Empty Nose Syndrome

The Empty Nose Syndrome (ENS ) ( " empty nose syndrome ", also called " Open nose ") is the result of an excessive removal of tissue of the turbinates, causing the nose interior " to empty" is. This can no longer be adequately moisturizes inhaled air, so that also thickens the mucus and it comes to crust formation. The thickened mucus no longer adequately met its cleaning function of the nasal cavity and may be the cause of infections.

Formation

The turbinate reduction ( turbinectomy ) performed by ear, nose and throat doctors and cosmetic surgeons for various reasons. The main reason for the surgery is a chronic enlargement of the turbinates, which may obstruct the air passage in the nose. The main causes of such turbinate enlargement are allergies, hormonal fluctuations, the inhalation of dust, smoke or other irritants, structural defects of the nose, such as deviated septum and the long-term use of decongestant nasal drops.

The term "Empty Nose Syndrome " was originally coined by EB Core, formerly head of the ear, nose and throat department of the Mayo Clinic in Rochester (Minnesota) was. He and his colleagues noticed that more and more patients in whom a turbinate reduction was performed, symptoms of respiratory obstruction and shortness of breath had, although her nose passage was greatly expanded. Other symptoms were dryness in the nose and in the mouth and throat, dry eyes, shallow, restless sleep, impaired sense of smell, concentration difficulties and depressive moods. Magnetic resonance imaging in all patients showed that they had greatly expanded or almost completely empty nasal cavities, so they called the complaints "Empty Nose Syndrome ". Core then gave a series of lectures on the ENS, which he later summarized in a medical article.

Effects

If too much is removed from the nasal turbinates, the nose loses its ability to heat the air stream sufficiently to wet to filter and perceive odors. The nose feels dry and empty. The natural interaction that takes place during respiration between the nose, throat and lungs is impaired.

ENS has a series of changes leading to:

  • The air flow is turbulent, the flow resistance is thereby increased, there is less air is transported through the nose. This gives the feeling of stuffy nose.
  • The change in aerodynamics in the nose causing the airflow is directed into the empty bottom nasal cavities, which then prevents proper ventilation of the upper part of the nose. This leads to a partial loss of smell.
  • The atrophy of the nasal mucosa leads to dry cold, it is hardly more mucus produced. Inhaled pollutants are not transported and accumulate in the nasal cavities.

Symptoms

The main complaints at ENS are:

  • Paradoxical breathing obstruction, shortness of breath, the feeling of not getting enough air, although enough or even too much air is inhaled, the air flow is not felt. It is difficult to breathe calmly and slowly through your nose.
  • The inhaled air and nasal mucosa feel too dry and cold. Irritating feeling of an empty nose.
  • Either produces too little or too much mucus, or a constant, uncontrollable nose drops. Thick mucus drips constantly from the back of the nose into the pharynx.
  • Crusting in the nose
  • Reduced odor and / or taste, along with a hypersensitivity to volatile chemicals such as paint, perfume, detergents and petrol.
  • The voice often sounds to nasal.
  • Pressure in the sinuses and throat, even if no sinusitis was diagnosed.
  • Headache
  • Sometimes nosebleeds
  • Putrid smell in or out of the nose, bad breath ( halitosis )
  • Sleep through the nasal obstruction

Treatment

Conservative treatment

There are various treatments for ENS. Isotonic saline (0.9% saline) or lactated Ringer's solution can be used to flush the dry mucus and moisten the nasal cavities - this could also reduce infections. Some people feel an improvement when they take large amounts of dairy products, what increases the secretion. Vitamins A, E and D can improve the mucosal condition. Humidifiers can help against dryness and sleep disturbances if present, a ventilator (CPAP ) can be used with built-in humidifier. Nasal ointments moisten the mucous membrane and reduce the susceptibility to disease. Also, various oils, such as sea buckthorn oil, sesame oil or olive oil are helpful.

Acupuncture, Shiatsu, inversion therapy and regular exercise can help to improve blood circulation to the nose and to preserve the remaining nasal mucosa.

All mentioned non- surgical measures will help to reduce dryness and maintain the health of the remaining mucosal areas, but they can not restore the lost functions or normal perception in the nose.

Surgical treatment

ENS can be more or less successfully improved by trying to restore the structure and quality of the lack of turbinates. Implants can be made ​​of different materials; either taken from the body of the bone or cartilage fragments or of artificial materials such as Plastipore and Hydroxylapatitzement, more recently, of materials such as AlloDerm (collagen matrix of foreign human dermis ) or silicone.

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