Empty Nose Syndrome: Causes, Symptoms, Treatment

Empty Nose Syndrome is an extremely rare postsurgical complication that affects the nose and the nasal passages. People with Empty Nose Syndrome on examination will have clear nasal passages and normal appearing nose but will still have variety of symptoms of which the most common being problems with breathing. The surgery which increases the risk for having Empty Nose Syndrome is a turbinate surgery. Some of the presenting features of this condition include nasal dryness and crusting, and nasal obstruction. The person will also have a feeling of dyspnea all the time.^[1,2,3]

Why exactly a person develops this complication of Empty Nose Syndrome is not clearly understood but experts believe certain anatomical changes after surgical procedure causing alterations in local environment which interferes with mucosal cooling and other neurosensory mechanisms may be responsible for it. The diagnosis of Empty Nose Syndrome is quite difficult due to the rarity of this disease and inadequate correlation between the subjective and objective findings.^[1,2,3]

Nasal irrigation, humidifiers, and sometimes surgery are the preferred routes for treating Empty Nose Syndrome. Surgery is normally considered as a last resort when other treatments fail and involves turbinate reconstruction. Experts feel however that preventing this complication from occurring right at the time of surgery using turbinate sparing techniques is better than actually diagnosing and treating Empty Nose Syndrome. Nasal augmentation however is a procedure that can not only treat Empty Nose Syndrome but also improve the quality of life of people dealing with this condition.^[1,2,3]

As stated, Empty Nose Syndrome is a postsurgical complication. A person who has had a surgical procedure to the nose or the nasal passages is at most risk for developing this condition. Empty Nose Syndrome generally seem to develop in people who have surgery to remove the turbinates but it is not necessary that everyone who has this procedure will end up having this condition.^[3]

The surgery for removal of turbinates is medically termed as turbinectomy where a part or all the structures of the turbinates are removed. The aim of this surgery is to open up the nasal passages by making them big thereby promoting easier breathing. This procedure is done in people who have abnormally small nasal passages and it becomes difficult for air to flow through them normally thus affecting breathing.^[3]

This surgery is considered to be extremely beneficial and most people who undergo this procedure end up having significant improvement in their breathing and overall quality of life as they do not have to rely on medications or other means to improve breathing.^[3]

People with Empty Nose Syndrome will have a variety of symptoms. The most common among them is the feeling that they are not able to inhale air properly through their nose. Some people also feel that there is something obstructing the nasal passage which is interfering with the airflow through the nose. Additionally, headaches, decreased sense of taste and smell and nosebleeds are also quite common in people with Empty Nose Syndrome.^[3]

People with Empty Nose Syndrome also complain of a feeling that inhaled air is too dry and they have a sensation that they are not able to breathe properly. Some people also have dizziness and have lack of mucous as well. It is also quite common for a person with Empty Nose Syndrome to experience problems with sleeping due to not being able to breathe properly.^[3]

The feeling of not being able to breathe and suffocation significantly impairs their overall quality of life. Some people also have anxiety and depression as a result of Empty Nose Syndrome.^[3]

As Empty Nose Syndrome is quite rare, there is no clear cut treatment for it. Physicians aim at improving the symptoms and overall quality of life of the patient. Majority of treatments for this condition relieve the symptoms albeit temporarily. Saline sprays and gels are quite effective in taking care of the nasal dryness that os seen with Empty Nose Syndrome.^[3]

However, these sprays and gels also remove mucous from the nasal passages thus providing room for bacteria to thrive and spread in the nose and form the basis of an infection. This is the reason why saline sprays and gels are done in combination with antibiotic sprays. Some of the other treatments that are quite beneficial for Empty Nose Syndrome include using a humidifier especially when sleeping to promote normal breathing.^[3]

CPAP machine is also quite effective in promoting normal breathing. It is also recommended that a person with Empty Nose Syndrome live in warm temperatures and eat plenty of hot liquids like soup. There are also certain surgical options available for a person with Empty Nose Syndrome. The surgery is normally used as a last resort if other treatments are not beneficial and the symptoms become too discomforting to the individual.^[3]

The surgery for treatment of Empty Nose Syndrome involves using implants to increase the size of whatever turbinate that is left. If this is not feasible then the surgeon may implant material in other areas around the nose. The main aim of this surgery is to ensure proper airflow through the nasal passage.^[3]

Research is ongoing for other forms of treatments such as PRP injections as a mode of treatment for Empty Nose Syndrome. Additionally, estrogen creams and medications to treat erectile dysfunction have been found to be effective in treating Empty Nose Syndrome as these medications are known to cause inflammation in the nasal mucosa which inflates the turbinates and helps in relieving the symptoms of Empty Nose Syndrome.^[3]

With regard to the overall prognosis of Empty Nose Syndrome, as stated the condition is very rare and it is very difficult to diagnose and treat it. Thus, the overall prognosis is variable and differs from person to person. Surgery and medications may provide some degree of symptom relief and improve the quality of life. Empty Nose Syndrome can have significant impact on the mental health of a person.^[1,2,3]

Just by the thought of not being able to breathe properly and not being able to carry out daily activities could be of immense stress. This is where psychological support can be of help in dealing with all the stress and anxiety associated with Empty Nose Syndrome. As of now, there is no cure for Empty Nose Syndrome and treatment is only supportive and symptomatic. Through treatment however there is every chance that a person will have a better quality of life and will be better able to manage the symptoms of Empty Nose Syndrome.^[1,2,3]

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