Empty Nose Syndrome After Turbinate Surgery: Rare but Real, and How to Deal With Stigma Around Nose Picking

Understanding Empty Nose Syndrome After Turbinate Surgery

Empty Nose Syndrome after turbinate surgery is an uncommon but distressing complication in which a person feels paradoxically blocked or suffocated even though the nasal passages are wide open. Most people undergo turbinate reduction or turbinate surgery to breathe better. A small minority instead develop a constant sense of “air hunger,” dryness, and burning inside the nose that can drastically reduce quality of life.^[1–3]

What makes Empty Nose Syndrome particularly confusing is that examination often shows a wide, open nasal cavity. The problem appears to be less about a physical blockage and more about how airflow, sensation, and moisture in the nose are altered after surgery.^[2–4]

Inside each nostril are curved bony structures covered with soft tissue called turbinates. They help:

• Warm and humidify the incoming air
• Filter dust, pollen, and particles
• Direct airflow along the nasal walls so that temperature and pressure receptors can “sense” breathing

When turbinates are chronically enlarged due to allergies, structural issues, or chronic inflammation, people can feel blocked or stuffy all the time. Turbinate surgery or turbinate reduction is usually offered only after medical treatments fail. For most people, it improves nasal airflow and sleep quality.^[1]

In Empty Nose Syndrome, removing or reducing too much turbinate tissue—or even altering airflow patterns in a sensitive nose—can disturb the way the brain senses breathing. The person may breathe well objectively, but subjectively feels suffocated.^[2,4,5]

Empty Nose Syndrome is considered rare, but the exact frequency is unknown. Many ear, nose and throat specialists report seeing only a handful of cases across thousands of nasal surgeries.^[1,5]

Some estimates suggest it affects fewer than one percent of people who undergo turbinate reduction, though high-quality epidemiological data are lacking.^[1,5,7]

The condition is also probably underdiagnosed because:

• Symptoms can appear months or even years after surgery
• Some doctors have limited awareness or remain skeptical about the diagnosis
• Symptoms may be dismissed as “anxiety” or “psychological” when nasal passages look normal on examination^[3,5,10]

Despite ongoing debate, more research, case reports, and patient-reported outcome studies in recent years have pushed the medical community to recognise Empty Nose Syndrome as a legitimate, and sometimes debilitating, post-surgical complication.^[4,7–9]

The exact cause of Empty Nose Syndrome after turbinate surgery is still being studied, but several mechanisms have been proposed:

1. Altered airflow patterns

   With turbinates removed or reduced, air may rush straight through the nasal cavity without spending enough time along the mucosal surfaces. This can disrupt normal air conditioning and create a sensation of “too much space” or “air rushing to the throat.”^[1–3]

2. Loss of sensory feedback

   Receptors in the nasal lining detect changes in temperature and pressure and signal to the brain that breathing is happening. If turbinate tissue and its nerve endings are removed or damaged, the brain may no longer “feel” airflow properly, so breathing feels blocked even when the airway is open.^[2,5,7]

3. Dryness, crusting, and mucosal damage

   A wider nasal cavity with disrupted airflow can dry out the mucosa, reduce mucus production, and promote crust formation. This further irritates nerve endings and can make breathing feel harsh, cold, or painful.^[1,4,6]

4. Neurological and psychological factors

   Studies suggest interactions between nasal physiology, nervous system processing, and mental health. Some patients with Empty Nose Syndrome also have anxiety, depression, or hyperventilation syndromes, but that does not mean the condition is “all in the head.” It is more likely that physical changes and brain processing interact in complex ways.^[3,5,7]

People with Empty Nose Syndrome tend to describe a cluster of symptoms rather than just one problem. Common complaints include:

• A constant feeling of nasal suffocation or not getting enough air, even with clear passages
• A sense that the nose is “too open” or “hollow”
• Dryness, burning, or painful airflow in the nose
• Crusting, thick mucus, or the need to clear the nose repeatedly
• Reduced sense of airflow or inability to feel air pass through the nostrils
• Worsening symptoms in air-conditioned, heated, or very dry environments
• Severe anxiety about breathing, especially at night
• Poor sleep, unrefreshing sleep, and daytime fatigue
• Difficulty concentrating, irritability, and low mood

