Nasal Hyperventilation / Empty Nose After Turbinate Reduction

Dryness - Cold Air Feeling in The Nose After Turbinate Procedures

Nasal Hyperventilation,Empty Nose Syndrome,dry nose,Thick nasal secretion,

After turbinate reducing procedures, it is appropriate to see an otolaryngologist when there is a feeling of dryness, burning sensation, needle prickling in the nose that lasts for a very long time, even longer than 6 months, sticky secretion in the nasal cavity and a feeling of cold air contact in the nose.  Normally, when turbinate radiofrequency is performed in limited amounts, it provides a limited amount of tissue shrinkage;  It ensures that turbinate functions are not impaired.  Turbinates are warm tissues with 3 sausage-like shapes in each nasal cavity, with a layer of ciliated epithelium on it, covered with a mucus layer, and a dense blood circulation network inside.  In order for these structures to rotate, heat, increase and moisten the air in the nose in a healthy way, their volume should be sufficient, there should be a secreting epithelial layer on it, and there should be circulation in the dense capillaries inside.  When turbinate radiofrequency is overdone in an uncontrolled manner, or when the turbinates are excised and partially resected with a shaver, severe reduction in turbinate functions may occur.  As seen in the photo above, there are dry, occasionally crusted, reddened and inflamed mucosal areas in the right nasal cavity and left nasal cavity.  In particular, it is seen that the air passage inside the left nostril is abnormally large and very little of the inferior turbinate remains here.  Preservation of the mucous structure on both the outer surface of the turbinates at the moment;  preservation of both volumes as much as possible;

 It is aimed to keep these tissues warm, moist and of sufficient size by preserving the transportation network in the capillaries as well as possible.  There are radiofrequency devices used for this purpose that measure tissue resistance.

Nasal turbinate anatomy

Nasal turbinates, also known as nasal conchae or nasal scrolls, are structures located inside the nasal cavity. There are three pairs of turbinates: the superior, middle, and inferior turbinates. These bony play a vital role in the respiratory structures of the nose by helping to humidify, filter, and warm the air we breathe.

 1. Superior Turbinates:

 The superior turbinates, also called the superior conchae, are the smallest of the three pairs and are located at the topmost portion of the nasal cavity. They arise from the lateral wall of the ethmoid bone, a bone located between the eyes. The superior turbinates contain thin and delicate bony plates covered by a mucous membrane. Their main function is to redirect and regulate the airflow, aiding in the process of air filtration and humidification.

 2. Middle Turbinates:

 The middle turbinates, also referred to as the middle conchae, are the largest and most prominent of the three pairs. They arise from the lateral wall of the nasal cavity and are formed by the ethmoid bone. The middle turbinates consist of a bony core surrounded by a mucous membrane. They have a more complex structure with multiple folds and recesses. The middle turbinates help to slow down the airflow, allowing for efficient humidification, filtration, and warming of the inhaled air.

 3. Inferior Turbinates:

 The inferior turbinates, also known as the inferior conchae, are located at the lowermost part of the nasal cavity. They are the largest and most robust of the three pairs of turbinates. The inferior turbinates arise from the maxillary bone, which forms the upper jaw. Like the other turbinates, they consist of a bony core covered by a mucous membrane. The inferior turbinates have a curved shape and play a crucial role in directing and regulating airflow. They also contribute to the conditioning of the inhaled air by providing increased surface area for contact with the mucous membrane.

The nasal turbinates are highly vascular structures, meaning they have an extensive network of blood vessels. This vascularization helps to warm the air as it passes over the turbinates, ensuring that the air reaches the lungs at an optimal temperature. Additionally, the mucous membranes covering the turbinates produce mucus, which helps to humidify the air and trap particles such as dust, allergens, and pathogens, preventing them from entering the respiratory system.

 It's important to note that the size and shape of the turbinates can vary among individuals, and alterations in their anatomy can contribute to nasal congestion and breathing difficulties. Conditions such as turbinate hypertrophy (enlarged turbinates) or turbinate atrophy (shrunken turbinates) can lead to nasal obstruction and may require medical intervention or surgical treatment.

Understanding the anatomy of the nasal turbinates is crucial for diagnosing and managing nasal conditions. Ear, nose, and throat specialists, known as otolaryngologists or rhinologists, have expertise in evaluating and treating disorders related to the nasal cavity, including issues involving the nasal turbinates.

