The Causes and Treatment of Empty Nose Syndrome (ENS)

You may have heard of a serious nasal and sinus issue called “empty nose syndrome”. The lay literature has frequent warnings for people considering nasal and sinus surgery about this complication.

The patient would then suffer from a chronically dry nose, crusting, a sensation of a restricted airway, congestion, and recurring sinus infections. It is quite debilitating and it is also completely avoidable.

There are several causes of empty nose syndrome:

  • Removal of the inferior turbinates actually called turbinate resection, but some surgeons will do this and call it a turbinate reduction. The inferior turbinates should NEVER be removed in part or in whole. Turbinate reduction with a special instrument called a suction microdebrider is the correct way to reduce swollen turbinates similar to liposuction. This preserves all of the lining and bone and leaves the turbinates looking totally normal and functioning as they are intended. It also improves the patient’s breathing.
  • Removal of the middle turbinates. Many surgeons for years have routinely removed these structures to gain access as part of sinus surgery. These structures are actually just as critical to the warming, humidification, and filtering as the inferior turbinates. It is safe to shrink them if they have grown polyps or shrink them if they have expanded with air (called a concha). But once shrunk they should look like a normal middle turbinate and their intact structure should remain.
  • Sinus surgery can also create empty nose syndrome. For years sinus surgeons have routinely removed sinus anatomy as part of a sinus surgery to make the sinuses drain better. Every effort should be made to preserve all normal sinus anatomy to protect the conditioning they provide. That is why modern balloon sinuplasty is the much preferred method to open the sinuses and resolve sinus issues. In this technique all of the normal sinus anatomy is preserved as the sinus outflow tracts are simply dilated in the same was cardiology procedures open the heart arteries. There is no stenting required and the balloon does not stay in the nose.

How do you avoid empty nose syndrome?

The best way to avoid empty nose syndrome is to see a modern up to date sinus surgeon that uses minimally invasive balloon sinuplasty techniques and understands the critical function of the nasal and sinus structures and works therefore to preserve all of the normal anatomy.

What if you already have ENS?

If you have had the misfortune of developing empty nose syndrome from previous procedures we can definitely help alleviate this issue. Our empty nose syndrome protocol involves relieving the persistent sinus infection non-surgically with medical therapy and /or balloon sinuplasty, using antibiotic nasal sprays made custom by the compounding pharmacy, using a special moisturizing nasal spray made by the compounding pharmacy, allergy testing and using allergy drops to treat the allergy successfully without the drying effect of allergy medications. With this approach, we can restore the health of your nose and sinuses.

If you are suffering from empty nose syndrome come see us for the right path forward. If you are contemplating any nasal surgery make sure and ask these critical questions and choose our minimally invasive office-based techniques as your plan.  Call or securely text us at 512-601-0303 or complete our Request An Appointment form.

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Posted in: Empty Nose Syndrome, Sinus and Nasal, Sinus Surgery

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