Inferior Meatal Cartilage Implant For Treatment of Nasal Hyperventilation

Submucosal Costal Cartilage Implantation (Inferior Meatus Augmentation Procedure (IMAP))

dry nose,Empty Nose Syndrome,Inferior Meatus Augmentation,Nasal Hyperventilation,Submucosal Costal Cartilage Implantation, fibrotic turbinate, cooling of turbinates

Cartilage Implantation areas are marked with yellow arrows. In the previous photo, the endoscopic nasal cavity is predominantly seen before the operation. The patient's complaints such as the feeling of cold air contact and the feeling of sticky secretion are seen in the right nasal cavity. As seen in the photo above, the inferior Turbinate is smaller than normal, the inferior meatus is seen as wider than normal, and the nasal mucosa is dry. The patient underwent inferior meatus submucosal cartilage Implantation and the following endoscopic examination photos were taken just two days after the procedure. As seen in the photo below, it is seen that the intranasal volume has decreased, the mucosa is quite healthy, and the incision scar in the implanted area is still not healed.

The patient, who had previously undergone radiofrequency turbinate reduction and septoplasty operations in a different clinic, presented with complaints of nasal dryness, feeling of cold air in the nose, sticky secretion, feeling of cold air and dryness in the nasal cavity. Most of the complaints were related to the right nasal cavity. On examination, it was observed that the posterior part of the right inferior turbinate was more prominent and smaller than normal. Right inferior meatus augmentation was planned. The patient underwent submucosal cartilage implantation (grafts obtained from cadaveric rib cartilages were used). You can find the intranasal images of the patient before and after the procedure below. Here, it was thought that most of the patient's complaints were related to enlarged intranasal air volume and nasal hyperventilation. Although the patient's turbinate was not very small, fibrosis due to radiofrequency application and decrease in tissue circulation (cooling of the turbinates) may have caused a decrease in heating and humidification capacity.

Turbinate with fibrotic tissue, intra-tissue scarring

During the examination of the patients, we can check many things endoscopically, such as the volume of the turbinates, whether the mucosa is dry and reddened, whether there is a purulent secretion in the nasal region, or the nose. In addition, it is not possible to evaluate intra-turbinate fibrosis and scar development, and the decrease in circulation in turbinates with endoscopic examination alone. Apart from these, it is not possible to fully evaluate whether the ciliated epithelium on the turbinate is damaged or not by endoscopic examination.

Photo description above: The red arrows in the top photo indicate the enlarged intranasal air passage area where cartilage implantation will be performed before the operation. Bottom photo was taken 2 days after inferior meatal augmentation with submucosal cartilage implantation. Redness is seen in the mucosal incision area made for implantation.

Treatment of turbinate hypertophy

The treatment of turbinate hypertrophy, which refers to the enlargement of the nasal turbinates, can vary depending on the severity of the condition and the individual's specific symptoms. Here are some common treatment options:

1. Conservative Measures:

- Nasal Steroid Sprays: These prescription sprays can help reduce inflammation and congestion in the nasal passages, including the turbinates.

- Antihistamines: If allergies contribute to turbinate hypertrophy, antihistamines may be recommended to manage symptoms.

- Nasal Saline Irrigation: Rinsing the nasal passages with a saline solution can help moisturize and reduce congestion.

2. Medications:

- Decongestants: Short-term use of decongestant nasal sprays or oral medications may provide temporary relief from nasal congestion, but prolonged use should be avoided to prevent rebound congestion.

- Oral Steroids: In more severe cases, a short course of oral steroids may be prescribed to reduce inflammation and shrink the turbinates.

3. Minimally Invasive Procedures:

- Turbinate Reduction: Various techniques can be used to reduce the size of the turbinates, including:

- Submucosal Radiofrequency Ablation: Controlled radiofrequency energy is delivered to the turbinate tissues to reduce their size.

- Laser Turbinoplasty: Laser energy is used to remove excess tissue and reshape the turbinate.

- Coblation Turbinoplasty: A low-temperature plasma technology is employed to shrink the turbinates.

- Cryosurgery: Cold temperatures are applied to the turbinates to reduce their size.

- Microdebrider-assisted Turbinoplasty: A surgical instrument is used to trim and remove excess tissue from the turbinates.

4. Surgical Intervention:

- Turbinectomy: In severe cases that do not respond to conservative or minimally invasive treatments, a partial or total turbinectomy may be performed. This involves surgically removing a portion or the entire turbinate to improve nasal airflow.

