REVIEW OF EMPTY NOSE SYNDROME

The research article on Empty Nose Syndrome (ENS) provides a comprehensive overview of this complex condition, which is often misdiagnosed or misunderstood. ENS typically occurs following surgical procedures involving the nasal turbinates, particularly inferior turbinectomy, and is characterized by a paradoxical sensation of nasal obstruction despite the nasal passages being physically open. This condition can lead to significant distress, as patients may experience symptoms such as dryness, crusting, and a feeling of suffocation.

Summary of Findings

Distinction from Atrophic Rhinitis: The article highlights that ENS was historically considered a form of atrophic rhinitis. However, recent literature suggests a clear distinction between the two, as ENS involves unique symptoms and underlying mechanisms. While both conditions share symptoms like nasal obstruction and dryness, ENS is specifically linked to surgical alterations in the nasal anatomy.

Symptoms and Diagnosis: The primary symptom of ENS is a sensation of nasal obstruction, which can be accompanied by feelings of breathlessness and suffocation. Diagnosis is primarily clinical, relying on patient-reported symptoms and physical examination findings, such as pale and dry nasal mucosa. The cotton test is mentioned as a simple diagnostic tool, where a piece of moist cotton is placed in the nasal cavity to assess symptom relief.

Surgical and Medical Management: The article emphasizes the importance of conservative surgical techniques to minimize the risk of ENS. It advocates for preserving turbinate structures during surgery to maintain physiological functions such as humidification and airflow regulation. Medical management includes nasal hydration, saline lavage, and possibly local corticosteroids, although these treatments may be less effective in ENS compared to atrophic rhinitis.

Future Directions: The authors call for further research to better understand the pathophysiology of ENS and to develop standardized diagnostic criteria and treatment protocols. They also highlight the need for psychological support for patients, as the condition can significantly impact their quality of life.

Conclusion

The study concludes that Empty Nose Syndrome is a significant clinical entity that should not be overlooked, particularly as it can severely affect patients who initially present with nasal obstruction. The authors stress the importance of preventive measures, advocating for the least invasive surgical options and comprehensive medical management to address symptoms effectively. The findings underscore the need for a multidisciplinary approach to manage ENS, considering both the physical and psychological aspects of the condition.

In summary, the research sheds light on the complexities of ENS, revealing its distinct characteristics, the interplay of psychological factors, and the necessity for careful surgical planning and patient support.

Empty Nose Syndrome Limbic System Activation Observed by Functional Magnetic Resonance Imaging

The study titled "Empty Nose Syndrome: Limbic System Activation Observed by Functional Magnetic Resonance Imaging" investigates the neurological and psychological aspects of Empty Nose Syndrome (ENS), a condition that arises after radical resection of nasal turbinates, leading to a persistent sensation of impaired nasal patency despite objective measurements indicating otherwise. The research aimed to elucidate the differences in cerebral activation in ENS patients during free breathing and after inhalation of specific fragrances, namely menthol and lemonene.

Study Design and Methods: The study was a prospective, controlled intervention involving ten right-handed ENS patients and fifteen control subjects. The researchers employed functional magnetic resonance imaging (f-MRI) to analyze brain activity while participants rated their perception of nasal patency. Nasal airflow was measured using rhinomanometry, and participants rated their nasal patency on a four-point scale. The study specifically focused on the effects of menthol, which was hypothesized to provide a beneficial sensation, and lemonene, which served as a control fragrance without known effects on nasal patency.

Key Findings:

Perception vs. Objective Measurement: Despite similar objective nasal airflow measurements between ENS patients and controls, ENS patients reported significantly worse nasal patency. This discrepancy highlights the subjective nature of nasal sensation in ENS.

Impact of Menthol: The inhalation of menthol was perceived to enhance nasal patency among patients. f-MRI data revealed distinct activation patterns in the temporal cortex and limbic system areas, particularly the amygdala, during the rating task after menthol inhalation.

Cerebral Activation Patterns: The comparison between ENS patients and controls showed specific activation in the temporal and cerebellar areas, as well as the amygdala, indicating that ENS patients process the sensation of nasal patency differently than healthy individuals. The activation of limbic system areas suggests a strong emotional component associated with the perception of nasal airflow.

Conclusions: The study concluded that ENS patients exhibit altered cerebral processing related to their perception of nasal patency, with significant activation in brain regions associated with emotional responses. The findings suggest that the beneficial effects of menthol correspond to these activation differences, particularly in the temporal pole. This research provides a neuronal substrate for understanding the symptoms of ENS and their relief, emphasizing the complex interplay between sensory perception, emotional processing, and the physiological state of nasal airflow.

Overall, the study sheds light on the psychological and neurological dimensions of ENS, suggesting that treatment approaches may need to consider both the physical and emotional aspects of the condition to improve patient outcomes.