Natural intranasal airflow characteristics

Natural intranasal airflow characteristics refer to the patterns and dynamics of air movement within the nasal cavity during normal breathing. The nasal cavity plays a crucial role in conditioning and filtering the inhaled air before it reaches the lungs. Understanding the natural intranasal airflow characteristics can provide insights into the functions of the nasal passages and the mechanisms behind various nasal conditions.

1. Turbulent and Laminar Flow:

The airflow within the nasal cavity can be classified into two main types: turbulent flow and laminar flow. Turbulent flow occurs when the airflow becomes irregular and chaotic, causing the air to mix vigorously. This turbulent flow is more prevalent in the anterior part of the nasal cavity, closer to the nostrils, where the nasal passages are narrower. In contrast, laminar flow is Characterized by smooth and streamlined airflow. It is more prominent in the posterior part of the nasal cavity, where the passages are wider and the air can flow in a more organized manner.

 2. Nasal Valve Area:

 The nasal valve area, located just inside the nostrils, is considered a critical region for airflow regulation. It acts as a narrowing point in the nasal passages, helping to control the velocity and direction of the inhaled air. The nasal valve area plays a role in the filtration, conditioning, and humidification of the air, as well as in the perception of airflow and the sensation of nasal airflow resistance.

 3. Nasal Cycle:

 The nasal cycle refers to the alternating congestion and decongestion of the nasal passages, which occurs naturally and rhythmically throughout the day. This cycle is regulated by the autonomic nervous system and involves the expansion and contraction of the blood vessels in the nasal tissues. It leads to changes in airflow distribution between the nostrils, with one nostril being more open while the other is relatively constricted. The nasal cycle helps to ensure that both of the nasal cavity receive adequate airflow and allows for the regeneration and maintenance of the nasal tissues.

4. Nasal Resistance:

Nasal resistance refers to the opposition encountered by the airflow as it passes through the nasal passages. It is influenced by factors such as the size and shape of the nasal cavity, the condition of the nasal turbinates, and the presence of any obstructions or blockages. The nasal resistance affects the efficiency of air conditioning, filtration, and humidification, and alterations in nasal resistance can impact overall breathing comfort and function.

 5. Mucociliary Clearance:

The nasal cavity is lined with a layer of mucus, which helps to trap and remove particles such as dust, allergens, and pathogens from the inhaled air. The mucus is propelled by tiny hair-like structures called cilia, which beat in coordinated waves to move the mucus along the nasal passages toward the throat. This mucociliary clearance mechanism plays a vital role in maintaining the cleanliness and health of the nasal cavity.

Understanding the natural intranasal airflow characteristics is important in diagnosing and managing nasal conditions such as nasal congestion, nasal obstruction, and respiratory disorders. Various factors, including the shape of the nasal passages, the position of the nasal septum, the size of the turbinates, and the presence of any abnormalities, can affect the airflow patterns and contribute to nasal symptoms. Healthcare professionals, such as otolaryngologists or rhinologists, use this knowledge to assess and address nasal conditions effectively.

History of Turbinate Surgeries

Turbinate surgery, also known as turbinate reduction or turbinate resection, is a surgical procedure performed on the nasal turbinates, which are structures located on the sides of the nasal passages. The history of turbinate surgery dates back several decades and has evolved over time with advancements in medical techniques and technology.

 The nasal turbinates are responsible for humidifying and filtering the air we breathe. However, when they become enlarged or inflamed, they can obstruct the nasal passages, leading to symptoms such as nasal congestion, difficulty breathing, snoring, and sleep apnea. In cases where conservative treatments like medication or nasal sprays fail to provide relief, turbinate surgery may be considered.

 The earliest form of turbinate surgery involved a procedure called cauterization, which dates back to the early 20th century. Cauterization involved using a heated instrument to burn or destroy a portion of the turbinate tissue, reducing its size and improving airflow. While effective in some cases, cauterization often resulted in tissue scarring and potential long-term complications.

 As medical knowledge and surgical techniques advanced, alternative approaches to turbinate surgery emerged. In the mid-20th century, submucous resection (SMR) gained popularity as a surgical method for turbinate reduction. SMR involved making an incision in the lining of the turbinate and removing a portion of the bone and soft tissue. This procedure is aimed to decrease the size of the turbinate and improve nasal airflow. However, SMR had limitations, and it carried a risk of complications such as bleeding, infection, and the potential for long-term nasal dryness.

