Empty Nose Syndrome

Overview

What is empty nose syndrome?

Empty nose syndrome (ENS) is a phenomenon that some people experience after nasal surgery. It can cause breathing difficulties, headaches, nosebleeds and nasal dryness.

Is empty nose syndrome rare?

Yes. Empty nose syndrome is considered rare. This is because most nasal surgeries are successful — very few result in ENS.

Is empty nose syndrome real?

Empty nose syndrome is controversial in the medical community. This is because the disorder isn’t widely understood. For example, it doesn’t make logical sense that surgery used to open up the nasal passages can actually make breathing more difficult. Yet, this is exactly what many people experience.

To sum it up: Yes, empty nose syndrome is real, but experts don’t know why it happens.

Who does empty nose syndrome affect?

ENS mostly affects people who’ve had nasal surgeries, such as septoplasty or turbinate reduction.

Symptoms and Causes

What are the symptoms of empty nose syndrome?

Most people with ENS feel like they can’t inhale a full breath through their nose. Other empty nose syndrome symptoms include:

  • Nasal congestion, even though your passageways are clear.
  • Nosebleeds.
  • A sensation that the air you inhale is too cold or dry.
  • Dizziness.
  • Reduced mucus production.
  • Severe nasal dryness.
  • Reduced sensation of breathing.
  • Headaches.
  • Sensation of drowning.
  • Post-nasal drip.
  • Pain.
  • Inflammation.
  • Problems with taste (ageusia) or smell (anosmia).
  • Insomnia.
  • Tiredness.

Symptoms are different for each person. They may develop weeks, months or even years after nasal surgery. Because empty nose syndrome symptoms can be distracting, many people have difficulty focusing on routine tasks. People with ENS may also develop anxiety and depression as a result of their condition.

What causes empty nose syndrome?

Experts don’t know why empty nose syndrome affects some people who’ve had nasal surgery but not others. Research is ongoing in this area to find out how healthcare providers can prevent or reduce the risk of this condition. Studies are looking at these possible empty nose syndrome causes:

  • Levels of nasal pressure: Your body might be able to sense when there are different levels of pressure or temperature inside each of your nasal cavities. As a result, you may not be able to fully feel when you’re breathing.
  • Disruption of nasal receptors: Receptors that sense pressure or temperature changes may be located on your turbinates (bony structures inside of your nose). Surgery may interfere with these receptors. As a result, you might lose your sense of nasal breathing.
  • Increase in harmful bacteria: When you have nasal surgery, it might eliminate some of your mucus, which helps regulate healthy bacteria inside of your nose. This reduction in mucus could increase your risk for harmful bacteria, which can make empty nose syndrome symptoms worse.

Diagnosis and Tests

How is empty nose syndrome diagnosed?

Because ENS isn’t well understood, diagnosing it can be tricky. Currently, there aren’t any standard tests or assessments that can tell you if you have the disorder. That being said, your healthcare provider can make a diagnosis once they rule out other conditions that cause similar symptoms. To do this, they may look inside of your nose with an endoscope (a flexible tube with a tiny camera and light at the end).

Management and Treatment

How is empty nose syndrome treated?

The goal of empty nose syndrome treatment is to ease discomfort and manage symptoms. Treatments may involve home remedies, medications and in some cases, surgery.

Home remedies

At-home treatments that may ease your empty nose syndrome symptoms include:

  • Consuming plenty of hot liquids, such as soup and tea.
  • Sleeping with a humidifier.
  • Using a CPAP machine to help you breathe during sleep.

People who live in warm, humid climates — especially those with salty air — seem to experience less severe ENS symptoms. This is likely due to increased nasal moisture. For this reason, your healthcare provider may recommend using various nasal and saline sprays. This can help relieve dryness, crusting and discomfort.

Medications

Certain medications — such as estrogen creams and erectile dysfunction drugs — can enlarge your nasal tissue and hopefully reduce your ENS symptoms.

Additionally, saline sprays can help moisturize your nasal passages. However, because they can wash away good bacteria, it’s a good idea to use an antibiotic nasal spray in combination with saline flushes.

Surgery

The goal of surgery is to bulk up the remaining turbinate tissue inside of your nose. This can be done using tissue implants or other materials. This may help balance the airflow inside of your nasal passages and reduce your symptoms.

Experts are also researching nonsurgical treatments for ENS, such as platelet-rich plasma injections.

Prevention

How can I prevent empty nose syndrome?

Currently, there isn’t a known way to prevent ENS from occurring altogether. But some studies suggest that less invasive laser techniques, such as radiofrequency turbinate reduction, may be beneficial in reducing your risk for ENS. This is because radiofrequency techniques are more precise, and they prevent excess removal of nasal tissue.

If you need nasal surgery, ask your healthcare provider about less invasive radiofrequency techniques.

Outlook / Prognosis

What can I expect if I have empty nose syndrome?

Empty nose syndrome can be uncomfortable and frustrating. Trial and error is often necessary to determine which treatment will best manage your symptoms. Your healthcare provider will help find a solution that works for you.

Can you cure empty nose syndrome?

Currently, there’s no known cure for empty nose syndrome. Working with your healthcare provider gives you the best chance of managing your condition.

Living With

When should I see my healthcare provider?

If you develop symptoms of ENS, such as difficulty breathing, nasal dryness or nosebleeds, call your healthcare provider right away. They can determine if your symptoms are due to ENS or another condition.

A note from Cleveland Clinic

Empty nose syndrome can interfere with proper breathing and healthy respiratory function. Additionally, you may experience emotional and psychological effects that negatively impact your quality of life. If you have difficulty breathing, or if you notice any other worrisome ENS symptoms, it’s important to visit your healthcare provider right away. Proper diagnosis and treatment can get you back on track to living a normal life.

Last reviewed by a Cleveland Clinic medical professional on 06/02/2022.

References

  • American Academy of Otolaryngology-Head and Neck Surgery. Deviated Septum. Accessed 6/2/2022.
  • Kanjanawasee D, Campbell RG, Rimmer J, et al. Empty Nose Syndrome Pathophysiology: A Systematic Review. (https://pubmed.ncbi.nlm.nih.gov/34665687/) Otolaryngol Head Neck Surg. 2021 Oct 19:1945998211052919. Accessed 6/2/2022.
  • Kuan EC, Suh JD, Wang MB. Empty nose syndrome. (https://pubmed.ncbi.nlm.nih.gov/25430954/) Curr Allergy Asthma Rep. 2015 Jan;15(1):493. Accessed 6/2/2022.

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