Empty Nose Syndrome: Symptoms, Causes and Treatments

Empty nose syndrome (ENS) is a relatively recent medical disorder. It is not fully a formally recognized health issue. But it appears to be attracting more attention, compared to the past, due to the troubling effects that it has on people with it.

Some people live with symptoms of this disorder for years without even knowing they have it. ENS is rare and not all doctors think in its direction when diagnosing patients.

This article provides you with all you need to know about this condition. We discuss the symptoms, causes and available treatment options, among others.

What is Empty Nose Syndrome?

ENS is a rare clinical condition of the nose that results from certain imperfections relating to turbinates. These are structures that help to filter air going into the lungs. They as well control temperature and humidity. Over-resection of the turbinate is a factor in this disorder, which is a form of secondary atrophic rhinitis.

Talking about imperfections, majority of individuals do not have a perfect nose. The bone and cartilage running along the center of the nose, which is known as septum, is usually off-centered. Some are born that way, while others got it from an injury or trauma.

The septum is typically more off-center in cases of empty nose syndrome. It is for this reason that some describe the disorder as deviated septum.

Empty nose syndrome is a controversial disorder. Many people in the medical community don't recognize it as a problem. Perhaps, this is because it is reported in a tiny fraction of the population.

Dr Eugene Kern of Mayo Clinic, who is credited with the name of the condition, played a very important role in promoting awareness. The name points to absence or reduction of tissue, such as the nasal mucosa. The surgeon reportedly decided to take more time to increase awareness of the disorder after seeing patients commit suicide as a result.

Still, empty nose syndrome remains a somewhat controversial disorder.

What are the Symptoms?

The primary symptom of empty nose syndrome is severe nasal congestion. Patients feel they have a clogged or stuffy nose. And this is despite having widely open nasal passages.

Other ENS symptoms include:

Nasal dryness
Chronic nasal infections
Inability to feel airflow in the nose
Crusting
Frequent gasp for air
Headaches
Nosebleeds
Nasal pain
Swelling
Heart palpitations
Fatigue from inadequate oxygen supply
Difficulty breathing

These symptoms can be so serious to the extent of having psychological effects. Patients can become anxious or depressed as a result of breathing difficulty and other unpleasant symptoms. Perhaps, this explains why some have no inhibition about attempting or committing suicide.

What's Responsible for Empty Nose Syndrome?

There is no consensus among researchers on the specific causes of many medical conditions. Empty nose syndrome happens to be one of those. This should especially not be surprising given some professionals do not view it as a genuine medical disorder.

Experts, however, believe ENS may be the result of changes to the mucous membrane in the nose. Disruption of nerve endings in the nasal mucosa can possibly lead to it as well. Latest research suggests that changes in the amounts of pressure and/or temperature in the nasal cavities can bring about the disorder.

Surgical procedures, such as turbinate resection or septoplasty, are the main culprits when it comes to ENS. Most, if not all, of those having the disorder had undergone these procedures at some point.

Years ago, turbinate reduction was commonly carried out to improve breathing, deal with sleep problems, or control allergic rhinitis. The procedure, unfortunately, ended up worsening matters in some patients.

Through surgery, the functioning of receptors for pressure or temperature, which are possibly present on turbinates, may be disrupted. This probably explains why some patients are unable to feel airflow through the nose.

A surgical procedure can also cause you to lose part of the mucus your nose produces. When this happens, harmful bacteria thrive and ENS symptoms may worsen as a result.

Researchers also think psychological factors may also explain the occurrence of the disorder.

How is ENS Diagnosed?

There is no standard means of diagnosing empty nose syndrome yet. This, also, is not really surprising considering the lack of formal medical recognition.

Effectively, it is left to individual doctor to determine what approach to use in making a diagnosis. Assessment of symptoms is often the first step in an attempt to rule out other conditions. This will probably be followed by an examination of the nasal passage.

A possible means of diagnosis known as the "cotton test" has been proposed. This involves inserting moist cotton into the usual position of a turbinate. If there is relief, that may be an indication of the presence of the disorder.

Treatment Options For ENS

There is no cure for empty nose syndrome – at least, at present. But there are things you can do to control the symptoms of the disorder, if you have it.

Typically, an approach similar to that of atrophic rhinitis is adopted for treatment. The goals of intervention include keeping the nasal mucosa moist, preventing infections, reducing pain, and enlarging turbinate tissue.

The means of achieving these goals include:

Saline or oil-based lubricants
Cool mist humidifiers
Hot beverages
Acupuncture
Antibiotic nasal irrigations
Phosphodiestrase inhibitors, such as Viagra

Surgery may be the last resort if other forms of medical intervention fail. People who have had excessive resections of the turbinate are particularly candidates for such procedures. The goal of the treatment is to restore the nose to its earlier state. Implants or bulking materials are used to achieve this goal.

What patients may find a bit disturbing is that some of this treatment options may also bring about other issues. For instance, nasal irrigations can lead to loss of beneficial bacteria in the nose.

Advances in ENS Treatment and Other Options

Researchers continue to work on finding a cure for empty nose syndrome. The most effective means of achieving that feat appears to be finding a means of regenerating turbinates in the nose. These will come from stem cells.

The latest, most promising treatment for this condition is a combination of acellular extracellular matrix (Acell MatriStem) and platelet-rich plasma (PRP).

Acellular dermis implants

Acellular dermis is actually one of the implant or bulking material options for surgery to correct ENS. MatriStem, a popular offering from Acell, has found use in diverse surgical procedures and wound management.