 In recent years, advancements in endoscopic techniques have revolutionized turbinate surgery. Endoscopic turbinate surgery involves the use of a thin, flexible tube with a camera and surgical instruments, which allows the surgeon to visualize and access the nasal structures with greater precision. This technique has several variations, including partial turbinectomy, submucosal resection, and turbinate coblation.

Partial turbinectomy involves removing a portion of the turbinate, either with a scalpel or a specialized instrument, to reduce its size and improve nasal airflow. Submucosal resection aims to remove excessive tissue from the turbinate while preserving its overall structure. Turbinate coblation is a procedure that utilizes radiofrequency energy to shrink and reshape the turbinate tissue, reducing its size without the need for tissue removal.

These endoscopic techniques have several advantages over traditional turbinate surgeries. They offer improved visualization, decreased tissue trauma, reduced risk of complications, and faster recovery times. Moreover, these procedures can be performed on an outpatient basis, allowing patients to return home on the same day.

It's worth noting that turbinate surgery is not always necessary and is typically considered after conservative treatment options have been exhausted. The decision to undergo turbinate surgery should be made in consultation with an ear, nose, and throat (ENT) specialist or a rhinologist, who can evaluate the individual's symptoms, conduct a thorough examination, and determine the most appropriate treatment approach.

Overall, the history of turbinate surgery has seen a progression from cauterization to submucous resection, and finally to endoscopic techniques. These advancements have greatly improved the outcomes of turbinate surgery, providing effective relief for individuals with nasal obstruction due to enlarged or inflamed turbinates.

In the early days, doctors misunderstood the "turbinates", which they interpreted as "tissue created by God wrongly, as "tissue that obstructs the nasal cavity unnecessarily, reducing oxygen and air intake", by destroying them with hot metal objects, causing them to evaporate or disappear. A destructive technique in the form of destruction has been defined. Over time, the structure and functions of "Turbinates", which are accepted as "unique tissue or organ", have been understood. Techniques that involve the reduction of both the surface mucosa, its volume and the intense blood circulation in it, without deterioration, have begun to be defined.

Nasal hyperventilation

Nasal hyperventilation refers to a condition characterized by excessive and rapid breathing through the nose. It is often associated with a feeling of breathlessness and can lead to various physical and psychological symptoms. If the inferior turbinates, which are one of the main structures forming the resistance in the nose, are excessively reduced or removed by resected, the enlarged airway and accelerated air flow in the nose may result in drying in the nose, a feeling of cold air contact, sticky secretion and air hunger. This situation can be perceived as the leading symptom of the empty nose syndrome or as a previous situation. If the turbinates are completely excised, empty nose syndrome may occur. The airflow turns from the turbine to a linear and accelerated shape.

Empty nose syndrome (ENS)

Empty Nose Syndrome (ENS) is a rare and often debilitating condition that affects the nasal passages. It is characterized by a set of persistent symptoms, including a constant feeling of nasal obstruction or congestion, despite having wide- open nasal passages. Individuals with ENS may also experience difficulty breathing, a sensation of dryness or numbness in the nose, and altered airflow sensations. ENS can significantly impact a person's quality of life and overall well-being.

The exact cause of Empty Nose Syndrome is not fully understood. However, it is believed to result from surgical interventions that involve the removal or reduction of the nasal turbinates. The turbinates play a crucial role in the proper functioning of the nasal passages by humidifying and filtering the inhaled air. When these structures are excessively removed or damaged during surgery, the normal airflow dynamics within the nasal cavity are disrupted, leading to the development of ENS.

Several surgical procedures have been associated with the development of ENS, including turbinate reduction surgeries, septoplasty, and functional endoscopic sinus surgery (FESS). These procedures are commonly performed to alleviate nasal congestion, improve nasal breathing, or treat conditions such as nasal polyps or chronic sinusitis. However, in some cases, the surgical removal or reduction of the turbinates can result in an imbalance of airflow and create a sensation of empty space or obstruction in the nose.

 The symptoms of ENS can vary in severity and may worsen over time. Common symptoms include:

 1. Persistent nasal congestion or obstruction, despite clear nasal passages.

 2. Paradoxical nasal obstruction, where the sensation of obstruction is present even when the nostrils are wide open.

 3. Altered airflow sensations, such as a feeling of increased airflow or loss of normal resistance.

 4. Dryness or numbness in the nose.

 5. Difficulty breathing through the nose.

 6. Decreased sense of smell (hyposmia) or complete loss of smell (anosmia).

 7. Chronic nasal discomfort or pain.

 8. Sleep disturbances, including snoring or sleep apnea.

Diagnosing Empty Nose Syndrome can be challenging because the symptoms can overlap with other nasal conditions. It often requires a thorough evaluation by an otolaryngologist or rhinologist who specializes in nasal disorders. The diagnosis is typically based on the presence of characteristic symptoms, a history of nasal surgery, and ruling out other potential causes of nasal obstruction.

