396048/fr/de-nouvelles-recommandations-pour-prevenir-et-prendre-en-charge-le-syndrome-du-nez-vide

About HAS:  Haute Autorité de Santé (HAS) is an independent public institution in France, established in 2004. HAS is responsible for improving the quality and safety of healthcare and social services by issuing recommendations, guidelines, and evaluations. Their work includes:

1. **Development of guidelines and recommendations:** HAS creates guidelines and recommendations for healthcare professionals to ensure the best possible care for patients. These guidelines are based on the latest scientific research and expert knowledge.

2. **Assessment of medical and technical innovations:** HAS evaluates new medical and technical methods to determine their effectiveness, safety, and cost-efficiency before recommending them for general use in healthcare.

3. **Certification of healthcare facilities:** HAS conducts inspections and certifications of hospitals and other healthcare facilities to ensure they meet high standards of quality and safety.

4. **Patient information:** HAS provides information and resources for patients and the public on various health conditions, treatments, and care options, helping patients make informed decisions about their care.

HAS plays a central role in ensuring that healthcare in France is evidence-based and follows best practices, contributing to a high standard of care and patient safety in the country.


Original text in French

De nouvelles recommandations pour prévenir et prendre en charge le syndrome du nez vide

ACTUALITE PRESSE - Mis en ligne le 15 déc. 2022

15 décembre 2022

À la suite d’une saisine d’associations de patients, la HAS a élaboré une recommandation de bonne pratique sur la prévention, le diagnostic et la prise en charge du syndrome du nez vide (SNV). Ce syndrome, souvent très mal toléré par ceux qui en souffrent, est une des complications possibles d’une chirurgie du nez pratiquée chez des patients atteints d’obstruction nasale persistante (turbinectomie). Elle se caractérise par l’apparition d’un cortège de symptômes nasaux et extra-nasaux dont les répercussions psychologiques peuvent être majeures : dépression, désocialisation, agoraphobie…

Saisi par la Fédération française des associations et amicales de malades, insuffisants ou handicapés respiratoires (FFAAIR) et l’association Syndrome du nez vide France, la HAS a élaboré des recommandations sur le syndrome du même nom. Celui-ci occasionne de multiples symptômes nasaux et extranasaux survenant dans un délai variable n’excédant pas deux ans après une turbinectomie dont il est une complication. Cette intervention chirurgicale est proposée chez des patients qui souffrent d’obstruction nasale persistante et invalidante, rhinite ou sinusite chronique par exemple. Elle consiste à ôter une partie des petites croissances situées dans les fosses nasales (que l’on appelle les cornets). Elle peut être réalisée isolément ou associée à d’autres gestes sur les structures nasosinusiennes.

La HAS rappelle que le syndrome du nez vide est toujours la conséquence d’un acte chirurgical invasif sur les cornets inférieurs, voire moyens, du nez et souligne notamment l’importance des actions de prévention pour réduire au maximum la survenue de cette complication. 

La HAS recommande notamment de privilégier les gestes chirurgicaux les moins à risques de survenue du syndrome, de n’envisager la turbinectomie qu’en dernière intention, en cas d’obstruction nasale persistante et invalidante en échec de traitement médical et en conservant au maximum les cornets. Elle rappelle l’importance d’une décision partagée avec le patient autour de cette intervention après l’avoir dûment informé du risque de syndrome du nez vide.

En plus d’un interrogatoire à la recherche, notamment, d’une précédente turbinectomie, l’examen clinique et endoscopique du nez est indispensable au diagnostic de cette complication. En complément, la HAS recommande de réaliser le test au coton humide (en insérant un coton humide dans la fosse nasale pour observer ou non l’amélioration des symptômes) et une imagerie permettant l’appréciation du volume résiduel des cornets.   

Enfin, la HAS recommande la prise en charge pluridisciplinaire du syndrome du nez vide, associant l’ORL, le médecin généraliste et d’autres professionnels si nécessaire (psychiatre, pneumologue, orthophoniste, kinésithérapeute, …).

Retrouvez la totalité de la recommandation de bonne pratique sur le site de la HAS.


Translated to swedish 

Nya rekommendationer för att förebygga och hantera Empty Nose SyndromPRESSMEDDELANDE - Publicerat online den 15 december 2022

Efter en begäran från patientföreningar har HAS (Haute Autorité de Santé) utvecklat en rekommendation om god praxis för förebyggande, diagnostisering och hantering av Empty Nose Syndrome (ENS). Detta syndrom, som ofta är svårt att tolerera för de som drabbas, är en av de möjliga komplikationerna av näskirurgi som utförs på patienter med ihållande näsobstruktion (turbinotomi). Det kännetecknas av en uppkomst av en rad nasala och extra-nasala symptom, med potentiellt betydande psykologiska följder: depression, social isolering, agorafobi etc.

Efter en begäran från Franska förbundet för föreningar och vänner till sjuka, andningsinsufficiens eller handikappade (FFAAIR) och föreningen Empty Nose Syndrome Frankrike, har HAS utvecklat rekommendationer om detta syndrom. Det orsakar flera nasala och extra-nasala symptom som uppträder inom en variabel period som inte överstiger två år efter en turbinotomi, vilket är en komplikation av denna. Denna kirurgiska ingrepp erbjuds patienter som lider av ihållande och funktionshindrande näsobstruktion, till exempel kronisk rinit eller bihåleinflammation. Det innebär att en del av de små utväxterna i näshålorna (kallade näsmusslor) avlägsnas. Det kan utföras ensamt eller i kombination med andra ingrepp på näsbihålorna.