The functional and psychological burden of empty nose syndrome

The research titled "The functional and psychological burden of empty nose syndrome" investigates the significant mental health and functional impairments experienced by individuals suffering from Empty Nose Syndrome (ENS). Conducted under the auspices of the human ethics and research committee at Stanford University, the study involved self-identified ENS patients recruited from online forums between January and May 2017. Participants were required to demonstrate a positive score on the Empty Nose Syndrome 6-item Questionnaire (ENS6Q) and provide medical documentation and CT imaging confirming a history of inferior turbinate reduction.

The study included 53 ENS individuals, with an average age of 39.8 years, and assessed various aspects of their health using several validated questionnaires, including the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder questionnaire (GAD-7), and the Work Productivity and Impairment questionnaire (WPAI). The results revealed that a significant proportion of participants reported clinically significant symptoms of depression (68%) and anxiety (66%). The average duration of symptoms among participants was 8.2 years, indicating a long-term burden.

Key findings highlighted a strong correlation between the severity of ENS symptoms and levels of depression, anxiety, and impairment in daily activities. Specifically, participants reported a 62% reduction in workplace productivity and a 65% reduction in their ability to engage in non-work-related activities. The study also found that participants experienced moderate difficulties in mobility, pain/discomfort, and anxiety/depression, as measured by the EuroQol General Health State Survey (EQ-5D-5L).

The study concluded that individuals with ENS carry a clinically significant psychiatric disease burden, which severely impacts their quality of life and daily functioning. The findings underscore the need for further research to explore the psychiatric aspects of ENS and to develop comprehensive treatment strategies that address both the physical and mental health challenges faced by these patients. Future studies are encouraged to include mental health and functional outcomes as part of clinical improvement markers in ENS treatment interventions, thereby informing better management strategies for this condition.

 

Empty Nose Syndrome Pathophysiology: A Systematic Review

The research article presents a systematic review of the pathophysiology of Empty Nose Syndrome (ENS), a condition characterized by paradoxical nasal obstruction and a sensation of emptiness in the nasal cavity, often following surgical interventions aimed at relieving nasal obstruction. The review aimed to consolidate existing knowledge regarding the mechanisms underlying ENS, which remain poorly defined despite significant research efforts.

The authors conducted a comprehensive search of the literature, yielding 2,476 studies after removing duplicates. Ultimately, 19 studies were included in the qualitative analysis. These studies varied in design, including case-control and cross-sectional studies, and involved a total of 489 adult patients diagnosed with ENS. The definition of ENS varied across studies, with some relying on self-identification, while others used specific questionnaires like the Empty Nose Syndrome 6 Questionnaire (ENS6Q) or defined it by the presence of paradoxical obstruction.

Key findings from the review highlighted several important themes:

Symptomatology: Patients with ENS reported a range of symptoms, including nasal obstruction, dryness, and a lack of sensation. The severity of these symptoms was often comparable to those experienced by patients with chronic rhinitis, indicating a significant impact on quality of life.

Mental Health: A notable correlation was found between ENS symptoms and mental health issues, such as anxiety and depression. The burden of these psychological conditions was significant, with some patients experiencing severe distress and a diminished quality of life.

Anatomical and Physiological Changes: The review noted that while patients with ENS often had a patent nasal airway, structural changes in the nasal cavity could still be present. However, the relationship between these anatomical changes and the symptoms of ENS was not straightforward, as many patients did not exhibit typical signs of nasal obstruction.

Airflow Dynamics: The influence of altered airflow on the perception of nasal patency was discussed, with some theories suggesting that changes in airflow dynamics could contribute to the sensation of emptiness experienced by ENS patients.

Neurosensory Dysfunction: The review also explored the possibility of neurosensory decline, where patients may have an altered perception of nasal sensations, leading to the symptoms associated with ENS.

Psychogenic Factors: Psychogenic dysfunction was identified as a potential contributor to ENS, with some patients experiencing heightened awareness of their symptoms, which could exacerbate their condition.In conclusion, the systematic review underscored the complexity of ENS, revealing that it is not merely a result of anatomical changes following surgery but is also influenced by psychological, sensory, and airflow-related factors. The findings emphasize the need for a multidisciplinary approach to understanding and managing ENS, considering both the physical and psychological aspects of the condition. The authors advocate for further research to clarify the pathophysiological mechanisms of ENS and improve diagnostic and therapeutic strategies for affected patients.

Turbinate reduction / Turbinectomy and Priscilla Roberts Empty Nose Syndrome Testimony

Over three decades have passed since Dr. Eugene Kern first identified Empty Nose Syndrome (ENS), yet the number of people developing this condition post-septoplasty, sinus surgery, turbinate reduction, rhinoplasty, and spreader graft surgery continues to rise.

