Empty Nose Syndrome

Empty nose syndrome (ENS) is a rare group of symptoms that can show up after nasal surgery. With ENS, you may feel as if you can’t get enough air when you breathe in through your nose. Or your nasal cavity may feel too open, like the air you inhale is rushing to the back of your throat. Symptoms can be so intense that they get in the way of day-to-day living.

Empty nose syndrome affects less than 1% of people who have turbinate reduction surgery (TRS)

Your turbinates are tiny structures inside your nose. They clean, heat and humidify the air you breathe. But sometimes, they can make your nose feel blocked, so it’s hard to breathe. If this happens and other treatments don’t help, an otolaryngologist (ENT) may do TRS to make your turbinates smaller. It creates more empty space in your nose, so air can move more freely.

TRS helps the vast majority of people who need this surgery. But for reasons ENTs don’t completely understand, it can cause new symptoms in some people. It can cause new feelings of nasal obstruction. This is especially odd, as there’s actually more empty space in your nose.

Healthcare providers are still studying why this condition happens and how to best manage it. In the meantime, your provider will work with you to find treatments that can help.

Symptoms of empty nose syndrome

ENS can feel like you can’t inhale a full breath through your nose. It may even hurt to breathe. You may have one or more of the following symptoms:

• A sense of diminished airflow through your nose
• A sense that your nose feels too open
• Crusting inside your nose
• Dryness inside your nose
• Painful airflow when you breathe in (may feel freezing cold or like razors)
• Suffocation (may feel like someone is holding a pillow over your nose)

It may feel odd explaining to others that your nose feels blocked and too open at the same time. But this is a common contradiction in ENS.

Empty nose syndrome causes

Experts don’t know why ENS affects some people but not others. It’s linked to having more space in your nose after TRS. But the amount of empty space doesn’t always match the symptoms. One person may have lots of their turbinate tissue removed and have no issues. Another may have just a little tissue removed and have ENS.

The most likely explanation is that the loss of turbinate tissue changes how you sense your breathing. It may impact the receptors inside your nose that sense pressure or temperature changes. As a result, you may not be able to fully feel when you’re breathing.

But empty nose syndrome is a bit of a medical mystery. ENTs aren’t exactly sure why it happens.

Complications of this condition

ENS symptoms can feel miserable and take a toll on your well-being. Trouble breathing can interrupt your sleep. It can lead you to focus on each breath so much that you become anxious about how bad it will feel.

It’s essential to speak to an ENT before your symptoms reach this point.

How doctors diagnose this condition

Your healthcare provider will consider your symptoms in light of whether you’ve had turbinate reduction surgery in the past. Symptoms can happen weeks, months or even years later. Your provider may order a CT scan to see inside your nose. They may look inside your nose with an endoscope (a flexible tube with a light at the end).

They may do tests, like:

• ENS6Q: This questionnaire asks about the symptoms linked to ENS. You’ll say whether you have a symptom. You’ll rank its severity on a scale from 1 to 5.
• Cotton test: Your provider may place cotton inside your nose where the turbinate tissue once was. Then, they’ll ask if it helps your symptoms. If the cotton helps, you may benefit from injections or surgery to fill in some of the empty space.

How is empty nose syndrome treated?

The goal of empty nose syndrome treatment is to ease discomfort and manage symptoms. Your healthcare provider may suggest:

• Medicine that enlarges nasal tissue: Estrogen creams and erectile dysfunction drugs can enlarge your nasal tissue. This creates more nasal pressure when you breathe.
• Nasal sprays and oil lubricants: These treatments keep your nasal passages moist. This can relieve dryness, crusting and discomfort.
• Injections: Your provider may plump up the tissue by injecting gel fillers or platelet-rich plasma. These treatments are temporary. So, you may need them regularly.

You may also need to sleep with a CPAP machine or a humidifier if you’re having trouble breathing at night. Clean the humidifier regularly. That way, you’re not breathing in the mold or fungus that can build up inside the machine.

When should I see my healthcare provider?

Call your healthcare provider if you develop symptoms of ENS. They can determine if your symptoms are due to ENS or another condition.

Talk to your provider if you’re deciding whether to have turbinate reduction surgery and you’re concerned about empty nose syndrome. They can tell you how common it is in their practice. (It’s extremely rare.) They can explain how the procedures they use may reduce the risks.

What can I expect if I have this condition?

There isn’t a cure for empty nose syndrome, but there are solutions that can help you feel better. It may take some trial and error to find the best treatments that ease your symptoms. But with some patience, your healthcare provider will help find a solution that works for you.