In some severe cases, people describe their condition as life-altering, and there are reports of major emotional distress and suicidal thoughts related to unmanaged Empty Nose Syndrome.^[3,6,9,10]

There is no single, universally accepted test for Empty Nose Syndrome. Diagnosis usually involves:

• A detailed history of nasal symptoms and prior turbinate or nasal surgery
• Nasal examination and endoscopy to look for missing or reduced turbinate tissue, crusting, and the degree of nasal openness
• Excluding other causes of nasal symptoms, such as active infection, major structural obstruction, or uncontrolled allergy^[3,4,8]

Several tools can support the diagnosis:

• Symptom questionnaires specifically developed for Empty Nose Syndrome help measure severity and impact on daily life^[3]
• The “cotton test,” where moist cotton is placed at the site of missing turbinate tissue to see if symptoms temporarily improve. Relief with this test may indicate that augmenting tissue in that region could help.^[3,4]
• Imaging and airflow studies such as computed tomography and computational fluid dynamics are used in research to understand airflow patterns but are not routinely available everywhere.^[5,7]

There is no single cure for Empty Nose Syndrome after turbinate surgery, but a combination of measures can often reduce symptoms and improve quality of life. Management usually involves both symptom relief and, in selected cases, attempts to restore more normal airflow.

Many treatment plans start with conservative measures aimed at keeping the nose moist and less irritated:

• Regular saline rinses or sprays
• Oil-based nasal lubricants recommended by a physician
• Home humidifiers, especially at night
• Avoiding excessively dry, smoky, or dusty environments
• Gentle cleaning of crusts rather than aggressive picking or scraping

These measures may not completely remove the sensation of air hunger but can significantly reduce burning, crusting, and bleeding.^[1,6]

Depending on the individual case, doctors may suggest:

• Topical treatments that stimulate mucosal healing or improve moisture
• Antibiotics only if there is evidence of infection
• Short-term use of medicine for anxiety or sleep disturbance when appropriate
• Psychological counselling or cognitive behavioural therapy to help manage distress, fear of suffocation, and insomnia

Studies emphasise that mental health support does not mean the condition is “imaginary”; it acknowledges that a chronic breathing disorder and altered nasal sensation can be emotionally traumatic.^[3,7,9]

For selected patients, procedures that add bulk to the inside of the nose can help:

• Temporary fillers, such as gel injections, may simulate the presence of turbinates, change airflow patterns, and offer a “test run” for more permanent reconstruction
• Surgical implants or grafts made from cartilage or other materials aim to recreate turbinate-like structures and restore more natural airflow^[1,5,6–9]

These procedures are complex and should be performed only by surgeons experienced in Empty Nose Syndrome. Even with surgery, improvement is often partial rather than complete, but many patients report better comfort, reduced dryness, and fewer suffocation sensations.^[6–9]

One aspect that is rarely discussed openly is how Empty Nose Syndrome can lead to behaviours that others misinterpret—especially frequent nose cleaning or nose picking.

Because the nasal cavity becomes dry and prone to crusts, people with Empty Nose Syndrome often feel:

• An intense urge to remove crusts that block airflow or cause irritation
• Discomfort if dried mucus stays in place
• A temporary sense of relief when the nose is cleared

If saline sprays, rinses, or lubricants are not enough, it becomes very tempting to use a finger or tissue to pull crusts out. Unfortunately, this can:

• Injure the delicate mucosa further
• Increase bleeding
• Trigger more crust formation and a vicious cycle

From the outside, frequent nose touching or nose picking may be seen as unhygienic or childish behaviour. For the person living with Empty Nose Syndrome, it is often an attempt to breathe more comfortably and reduce irritation.

The social stigma around nose picking is powerful. Many cultures consider it a rude or dirty habit, especially in adults. When you have a chronic nasal condition, this can create a painful mix of physical and emotional stress: you are desperately trying to breathe better, yet you feel judged for the way you relieve symptoms.

Here are practical ways to cope.

Instead of reacting to discomfort by immediately using a finger, try to build routine, private nose care into your day:

• Use saline rinses or sprays morning and evening
• Apply a thin layer of doctor-approved nasal lubricant at bedtime
• Keep saline spray or a small bottle of lubricant with you during the day
• Step into a restroom or private area to gently clean the nose with soft tissue or cotton swabs (only as deeply as you can see)

This helps you feel more in control and reduces the need for impulsive nose picking in public.