Now let's start the video by listening shortly to What Eugene Kern has to say about the condition

Since the 1980s, improvements in endoscopic cameras have led to the development of various instruments for turbinate reduction. Medical device manufacturers have mass-produced tools for Coblation, Radiofrequency, and Laser Ablation, aiming to maximize profit.

One instrument after another has been increasingly effective at destroying and shrinking the nasal turbinates. Unfortunately, this process has completely disregarded the fact that nerves, receptors, blood vessels, cilia, and goblet cells are destroyed in the process. When a significant number of these receptors are damaged, the individual loses the ability to sense airflow in the nose, leading to a constant fight-or-flight response. The nose also becomes severely dry, and over time, the nasal mucosa may degenerate into a condition known as atrophic rhinitis.

Furthermore, these processes open up the nose to an abnormal level where the lungs don't get enough air resistance in the nose to inflate fully. Air flows in and out too fast without proper nasal resistance, causing hyperventilation and severe problems with gas exchange in the lungs. For example, we have seen a case where an overly open nose led to nightly hypoventilation and carbon dioxide poisoning.

Advancements in technology have led to an increase in nasal surgeries for congestion, turning them into routine practice. Despite numerous reports of adverse outcomes, the medtech industry and ENT surgeons are hesitant to confront these problems. Their main concern seems to be maintaining business operations rather than ensuring patient health. To protect the ENT field, surgeons are quick to attribute complications to poor healing or dismiss them as psychological issues. While some surgeons may be uninformed, most are aware of the essential role nasal turbinates play; they just keep quiet to not reject potential income.

Unfortunately, it is becoming more common for these surgeries to lead to suicides due to severe suffering. One would think that suicides linked to ENS would lead to a reevaluation of nasal surgeries, but this has not been the case. Whether there are ten or thousands of suicides, surgeons appear indifferent as long as their practice is not affected.

Now, let's listen to yet another ENS-related death. This is the testimony of Robert Priscilla, who passed away on August sixth, 2015, due to Empty Nose Syndrome.

Everything started in 2009. I suffered from sinus infections all year long. While on sick leave, my doctor referred me to specialists, an allergist and an ophthalmologist, because of severe eye pain. It turned out I also had asthma. Eventually, my general practitioner sent me to an ENT specialist who diagnosed swollen turbinates. Initially, he suggested laser treatment. In March, I underwent the procedure to burn the turbinates. Unfortunately, I didn't notice any improvement in my breathing post-surgery.

Four weeks later, I returned to the ENT specialist, still dissatisfied with my condition. He then recommended removing the lower turbinates and performing a septoplasty to correct my nasal septum. The surgery took place in April, followed by nasal packing. The next day, I experienced a minor hemorrhage from my left nostril after the packing was removed. Despite assurances from the nurse that I should be able to breathe better, I continued to face obstruction. The pain in my nose intensified, and my headaches worsened. Anxiety attacks became frequent, and I struggled to stand due to severe discomfort.

The situation escalated to the point where I needed emergency care. However, the on-call ENT specialist refused to acknowledge any connection to my recent surgeries. After discharge, I sought a second opinion, only to be turned away due to concerns over a colleague's work. In desperation, I traveled to Paris for a third opinion and underwent a sleep study revealing poor sleep quality, snoring, and atrophic rhinitis.

Since 2011, my life has been a nightmare. I barely eat, and I can no longer sleep. I've lost my sense of smell, and my nose is even more blocked than before the surgeries. Exertion is nearly impossible. I live in constant hyperventilation with a perpetually dry nose. The cold burns, and even speaking is excruciating. Pressure from my nose to my forehead feels like my head is being crushed. Lying down is torture; I feel like I'm suffocating. I am utterly exhausted, isolated, and deeply depressed. This is not how someone my age should live, it's not living at all.

My condition has only deteriorated since the surgeries. Had I known the risks, I would have never consented. I found solace in an association that provides emotional support, though many countries don't recognize this syndrome. Why? I share my story hoping others can avoid my suffering. The laser treatment and turbinectomy destroyed my life. Once active and engaged, I am now confined, semi-reclined, and condemned to suffer. Only one ENT specialist had the courage to tell me that turbinates never regenerate.

Priscilla Robert’s testimony reminds us that she passed away on August 6, 2015, due to Empty Nose Syndrome. Her story is just one of hundreds of patients whose lives have been irreparably damaged to the point where they could no longer bear to stay alive. More information about Prisilla can be found in the video description.

Link to Priscilla's Testimony Syndromedunezvide.com

Bellow you find everything we found about Priscilla Robert. Print or download the document at the bottom right corner.