Treatment for ENS aims to alleviate symptoms and improve quality of life. However, managing ENS can be complex, and there is no universally effective treatment. Some approaches that may be considered include:

 1. Medical Management: This may include using nasal saline irrigations, nasal moisturizers, or nasal corticosteroid sprays to alleviate symptoms of dryness and congestion.

 2. Reconstructive Procedures: In some cases, revision surgery or reconstructive procedures may be attempted to restore nasal function and alleviate symptoms. This may involve techniques to increase nasal airflow or to reconstruct the nasal turbinates. There are different applications such as inferior meatal cartilage implantation, Young and Modified Young's operation, turbinate augmentation with Gel filler injection. When you type a word in the search box above and press enter, you can access videos and information about related applications. Unfortunately, the regeneration of turbinates and definitive treatment of ENS is currently not possible. Apart from these, there are also applications that provide temporary relief, such as PRP and stem cell injections.

 3. Supportive Therapies: Non-surgical interventions such as cognitive-behavioral therapy, counseling, or support groups can help individuals cope with the emotional and psychological aspects of living with ENS.

 It is important to note that the outcomes of treatment for ENS can vary, and not all individuals experience significant relief of symptoms. The management of ENS requires an individualized approach, with careful consideration of the specific symptoms and their impact on the person's well-being.

 If you suspect you have Empty Nose Syndrome or are experiencing persistent nasal symptoms following nasal surgery, it is essential to consult with a qualified healthcare professional, such as an otolaryngologist or rhinologist, who can provide an accurate diagnosis and develop a comprehensive treatment plan tailored to your needs.

Treatment of empty nose syndrome (ENS)

The treatment of Empty Nose Syndrome (ENS) aims to alleviate symptoms and improve quality of life for individuals affected by this condition. While managing ENS can be challenging, several approaches may be considered:

1. Nasal Moisturizers: Using nasal moisturizing sprays, gels, or ointments can help alleviate dryness and provide temporary relief from symptoms.

2. Nasal Irrigation: Regular use of saline nasal rinses or irrigations can help hydrate the nasal passages, reduce discomfort, and promote overall nasal health.

3. Intranasal Narrowing Products: intranasal laser, cotton balls impregnated with eye ointment, apparatus for narrowing the nostrils

4. Medications: In some cases, medications such as nasal corticosteroids or antihistamines may be prescribed to alleviate symptoms associated with ENS, such as congestion or inflammation.

5. Surgical Interventions: Reconstructive procedures or revision surgeries may be considered in severe cases of ENS. These procedures aim to restore normal nasal airflow and address any anatomical abnormalities that may contribute to symptoms.

6. Psychological Support: ENS can have a significant impact on mental well-being. Psychological support, counseling, or therapy may be beneficial in helping individuals cope with the emotional and psychological aspects of living with ENS.

It's important to note that the treatment of ENS is highly individualized, and the effectiveness of interventions can vary among individuals. Consulting with an otolaryngologist or rhinologist who specializes in nasal disorders is crucial for proper evaluation, diagnosis, and the development of a personalized treatment plan.

Why does dry nose occur after nose surgery?

Dry nose, also known as nasal dryness or postoperative nasal dryness, is a common symptom that can occur after nose surgery, particularly procedures that involve the nasal turbinates or the nasal septum. Several factors contribute to the development of dry nose following nasal surgery

1. Reduced Mucus Production: Nose surgery can disrupt the natural production and secretion of mucus in the nasal passages. Mucus plays a crucial role in maintaining the moisture and humidity of the nasal cavity, as well as providing a protective barrier against irritants and pathogens. When mucus production is reduced, the nasal tissues become drier, leading to a sensation of dryness in the nose.

2. Disruption of Nasal Blood Supply: During nasal surgery, the blood supply to the nasal tissues can be temporarily disrupted or altered. The blood vessels that supply the nasal cavity contribute to the humidification and moisturization of the nasal tissues. When the blood supply is compromised, it can result in decreased blood flow to the nasal mucosa, leading to dryness.