It's important to note that the choice of treatment depends on factors such as the severity of turbinate hypertrophy, associated symptoms, individual patient characteristics, and the recommendations of an ENT specialist. A thorough evaluation by a healthcare professional is crucial to determine the most suitable treatment approach for turbinate hypertrophy in each specific case.

Turbinectomy risks

Turbinate surgery, specifically turbinectomy, is a procedure performed to address turbinate hypertrophy, which involves the removal or reduction of nasal turbinates. While it can provide relief from nasal obstruction and congestion, it is important to be aware of the potential risks and complications associated with this surgery. Some of the risks include:

1. Bleeding: As with any surgical procedure, there is a risk of bleeding during or after the surgery. Although rare, excessive bleeding may require additional interventions or medical attention.

2. Infection: There is a small risk of infection following turbinectomy. This risk can be minimized by adhering to proper post-operative care instructions and taking prescribed antibiotics, if necessary.

3. Scarring: Turbinectomy involves the removal or reduction of tissue, which can lead to scarring. While the surgeon will aim to minimize scarring, it may still occur and potentially affect nasal airflow.

4. Dryness and Crusting: After turbinectomy, some patients may experience increased dryness in the nasal passages, leading to the formation of crusts or scabs. Proper nasal hygiene, such as saline rinses, can help manage this issue.

5. Empty Nose Syndrome (ENS): ENS is a rare but potential complication of turbinate surgery. It occurs when there is excessive removal of the turbinates, resulting in a sensation of constant nasal obstruction, dryness, and difficulty breathing. This condition can significantly impact nasal function and quality of life.

6. Altered Nasal Function: Turbinectomy can potentially lead to changes in nasal airflow and function. Some patients may experience persistent nasal obstruction, a sensation of nasal dryness, or changes in the perception of airflow. These effects may vary depending on the extent of tissue removal and the individual's anatomy.

7. Septal Perforation: In rare cases, turbinectomy can cause injury to the nasal septum, resulting in a perforation (a hole) in the septum. This can lead to symptoms such as whistling sounds during breathing, crusting, and nasal discomfort.

It is crucial to consult with an ENT specialist or surgeon who can evaluate your specific condition, discuss the potential risks, and determine whether turbinectomy is an appropriate treatment option for you. They will provide you with detailed information about the risks involved and help you weigh the potential benefits against these risks before making an informed decision.

Excessive reduction of turbinate

Excessive reduction of the nasal turbinates during turbinate surgery, known as turbinate reduction, can lead to a condition called Empty Nose Syndrome (ENS). ENS is a rare but potentially debilitating condition that can significantly affect nasal function and quality of life. Here is an overview of the risks associated with excessive reduction of the turbinates:

1. Empty Nose Syndrome (ENS): ENS occurs when there is an over-resection or excessive reduction of the turbinates during surgery. The turbinates play a vital role in humidifying, filtering, and directing airflow in the nasal passages. If too much tissue is removed, it can disrupt the normal airflow patterns, leading to symptoms such as a constant sensation of nasal obstruction, dryness, difficulty breathing, and a paradoxical feeling of too much airflow.

2. Altered Nasal Function: Excessive reduction of the turbinates can result in changes to nasal airflow dynamics. The turbinates help regulate the temperature, humidity, and velocity of inhaled air. When too much tissue is removed, the nasal passages may become excessively open, disrupting these normal functions. This can lead to a sensation of cold, dry, or turbulent airflow, affecting overall comfort and nasal function.

3. Persistent Nasal Obstruction: Paradoxically, excessive reduction of the turbinates can lead to a feeling of ongoing nasal obstruction. Although the nasal passages may appear wide open, the loss of the normal turbinate structures and their functions can cause a sensation of reduced airflow and congestion.

4. Nasal Dryness and Crusting: The turbinates are responsible for moisturizing the inhaled air, and their removal can result in increased dryness within the nasal passages. This can lead to the formation of crusts or scabs, causing discomfort and nasal irritation.

5. Nasal Hyperresponsiveness: Excessive reduction of the turbinates can lead to increased nasal hyperresponsiveness. This means that the nasal tissues become overly sensitive to environmental triggers, such as changes in temperature, humidity, or irritants, resulting in heightened nasal symptoms.

