Texas Mother Suffers From Rare Empty Nose Syndrome After The Turbinate Reduction Operation

Idiopathic Abnormal Enlargement of the Intranasal Air Passage

Turbines in your nose take on unequal tasks such as humidifying, purifying, pressurizing and heating the nose air. In particular, inferior turbinates are responsible for many of these tasks. These turbinates can grow for a variety of reasons (allergy, polluted air, irritation, chronic infections, drug use ...). In the so-called Turbinate hypertrophy, it is intended to reduce the volume of the turbinates to a limited amount, without compromising the unique and flawless design of the nasal anatomy. Radiofrequency turbinate reduction is the most commonly used volume reduction method. If the volume of the turbinates is reduced or the resection is made in excess, Empty Nose Syndrome which manifests itself with impaired nasal decongestion, abnormally increased airflow and the resulting difficulty breathing through the nose, nasal dryness and crusting, painful stimuli with nasal swelling and pain, thick post-nasal drip back into the throat, can occur.

Unfortunately, the effect of medical treatment is limited in patients who have no definitive treatment, especially those whose turbinates have been removed near the mouth.

In the videoit's showing that the lady who complains after turbinate reduction and finds out that it is "Empty Nose Syndrome" at the end.

What happened to the patient I am sharing with you here is to highlight a major problem that a simple surgical procedure can cause. Turbinates are unique and magnificent tissues, it is most convenient to regard them as an "organ", to make the slightest possible anatomical change.

How is Empty Nose Syndrome Diagnosed?

The diagnostic criteria for empty nose syndrome have not yet been clearly emphasized, but in patients with a history of previous nose surgery, typical symptoms (dryness and sticky secretion in the nose, feeling of dryness in the nose and cold air contact, pain in the nose, feeling of air hunger, some symptoms) patients may describe it as suffocation) and the presence of turbinates in the examination of the patients, abnormally small or absent, the intranasal air passage is seen to be too large, and these symptoms decrease in case of narrowing of the nose.

Empty Nose Syndrome Treatment

The definitive treatment of empty nose syndrome is not possible. In patients whose turbinates are almost completely resected, it is not possible to replace or reproduce these tissues. Intranasal cartilage implantation, turbinate augmentation with filler injection, modified Young's operation and Young's operation can be performed only in order to reduce the airflow entering the nose accelerated (nasal hyperventilation). Apart from this, PRP and stem cell injections can be made into the nose (even if it has a temporary effect). The treatment tools I have listed here are used to reduce the symptoms. In patients with turbinates resected, these tissues cannot be restored. However, a simple method that we can recommend to our patients in order to confirm the diagnosis and prove that the intranasal air passage is abnormally large before the operation or treatment decision: "A cotton ball with a diameter of 1 cm impregnated with antibiotic eye ointment is placed in the nasal entrance and waited for a few hours, this should be done daily. and to determine whether there is a decrease in complaints. In patients who have no turbinate tissue left, injection of fillers containing hyaluronic acid may not provide much benefit. The means of treatment here are controversial. There can be many opposing views among physicians. At the end of the article, you can find the link group where you can find the images and videos about the treatment tools above.

Nutrition and Lifestyle Recommendations for Patients With Empty Nose Syndrome

In empty nose syndrome, linear flow instead of rotational movement and accelerated intranasal flow due to air flow, drying into the nose, crusting, secretions becoming sticky, drying of the airway mucosa up to the lung end airways, irritation of the nasal mucosa over time, cold and hot May cause intolerance in contact with media. It is appropriate for these patients to do some of the turbinate duties themselves and to pay attention to the following recommendations in order to increase the health of the nasal mucosa:

- Drinking a lot of water, eating vegetables with a high water content can increase the mucosal moisture content.
- Minerals in natural sea or ocean water have very beneficial effects on the nasal mucosa. Not only salt water, but also sprays containing sea and ocean water, or water brought directly from the sea or the ocean, should be used in nasal irrigation at least a day.
  It is useful to use it 3 times. Sprays containing only saline may increase dryness of the nasal mucosa in these patients.
- limiting the consumption of black tea, instant coffee or boiled coffee, which can have a diuretic effect
- avoidance of salty foods may increase nasal mucus moistness
- Excessive reflux can adversely affect the annal mucosa and avoiding eating at night, stopping eating at least 3 hours before going to bed, consuming only water while lying down, avoiding oily and industrial foods at dinner
- Squeezing antibiotic ointments into the nose in cold and dry weather can prevent moisture loss in the mucosa. Some patients are not very satisfied with products containing nasal moisturizer. In a cold and dry environment, using a mask can slow down the air entering the nose (you can also find apparatus on the internet that can reduce the intranasal air passage). When using heaters that dry the room air in a cold environment, cold steam machines can be used as the lady in the video did.
- In extremely hot weather, the humidity level in the air generally increases, but the amount of water consumed by mouth can be increased in addition
- It is appropriate not to mix the inside of the nose with a finger, napkin or cotton swab, which may cause damage and drying of the mucous membrane inside the nose.

Radiofrequency Devices That Stop Automatically by Measuring Tissue Resistance Can Be Useful in Preventing Empty Nose Syndrome!

Turbinate reduction with radiofrequency devices that measure tissue resistance is healthier and may reduce the likelihood of empty nose syndrome. In addition, resection of turbinates surgically or using a tool such as a shaver, tissue reduction, will cause permanent volume loss. Likewise, surgical cutting of the bone passing through the turbinate causes permanent shrinkage and structural changes in the turbinates. Turbinates are unique tissues that clean, humidify, pressurize and purify the air entering the nose. It is responsible for making clean, moist, germ-free and pressurized air that is not suitable for our lungs, dirty, cold and germs. Even though the turbinate shrinkage is also limited when a limited amount of transactions are made; it allows these tissues to continue their duties, when the turbinates become hypertrophied again, it is healthier to apply a limited amount of radiofrequency again. We need healthy and sufficiently sized turbinates to prevent the dirty and cold air from going to our lungs, to filter the viruses and bacteria that cause coronavirus and other upper respiratory tract infections! 

Cold and Small Turbinates!

Some of the radiofrequency devices, etc., are of the old type and do not stop the energy input by automatically measuring the tissue resistance. In these devices, if the doctor presses the button, the heat damage on the turbinate continues and the turbinates both shrink and lose their circulation network (resulting in a permanent decrease in blood supply), causing cooling on the hot surface. So over time it becomes cold and small. In this way, the air entering the nose accelerates and causes a limited amount of contact with a cold surface, causing a rapid movement of the lower air to the lungs without being heated.

Diagnostic Confusion and Treatment Controversies in Empty Nose Syndrome

In patients with empty nose syndrome, there may be serious differences of opinion among physicians about the approach to patients after listening to existing complaints. For example, is the air taken from the nose not enough (the feeling of air hunger), is it due to the air entering abnormally fast and too much, or is it due to insufficient air passage in the nose? In this regard, some physicians may decide to reduce the re-turbinate volumes even though the air passage in the nose is abnormally large and may cause exacerbation of nasal hyperventilation and further increase in symptoms. As the diameter of the intranasal air passage increases, oxygen absorption does not increase! The air passage in the nose should be open to a certain extent and the air entering the nose should be exposed to a little airway resistance. In this way, the air is rotated, slowly heated, humidified, purified and moves towards the back of the nose and the lungs. As the turbinate volume decreases, the intranasal airflow becomes linear, accelerates, cools, and dirty, cold air is delivered to the lungs. In this way, as the oxygen absorption decreases; negative effects also occur in the intranasal mucosa. A big nostril does not mean big oxygen. The belief that "turbinates are an unnecessary and faulty produced tissue", which was the subject of medical books many years ago, has turned into "unique purifying, moisturizing, pressurizing organs" in time. The fact that turbinates grow themselves and cause nasal congestion is actually for the protection of the lungs and lower respiratory tract by hormonal and reflex ways. For example, in an environment with very polluted air or in an environment with a high amount of allergens, symptoms such as itching, increased secretion and nasal congestion may occur in the nose before reaching the lungs, and it can be understood that the turbinates enlarge during the examination.

Link group where you can find detailed information about empty nose syndrome on this website >> https://www.ent-istanbul.com/search?q=empty+nose+syndrome

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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