HAS påminner om att Empty Nose Syndrome alltid är en följd av en invasiv kirurgisk åtgärd på de nedre, eller till och med mellersta, näsmusslorna och understryker särskilt vikten av förebyggande åtgärder för att minimera förekomsten av denna komplikation.

HAS rekommenderar särskilt att föredra de minst riskfyllda kirurgiska ingreppen för uppkomst av syndromet, att överväga turbinotomi endast som en sista utväg vid ihållande och funktionshindrande näsobstruktion som inte svarar på medicinsk behandling, och att bevara näsmusslorna så mycket som möjligt. De understryker vikten av ett delat beslut med patienten kring detta ingrepp efter att ha informerat denne noggrant om risken för Empty Nose Syndrome.

Förutom en noggrann patienthistorik, särskilt undersökande av tidigare turbinotomi, är den kliniska och endoskopiska undersökningen av näsan nödvändig för att diagnostisera denna komplikation. Dessutom rekommenderar HAS att utföra det fuktiga bomullstestet (att sätta in en fuktig bomullstuss i näshålan för att observera symtomförbättring) och bilddiagnostik för att bedöma den kvarvarande volymen av näsmusslorna.

Slutligen rekommenderar HAS en multidisciplinär hantering av Empty Nose Syndrome, som involverar ÖNH-specialister, allmänläkare och andra yrkesverksamma vid behov (psykiater, lungläkare, logoped, sjukgymnast, etc.).

Hitta hela rekommendationen om god praxis på HAS webbplats.

https://www.has-sante.fr/jcms/p_3395700/fr/prevention-diagnostic-et-prise-en-charge-du-syndrome-du-nez-vide


Haute Autorité de Santé är den franska motsvarigheten till socialstyrelsen

Haute Autorité de Santé (HAS) är en oberoende offentlig institution i Frankrike som i Sverige skulle motsvaras av Socialstyrelsen, denna etablerades år 2004. HAS ansvarar för att förbättra kvaliteten och säkerheten inom vården och socialtjänsten genom att utfärda rekommendationer, riktlinjer och utvärderingar. Deras arbete omfattar bland annat:

1. **Utveckling av riktlinjer och rekommendationer:** HAS skapar riktlinjer och rekommendationer för vårdpersonal för att säkerställa bästa möjliga vård för patienter. Dessa riktlinjer baseras på den senaste vetenskapliga forskningen och expertkunskap.

2. **Bedömning av medicinska och tekniska innovationer:** HAS utvärderar nya medicinska och tekniska metoder för att fastställa deras effektivitet, säkerhet och kostnadseffektivitet innan de rekommenderas för allmän användning inom sjukvården.

3. **Certifiering av vårdinrättningar:** HAS genomför inspektioner och certifieringar av sjukhus och andra vårdinrättningar för att säkerställa att de uppfyller höga kvalitets- och säkerhetsstandarder.

4. **Patientinformation:** HAS tillhandahåller information och resurser för patienter och allmänheten om olika hälsotillstånd, behandlingar och vårdalternativ, vilket hjälper patienter att göra informerade beslut om sin vård.

HAS spelar en central roll i att säkerställa att vården i Frankrike är baserad på evidens och bästa praxis, vilket bidrar till en hög standard för vård och patientsäkerhet i landet.


Here is an English translation of the whole document  

Turbinate Reduction & Sinus Surgery: Luke Botsis ENS Complications

Information about Luke Botsis is limited. Born on July 2, 1987 in the united states. Albany, New York. Luke underwent a Turbinate reduction surgery and had his ethmoid sinuses opened. After this surgery he got the condition (ENS) Empty Nose Syndrome. Luke wrote in a Facebook group for ENS:

"However, my guess is I have permanent nerve damage, especially considering my ethmoid cells were removed with a microdebrider."

Luke experienced severe symptoms including a sensation of suffocation and air hunger, as well as significant pain in his nose and between his eyes. He believed he had developed secondary atrophic rhinitis as a result of his previous nasal surgery. Every morning, he would wake up with a completely dry nose and green crusting.

In July 2019, Dr. Das performed a cartilage implant surgery to reduce the open space in Luke's nose following his Turbinate reduction. Two and a half months after the surgery, Luke reported a 50% improvement in nasal pain and a reduction in his sensation of suffocation. The surgery cost Luke $10,000 out of pocket. He described his progress: "Unfortunately, I still have pain, especially between my eyes and the deep interior of the upper half of my nose."

Luke's issues were so severe that he could not work. His goal with the implant surgery was to improve enough to return to work. He also tried PRP-Acell injections with Dr. Das and considered seeing a neurologist for his nasal pain but was unable to do so due to a lack of insurance. In October 2019, Luke tried hyaluronic acid injections in his nose to create more resistance, but these experimental injections, which cost $900, did not help.

Luke described the sensation of suffocation as unbearable and stated that this feeling is what drives people with ENS insane..

Ultimately, Luke decided he could no longer endure the problems resulting from his nasal surgery and chose to end his suffering on December 9, 2021. His life was indirectly taken by the surgeon who initially operated on his Turbinates and sinuses, Luke loved life but couldn't handle the suffocation and dryness any longer. Luke was 34 years old when he died.

We do not know the identity of the original surgeon. If you have this information, please contact us at fonderingar@gmail.com.

On July 1, 2019, Luke wrote on his Facebook:

"Death is nothing to be afraid of. Remember, you were dead billions of years before you woke up one day and were born and gained consciousness. Everything dies, even the magnificent sun up in our sky...will one day die."


Below you can watch Luke's video. If the embedded field doesn't work, follow this link.

Below you find everything we found out about Luke Botsis