It is crucial for surgeons performing turbinate reduction procedures to exercise caution and adhere to established guidelines to avoid excessive tissue removal. Every patient's anatomy and symptoms should be carefully evaluated to determine the appropriate amount of tissue reduction needed while preserving normal nasal function. Proper patient selection, meticulous surgical technique, and a conservative approach are key to reducing the risk of complications associated with excessive turbinate reduction.

If you are considering turbinate surgery, it is important to consult with an experienced ENT specialist or surgeon who can assess your specific condition, discuss the potential risks, and recommend the most suitable treatment approach to address your nasal concerns.

Minimal traumatic turbinate procedures

Minimal traumatic turbinate procedures, also known as minimally invasive turbinate procedures, are surgical techniques aimed at addressing turbinate hypertrophy and improving nasal airflow while minimizing tissue trauma and preserving the normal anatomy and function of the turbinates. These procedures are designed to reduce nasal obstruction and congestion with minimal disruption to the nasal structures. Here are a few examples of such procedures:

1. Radiofrequency Turbinate Reduction (RFTR):

- RFTR involves the use of radiofrequency energy to shrink the turbinates.

- A specialized instrument delivers controlled energy to the turbinate tissues, causing a controlled thermal injury.

- This results in reduction of turbinate volume, leading to improved nasal airflow.

- RFTR is typically performed in an outpatient setting and does not involve tissue removal.

2. Coblation Turbinate Reduction:

- Coblation technology utilizes a low-temperature plasma to remove or shrink turbinate tissues.

- The procedure involves the precise removal of hypertrophic tissue, while preserving the underlying structures.

- Coblation turbinate reduction is designed to minimize tissue trauma and promote faster healing compared to more invasive techniques.

3. Microdebrider-Assisted Turbinate Reduction:

- This technique utilizes a microdebrider, a powered rotating blade, to remove excess tissue from the turbinates.

- The microdebrider allows for precise and controlled tissue removal, minimizing trauma to surrounding structures.

- This procedure can be performed in conjunction with septoplasty or other nasal surgeries.

4. Laser Turbinoplasty:

- Laser turbinate reduction involves the use of laser energy to remove or reshape turbinate tissue.

- The laser selectively targets and vaporizes excess tissue while sparing the underlying structures.

- This technique allows for precision and minimal trauma to the surrounding tissues.

The goal of minimal traumatic turbinate procedures is to improve nasal airflow and alleviate symptoms of nasal obstruction while preserving the natural functions of the turbinates. These procedures are typically associated with shorter recovery times, reduced postoperative discomfort, and fewer complications compared to more invasive surgical techniques.

It is important to consult with an ENT specialist or surgeon who can evaluate your specific condition, discuss the available options, and recommend the most appropriate minimal traumatic turbinate procedure for your individual needs. They will be able to assess your symptoms, anatomy, and goals to determine the best course of action to address your nasal concerns while minimizing tissue trauma.

Among the techniques written above, applications made with radiofrequency devices that measure tissue resistance and minimizing mucosa and tissue damage may be more advantageous than others. Microdebrider-Assisted Turbinate Reduction and Laser Turbinoplasty may cause more heat damage and tissue volume reduction than radiofrequency application.

Treatment dilemma for Empty Nose Syndrome

Empty Nose Syndrome (ENS) presents a challenging treatment dilemma due to the complexity and unique nature of the condition. ENS is characterized by a constant sensation of nasal obstruction, dryness, and altered nasal airflow following excessive reduction of the nasal turbinates. The management of ENS poses several challenges as there is no universally accepted standard treatment approach. Here are some factors contributing to the treatment dilemma for ENS:

1. Limited Understanding: The exact cause and underlying mechanisms of ENS are not fully understood. This makes it difficult to develop targeted and effective treatment strategies. ENS may involve a combination of factors, including altered nasal airflow dynamics, nerve damage, disrupted sensory function, and psychological factors. Without a comprehensive understanding of the condition's pathophysiology, finding an optimal treatment approach becomes challenging.

2. Lack of Consensus: Due to the rarity of ENS and the lack of standardized diagnostic criteria, there is no consensus on the most effective treatment options. The severity and manifestation of ENS can vary greatly among individuals, making it challenging to develop a one-size-fits-all approach. This leads to a wide range of treatment strategies, often with mixed results.