Platelet-rich plasma

As its name hints, platelet-rich plasma is blood plasma with high amount of platelets. It is highly enriched with autologous platelets, which are obtained from blood passed through a centrifuge.

PRP boasts a variety of growth factors and cytokines, including:

Platelet derived growth factor (PDGF)
Insulin-like growth factor 1 and 2 (IGF-1 and IGF-2)
Fibroblast growth factor (FGF)
Vascular endothelial growth factor (VEGF)
Connective tissue growth factor (CTGF)
Interleukin 8
Epidermal growth factor (EGF)

The richness of platelet-rich plasma makes it very helpful for promoting fast wound and injury healing. It was mainly used for other purposes, such as oral surgery and bone repair. The use for nose issues is very recent.

PRP expedites the healing or regenerative process. It makes more growth factors available for repair or regeneration of damaged tissue. The belief is that it can potentially help to bring the nasal mucosa of people with empty nose syndrome to a better state.

Platelet-rich lipotransfer (PRL)

This is another PRP-related treatment that is also being promoted. Platelet-rich lipotransfer (PRL) is a combination of adipose tissue (fat) and PRP. Body fat is known to contain stem cells that can be beneficial for regenerative purposes.

Adipose tissue is obtained from another part of your body, such as buttocks or abdomen. Centrifuging and purification of the extract then follows. After this comes mixture with PRP. The end product is injected into the mucosa to promote regeneration of turbinates as well as other atrophic regions in the nose.

Growth hormone

Although it is not a recognized treatment option, human growth hormone (HGH) may possibly be beneficial to people with empty nose syndrome. It is highly crucial to cell and tissue repair and regeneration in the body.

HGH stimulates growth factors, notably IGF-1. This means it could serve similar purpose as PRP, at least to an extent.

Synthetic HGH injections offer the most efficacious means of boosting levels. But, legally, you are not allowed to use them for ENS or other unapproved complaints. You may have to make do with a good OTC HGH releaser or supplement to boost the amount of the hormone.

How Much Does ENS Treatment Cost?

It doesn't cost so much controlling the symptoms of empty nose syndrome – that is, by following the basic recommendations.

However, you should expect to spend thousands of dollars on treatment when exploring the advanced options. These include surgery and PRP. From our research, we found that some patients may have to pay up to $20,000! This is because there is usually no insurance coverage.

The US Institute for Advanced Sinus Care & Research puts the cost of first session of PRP/Acell therapy at $1,985. Subsequent injections come at a price of $1,635.

The first injection for a "PRP/Acell/Adipose Derived Stem Cells" therapy, which appears to include PRL, goes for $2,850. Subsequent injections will be available at $2,500.

Choose the Right Doctor

Ear, nose, and throat (ENT) doctors are the usual go-to professionals for help with treating nose issues. But, in the case of ENS, it appears not just anyone will do. This is because many do not yet recognize the disorder, going by a 2015 article in the journal Current Allergy and Asthma Reports.

ENS is a rare complication from nasal procedures. Many ENT doctors do not see it as a valid diagnosis due to the high success rate of these surgeries. Patients who reported symptoms now associated to this disorder were often considered somewhat hard to please.

Some doctors assumed that the complaints may well be because of significantly improved airflow. Others thought there may be a psychological dimension to the reported symptoms.

Although more ENT doctors now recognize empty nose syndrome, many still don't. You, therefore, want to make sure the particular professional you are working with recognizes this as a problem. It pays if he has treated or been treating other patients with similar complaints.

You should do your research to find the right doctor. As a starting point, the following are the names of some experts that are considered knowledgeable in this area:

Subinoy Das (US Institute for Advanced Sinus Care & Research)
Steven Houser
Eugene Kern's (Mayo Clinic)
Robert Bodlaj
Murray Grossan
Valerio Cervelli
William Bolger
Dale Rice

Although there is progress, researchers do not yet fully understand empty nose syndrome. Their work, however, has led to development of more effective treatment. Patients need to seek help from the right doctors to be able to improve the condition. Perhaps, the best way to prevent ENS is to avoid noise injury or nasal surgery, if possible.

REFERENCES

Empty nose syndrome - Wikipedia (https://en.wikipedia.org/wiki/Empty_nose_syndrome)

Empty Nose Syndrome: Treatment, Symptoms, and Death (https://www.healthline.com/health/empty-nose-syndrome)

Nose Revision Surgery and Surgeons: New(er) Treatments for Empty Nose Syndrome (https://noserevisionsurgeryandsurgeons.blogspot.co.ke/2015/01/newer-treatments-for-empty-nose-syndrome.html)

Empty Nose Syndrome — U.S. Institute for Advanced Sinus Care and Research (http://www.usasinus.org/empty-nose-syndrome/)

Treatment options - Empty Nose Syndrome (http://ensassociation.org/about-ens/treatment-options/)

Updated list of doctors who treat ENS - Empty Nose Syndrome (post nasal surgery dysfunction community) (https://www.tapatalk.com/groups/guestfr/updated-list-of-doctors-who-treat-ens-t4447.html)

Empty Nose Syndrome Doctors | Empty Nose Syndrome: A Medical Horror Story (https://ens3.wordpress.com/2010/03/17/empty-nose-syndrome-doctors/)

Petition · Allow doctors to treat Empty Nose Syndrome patients using health insurance coverage! · Change.org (https://www.change.org/p/ama-allow-doctors-to-treat-empty-nose-syndrome-patients-using-health-insurance-coverage)