3. Impaired Nasal Gland Function: Nose surgery can affect the function of the nasal glands, which are responsible for producing secretions that help moisturize the nasal passages. Surgical manipulation or trauma to the nasal tissues can disrupt the normal functioning of these glands, leading to a reduction in the amount of moisture in the nose.

4. Nasal Packing and Splints: In some cases, nasal packing or splints may be placed inside the nose during and after surgery to support the healing process. While these aids are necessary for proper wound healing and stability, they can contribute to a feeling of dryness by obstructing the natural airflow and limiting the distribution of moisture within the nasal cavity.

5. Medications and Healing Process: Certain medications, such as decongestants or antihistamines, prescribed after nose surgery can have drying effects on the nasal mucosa. Additionally, the healing process itself can cause temporary changes in the nasal tissues, leading to increased dryness.

Dry nose after nose surgery is usually a temporary condition that improves as the nasal tissues heal and adapt. However, it can cause discomfort and may lead to symptoms such as nasal congestion, itching, burning, or nosebleeds. To alleviate dry nose symptoms and promote healing, the following measures can be helpful:

1. Nasal Irrigation: Regular use of saline nasal sprays or nasal irrigation with a saline solution can help moisturize the nasal passages and flush out any crusting or debris.

2. Humidification: Using a humidifier in the environment or placing a bowl of water near a heat source can increase moisture levels and alleviate nasal dryness.

3. Nasal Moisturizers: Applying a thin layer of over-the-counter nasal moisturizing gel or ointment inside the nostrils can help alleviate dryness and provide a protective barrier.

4. Avoiding Irritants: Avoiding irritants such as dry air, smoke, and strong odors can help prevent further drying of the nasal passages.

5. Drinking Adequate Fluids: Staying hydrated by drinking plenty of fluids can help maintain overall body hydration, including the nasal tissues.

It is important to follow postoperative care instructions provided by your surgeon and consult with them if you experience persistent or severe symptoms of dryness after nose surgery. They can provide specific guidance and recommend appropriate interventions to manage and alleviate your symptoms.

Turbinate overreduction

Turbinate overreduction is a potential complication that can occur following turbinate reduction surgery. Turbinate reduction is a surgical procedure aimed at reducing the size of the nasal turbinates, which are structures inside the nose that help regulate airflow and humidify the air we breathe. However, when turbinate reduction is performed excessively or incorrectly, it can lead to turbinate overreduction.

Turbinate overreduction can result in several adverse effects and symptoms, including:

1. Nasal Dryness: Overreduction of the turbinates can disrupt the natural humidification process of the nasal passages, leading to excessive dryness in the nose.

2. Nasal Crusting: Decreased moisture in the nasal cavity due to turbinate overreduction can result in the formation of crusts or scabs inside the nose, causing discomfort and potential obstruction.

3. Nasal Congestion: Paradoxically, turbinate overreduction can lead to a sensation of nasal congestion or obstruction. This is because the turbinates play a role in regulating airflow and maintaining a proper balance of nasal resistance.

4. Empty Nose Syndrome (ENS): In severe cases, turbinate overreduction may contribute to the development of Empty Nose Syndrome. ENS is characterized by persistent symptoms of nasal obstruction, altered airflow sensations, and overall nasal discomfort, which significantly impact a person's quality of life.

To prevent turbinate overreduction and its associated complications, it is crucial for surgeons to carefully assess and plan the procedure, taking into account the individual's specific nasal anatomy and needs. Conservative and balanced turbinate reduction techniques are typically recommended to preserve adequate nasal function and avoid excessive tissue removal.

If turbinate overreduction occurs and symptoms persist, treatment options may include:

1. Nasal Moisturizers: Using nasal moisturizing sprays, gels, or ointments can help alleviate dryness and provide relief from associated symptoms.

2. Nasal Saline Irrigation: Regular irrigation with saline solutions can help maintain nasal moisture, reduce crusting, and alleviate congestion.

3. Reconstructive Procedures: In some cases, revision surgery or reconstructive procedures may be necessary to address the consequences of turbinate overreduction and restore normal nasal function.

It is crucial to consult with an experienced otolaryngologist or rhinologist if you suspect turbinate overreduction or experience persistent nasal symptoms after turbinate reduction surgery. They can evaluate your condition, provide appropriate treatment recommendations, and help alleviate your symptoms effectively.

Link group where you can read the articles I have prepared before on nasal hyperventilation on this website >>

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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