3. Multidimensional Nature: ENS affects not only the physical aspects of nasal function but also the psychological well-being of individuals. The constant sensation of nasal obstruction can lead to significant distress and impact quality of life. Addressing the multidimensional nature of ENS requires a holistic treatment approach that considers both physical and psychological factors. However, finding the right balance and combination of treatments can be complex.

4. Treatment Modalities: Various treatment modalities have been attempted for ENS, including medical management, surgical interventions, and non-pharmacological approaches. These may include topical therapies, medications, nasal irrigation, implantation of prosthetic materials, or revision surgeries. However, the outcomes can be variable, and no single treatment has demonstrated consistent success in relieving ENS symptoms for all individuals.

5. Risk-Benefit Assessment: ENS treatment involves weighing the potential benefits against the risks and potential complications. Surgical interventions, such as turbinate reconstruction or augmentation, carry their own set of risks and may not guarantee complete symptom resolution. The decision-making process involves carefully considering the risks and potential benefits of any intervention to ensure that the potential benefits outweigh the potential harm.

Given the treatment dilemma for ENS, a multidisciplinary approach involving ENT specialists, pain management experts, psychologists, and other healthcare professionals is often recommended. This allows for a comprehensive evaluation, individualized treatment planning, and ongoing support for individuals with ENS. Research efforts are also ongoing to further understand the condition and develop more effective treatment options.

It is essential for individuals with ENS to work closely with their healthcare providers to explore different treatment modalities, manage symptoms, and address the psychological impact. Open communication, shared decision-making, and a patient-centered approach are vital in navigating the treatment dilemma and finding the best possible strategies for managing ENS.

Treatment dilemma for Empty Nose Syndrome

Diagnostic dilemma for Empty Nose Syndrome

The diagnostic dilemma for Empty Nose Syndrome (ENS) stems from the complexity of the condition and the lack of standardized diagnostic criteria. ENS refers to a constellation of symptoms characterized by a constant sensation of nasal obstruction, altered nasal airflow, and nasal dryness following excessive reduction of the nasal turbinates. Here are some factors contributing to the diagnostic challenges of ENS:

1. Lack of Objective Measures: Currently, there is no definitive objective test or biomarker to diagnose ENS. Diagnosis is primarily based on the presence of characteristic symptoms and a history of prior turbinate surgery. The subjective nature of the symptoms makes it difficult to objectively assess and confirm the presence of ENS.

2. Heterogeneous Symptoms: The symptoms of ENS can vary among individuals, making it challenging to establish a uniform set of diagnostic criteria. While nasal obstruction and altered airflow are common features, the severity, frequency, and perception of symptoms can differ. Some individuals may also experience additional symptoms such as nasal dryness, paradoxical nasal congestion, or difficulty breathing.

3. Overlapping Symptoms: The symptoms of ENS can overlap with those of other nasal conditions, such as chronic rhinitis, chronic sinusitis, or allergic rhinitis. This can lead to misdiagnosis or delayed recognition of ENS. Distinguishing ENS from other nasal disorders is crucial for implementing appropriate management strategies.

4. Subjective Nature of Patient Reporting: Since ENS symptoms are primarily reported by the patients, variations in perception, interpretation, and communication of symptoms can pose challenges in diagnosis. Objective measures, such as nasal endoscopy or imaging, may not always correlate with the patient's symptomatology.

5. Lack of Consensus: Due to the rarity and complexity of ENS, there is no widely accepted consensus on diagnostic criteria. The absence of standardized guidelines can lead to variability in diagnosis and interpretation of ENS across healthcare professionals.

6. Psychological Factors: Psychological factors, such as anxiety, depression, and somatization, can influence the perception and reporting of symptoms in individuals with ENS. These factors may further complicate the diagnostic process and necessitate a comprehensive assessment that considers both physical and psychological aspects.

To navigate the diagnostic dilemma of ENS, a comprehensive evaluation is essential. This typically includes a detailed medical history, a thorough physical examination, and an assessment of nasal airflow and function. Nasal endoscopy may be performed to visualize the nasal structures and rule out other nasal pathologies. Additionally, patient-reported outcome measures and quality of life assessments can aid in evaluating the impact of symptoms on daily functioning.

Collaboration with an experienced ENT specialist or a multidisciplinary team can help in reaching a diagnosis by ruling out other potential causes of symptoms and considering the overall clinical picture. Keeping an open line of communication, actively listening to patient experiences, and taking into account their perspectives are crucial in overcoming the diagnostic challenges associated with ENS. Ongoing research efforts are aimed at further understanding the condition and developing standardized diagnostic criteria to improve accuracy and reliability in diagnosing ENS.

