Empty nose syndrome
| Empty nose syndrome | |
|---|---|
 |
|
| Altered nasal anatomy after bilateral subtotal inferior turbinectomy | |
| Classification and external resources | |
| ICD-10 | Xxx.x |
| ICD-9-CM | xxx |
Empty nose syndrome (ENS) is a rare clinical syndrome in which people who have clear nasal passages experience a range of symptoms, most commonly feelings of nasal obstruction, nasal dryness and crusting, and a sensation of being unable to breathe. People who experience ENS have usually undergone a turbinectomy (removal or reduction of turbinates, structures inside the nose) or other surgical procedures that interfere with turbinates; the overall incidence is unknown but it appears to occur in a small percentage of those who undergo nasosinal procedures. It appears to be a health care caused condition but its existence as a medical condition, cause, diagnosis and management are controversial. No one disputes that people with the symptoms suffer a great deal.
Empty Nose Syndrome (ENS), one form of secondary atrophic rhinitis, is a rare condition that occurs after nose or sinus surgery; it appears to be iatrogenic. All aspects have been subject to debate, including whether it should be considered solely rhinologic, or may have neurological or psychosomatic aspects. As of 2015 many ear, nose, and throat doctors do not recognize the condition.
Four types have been proposed:
There are no objective physical examination findings that definitely diagnose ENS. Generally, one or more turbinates may be reduced or absent when viewed in medical imaging or via endoscope with no sign of physical obstruction, the mucosa will be dry and pale, and there may be signs of secondary infection.
Symptoms of ENS include a sensation of being unable to breathe, a feeling of nasal obstruction and dryness, and crusting, oozing, and foul smells inside the nose from infections. A person with ENS may complain of pain in their nose or face, an inability to sleep and fatigue, and of feeling irritated, depressed, or anxious; they may be constantly distracted by the sense that they are not getting enough air.
The cause may be changes to the mucous membrane of nose and to the nerve endings in the mucosa caused by chronic changes to the temperature and humidity of the air flowing inside the nose, caused in turn by removal or reduction of the turbinates. The cause may be direct damage to the nerves caused by surgery, but because as of 2015 there was no technology that allowed mapping of the sensory nerves in the nose it has been difficult to determine if this is a cause. Because the occurrence of ENS is rare and investigators have been unable to identify consistent diagnostic features or precipitating features, psychological causes leading to a psychosomatic condition have been proposed.
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