Harsh self-criticism (“I am disgusting,” “People must think I am gross”) increases shame and may actually make nose picking more compulsive. Try to reframe:

• “My nose is dry and crusty because of surgery, not because I am dirty.”
• “I am learning healthier ways to care for my nose.”
• “Needing to clear my nose is a medical issue, not a moral failing.”

You are managing the consequences of a real medical condition, not just a bad habit.

If you live or work closely with others, it may help to have one short sentence ready when someone comments:

• “I had nasal surgery and my nose gets very dry, so I sometimes need to clear it.”
• “My nose lining is damaged after surgery; I use sprays and sometimes have to clear crusts to breathe better.”

You do not owe anyone a full medical history. A calm, factual statement often defuses judgment and may even invite understanding.

You are allowed to:

• Excuse yourself to the restroom if your nose is very uncomfortable
• Ask family members not to make jokes or comments about your nose
• Limit conversations about your condition to people you trust

If someone repeatedly mocks or shames you, that reflects more on them than on you.

In some people, repeated nose picking becomes partly driven by anxiety or obsessiveness, not just physical discomfort. If you notice:

• You cannot resist the urge, even when your nose is not very crusty
• You spend a lot of time thinking about your nose
• You pick until there is bleeding or injury

Consider speaking with a mental health professional. Cognitive behavioural strategies can help break the cycle, reduce compulsive urges, and separate genuine physical need from automatic habits.

Living with Empty Nose Syndrome after turbinate surgery can affect relationships in subtle and obvious ways:

• You may cancel outings due to fatigue or fear of dry environments
• Sleep disturbance may make you irritable or withdrawn
• Self-consciousness about nose symptoms and nose picking can reduce intimacy

Consider the following strategies:

• Share selectively but honestly: Let close friends or partners know that you have a rare post-surgical complication that affects your breathing and comfort.
• Describe what you need, not just what you feel: “I may need to step out for a few minutes to use a nasal spray,” or “I sleep better with a humidifier on.”
• Invite practical support: Ask a partner to help you remember humidifier use, accompany you to appointments, or simply offer a listening ear after a difficult day.

Supportive relationships can make a big difference in coping with chronic symptoms and the emotional weight of social stigma.

You should seek prompt medical advice if:

• There is a sudden worsening of breathing discomfort
• You have frequent nosebleeds or signs of infection (fever, foul smell, thick yellow-green discharge)
• You feel constantly panicky about breathing

You should seek urgent mental health support or emergency care if:

• You feel overwhelmed, hopeless, or have thoughts of self-harm or suicide

Empty Nose Syndrome is rare but real, and nobody deserves to suffer alone or in silence because of it.

For people considering turbinate or nasal surgery, the key is careful decision-making:

• Try medical treatment for a sufficient period before agreeing to surgery
• Ask your surgeon how much turbinate tissue will be preserved
• Seek a second opinion, preferably from someone familiar with Empty Nose Syndrome
• Discuss specific risks, including the possibility—however small—of Empty Nose Syndrome after turbinate surgery^{[1–4,7–9]}

Surgeons are increasingly emphasising conservative techniques that preserve as much functional turbinate tissue as possible. Awareness of Empty Nose Syndrome among both patients and doctors is one of the strongest tools for prevention.^[3,4,8,9]

Empty Nose Syndrome after turbinate surgery is an uncommon but serious condition that can turn the simple act of breathing into a constant struggle. It affects more than airflow: it influences sleep, mood, self-esteem, and social confidence.

If you are living with this condition, remember:

• Your symptoms are real, even if they are not obvious on a quick examination.
• Symptom relief is often possible through a combination of nasal care, environmental adjustments, and targeted medical or surgical treatments.
• Feeling embarrassed about nose picking or nasal crusting does not mean you are “dirty” or “weak”; you are dealing with a chronic medical issue.
• You deserve empathy and knowledgeable care—from doctors, from loved ones, and from yourself.

With the right combination of medical support, self-care strategies, and emotional tools, many people with Empty Nose Syndrome find ways to breathe more comfortably, reduce stigma, and reclaim their daily lives.