Imaging methods for Empty Nose Syndrome

Imaging methods play a limited role in the diagnosis and evaluation of Empty Nose Syndrome (ENS). ENS is primarily diagnosed based on clinical symptoms and a history of prior nasal turbinate surgery. However, imaging techniques can be useful in certain cases to assess the nasal anatomy, identify potential structural abnormalities, and rule out other nasal pathologies that may contribute to the symptoms. Here are some imaging methods that may be utilized in the evaluation of ENS:

1. Nasal Endoscopy: Nasal endoscopy is a commonly used diagnostic tool in evaluating nasal conditions. It involves the insertion of a thin, flexible tube with a light and camera (endoscope) into the nasal passages to visualize the internal nasal structures. Nasal endoscopy can help identify any residual turbinate tissue, assess the overall nasal anatomy, and rule out other underlying nasal abnormalities that may contribute to the symptoms.

2. Computed Tomography (CT) Scan: CT scans provide detailed cross-sectional images of the nasal and sinus structures. Although CT scans are not typically required for the diagnosis of ENS, they may be used in select cases to assess the nasal anatomy, identify any structural abnormalities, or rule out other potential causes of nasal obstruction, such as nasal polyps, sinus disease, or septal deviations. CT scans can provide valuable information to guide treatment decisions and rule out other potential causes of symptoms.

3. Magnetic Resonance Imaging (MRI): MRI scans use magnetic fields and radio waves to produce detailed images of the nasal and sinus structures. MRI scans are less commonly used in the evaluation of ENS compared to CT scans. However, they may be considered in certain cases to provide additional information about the soft tissue structures of the nose, such as the nasal turbinates and the nasal mucosa. MRI scans can help assess the integrity and position of the turbinates and identify any potential anomalies that may contribute to the symptoms.

It's important to note that while imaging methods can provide valuable information, they have limitations in diagnosing ENS directly. ENS is primarily a clinical diagnosis based on characteristic symptoms and a history of prior turbinate surgery. Imaging studies are typically used to complement the clinical evaluation and provide additional information about the nasal anatomy and potential contributing factors.

Ultimately, the diagnosis and management of ENS rely on a comprehensive evaluation by an ENT specialist or a multidisciplinary team. They will consider the patient's symptoms, medical history, and imaging findings (if necessary) to develop an individualized treatment plan and address the unique needs of each patient with ENS.

Empty Nose Syndrome and intranasal pain

Empty Nose Syndrome (ENS) is a condition characterized by a constant sensation of nasal obstruction, altered nasal airflow, and nasal dryness following excessive reduction or removal of the nasal turbinates. Intranasal pain is a common symptom experienced by individuals with ENS and can significantly impact their quality of life. Here's an overview of the relationship between ENS and intranasal pain:

1. Nasal Dryness and Irritation: ENS often leads to a dry nasal cavity, causing the nasal passages to become more susceptible to irritation and inflammation. The lack of proper nasal moisture and protective mucus can result in increased sensitivity and discomfort within the nasal passages. This can manifest as a persistent feeling of dryness, burning, or stinging sensation.

2. Disturbed Nerve Endings: Excessive reduction or removal of the turbinates during surgery can damage or disrupt the nerve endings within the nasal tissues. Nerves responsible for pain perception may be affected, leading to heightened sensitivity and the perception of pain in the absence of any obvious physical cause. This neuropathic pain can be challenging to treat and manage.

3. Altered Airflow Dynamics: ENS can disrupt the normal airflow patterns within the nose, leading to abnormal sensations and potential pain. The altered nasal airflow can cause turbulent air currents, changes in pressure, and increased airflow velocity, which can contribute to nasal discomfort and pain.

4. Hyperawareness and Psychological Factors: The persistent symptoms and altered nasal sensations associated with ENS can lead to heightened awareness and attention to the nasal region. This hyperawareness can increase the perception of pain or discomfort, amplifying the intranasal pain experienced by individuals with ENS. Additionally, psychological factors such as anxiety, depression, and stress can further exacerbate the perception of pain.

Addressing intranasal pain in ENS requires a comprehensive and multidimensional approach. Here are some strategies that may be considered:

1. Topical Therapies: Nasal moisturizers, saline sprays, and nasal lubricants can help alleviate dryness, reduce irritation, and provide temporary relief from intranasal pain.

2. Medications: In some cases, medications such as topical or oral analgesics, nerve pain medications, or medications targeting nerve sensitization (such as gabapentin or amitriptyline) may be prescribed to help manage intranasal pain. However, the response to medication can vary among individuals.

3. Non-pharmacological Approaches: Non-medication interventions, such as nasal irrigation with saline solutions, humidification of the nasal environment, and avoiding triggers that worsen symptoms, can help provide relief and alleviate intranasal pain.

4. Psychological Support: Given the potential psychological impact of ENS, addressing any associated anxiety, depression, or distress is crucial. Psychological support, counseling, and cognitive-behavioral therapy techniques can be beneficial in managing pain perception and improving overall well-being.

5. Multidisciplinary Care: Collaborating with an experienced ENT specialist, pain management specialists, and other healthcare professionals familiar with ENS can provide comprehensive care. They can assess the specific needs of individuals with ENS, develop personalized treatment plans, and offer a combination of medical, non-pharmacological, and psychological interventions.

It's important for individuals with ENS to work closely with their healthcare providers to discuss their symptoms, seek appropriate management strategies, and develop coping mechanisms to address intranasal pain. Treatment approaches may vary based on individual circumstances, and a tailored approach is necessary to meet each person's unique needs.

Diagnosis of Empty Nose Syndrome

The diagnosis of Empty Nose Syndrome (ENS) can be challenging due to the absence of standardized diagnostic criteria and the subjective nature of the symptoms. ENS is primarily a clinical diagnosis that relies on the presence of characteristic symptoms and a history of prior nasal turbinate surgery. Here's an overview of the diagnostic process for ENS:

1. Evaluation of Symptoms: The first step in diagnosing ENS is a thorough evaluation of the patient's symptoms. The primary symptom of ENS is a constant sensation of nasal obstruction, despite the nasal passages appearing clear. Other common symptoms include altered nasal airflow, nasal dryness, paradoxical nasal congestion, and a range of nasal discomforts. The presence, severity, and duration of these symptoms play a crucial role in establishing a diagnosis.

2. Medical History: A detailed medical history is essential in diagnosing ENS. The healthcare provider will inquire about any prior nasal surgeries, particularly those involving turbinate reduction or turbinectomy. The timing and extent of the surgery, as well as the correlation of symptom onset with the surgical procedure, are important factors to consider.

3. Nasal Examination: A physical examination of the nasal passages is typically performed to assess the nasal anatomy and rule out other potential causes of nasal obstruction. This may involve a nasal endoscopy, where a thin, flexible tube with a camera (endoscope) is inserted into the nose to visualize the nasal structures. The examination can help identify any residual turbinate tissue, structural abnormalities, or signs of inflammation.

4. Exclusion of Other Conditions: It is crucial to exclude other nasal conditions that can mimic or contribute to the symptoms of ENS. Conditions such as chronic rhinitis, chronic sinusitis, allergic rhinitis, septal deviations, or nasal polyps may present with similar symptoms. Additional diagnostic tests or imaging studies may be required to rule out these conditions and ensure an accurate diagnosis of ENS.

5. Collaboration with Specialists: In complex cases or when the diagnosis is uncertain, collaboration with an ENT specialist or a multidisciplinary team experienced in nasal disorders can be beneficial. These specialists can provide expertise in the evaluation, diagnosis, and management of ENS. They may consider additional diagnostic tests, imaging studies (such as CT scans or MRI), or functional assessments to further evaluate the nasal structure and function.

It's important to note that there are no definitive objective tests or specific imaging findings to confirm the diagnosis of ENS. The diagnosis is primarily based on the patient's reported symptoms, medical history, and ruling out other potential causes of nasal obstruction.

Given the subjective nature of ENS and the lack of standardized diagnostic criteria, an open and collaborative dialogue between the healthcare provider and the patient is crucial. Active listening to the patient's experiences, addressing concerns, and considering the overall clinical picture are essential in reaching a diagnosis of ENS. Ongoing research efforts are aimed at further understanding the condition and developing standardized diagnostic criteria to improve accuracy and reliability in diagnosing ENS.

Link group where you can read previously prepared and published articles about Cartilage Implantation on this website >> https://www.ent-istanbul.com/search?q=Cartilage+Implantation

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

Private Office:

Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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E-Mail: muratenoz@gmail.com
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