We Applied PRP Injection for Empty Nose Syndrome!

PRP Injection To Turbinates For Nasal Hyperventilation

Patient 1

Some of our patients may request a very large amount of PRP injection at one time. In the procedures we perform here, it is usually a PRP infection obtained by taking 5 or 10 millilitres of blood. Some patients want a blood sample of 40 millilitres at one time and approximately 20 millilitres of PRP content obtained from this subject to be injected into the turbinate remnanti. It is not possible to inject such a large amount of fluid into the turbinate at one time. Divided doses and repeated applications will be much healthier. I usually prefer to use a cannula during PRp injection, I do not use a needle. It is not always easy to inject fluid into these fibrous tissues that have previously undergone radiofrequency or other procedures.

Empty Nose Syndrome (ENS) is a rare but serious disorder in which patients feel that their nose is blocked despite having sufficient airflow in the nose (even more airflow than normal). It usually develops after surgical interventions on the turbinates (nasal flesh) located in the nose. Problems such as loss of sensation in the nasal tissues, airflow disorders and mucosal dryness are observed in ENS patients. Air hunger and painful areas in the nose may occur, and a feeling of cold air contact in the nose may occur. This condition causes patients to experience serious discomfort both physically and psychologically. In addition to procedures such as cartilage implantation, filler injection, and modified Young operation for the purpose of narrowing the abnormally widened airway in the nose; PRP (Platelet-rich plasma) and stem cell injections have recently begun to be performed for the purpose of improving mucosal health. In addition to these, fat injections are also performed together with stem cells for the purpose of narrowing the nasal air passage. We performed PRP injection on the patient who came today and had nasal hyperventilation symptoms after previous concha radiofrequency application. The right nasal passage was larger than the left. The patient stated in the cotton test that there was a decrease in complaints, especially when the nasal airway was narrowed on the right. The patient was planned to receive treatment for repeated PRP applications as a priority.

PRP injections have attracted attention as one of the innovative methods in ENS treatment in recent years!

PRP is a plasma obtained from the person's own blood and rich in growth factors. When applied into the nose, it aims to regenerate damaged mucosal tissue and increase blood circulation. In this way, partial recovery of intranasal sensation, improvement of mucosal moisture balance and general reduction of symptoms can be achieved in ENS patients. In office conditions, 10 ml of the patient's blood is taken and the plasma injected for PRP is obtained after centrifugation.

PRP injection is usually applied under local anesthesia, in several sessions at certain intervals. The fact that the application is non-invasive and contains the patient's own biological material makes the
risk of side effects quite low. However, since each patient's clinical condition is different, PRP treatment should be evaluated and planned by an experienced otolaryngologist. Although PRP does not provide a definitive treatment for ENS, it stands out as a promising option in relieving symptoms.

Patient 2 - We Injected 6 + 12 ml of PRP into the Turbinates of a Patient with Empty Nose Syndrome Symptoms

A patient who had undergone bilateral turbinate reduction during a rhinoplasty performed at a different clinic one year prior and was experiencing symptoms of empty nose syndrome was examined. The anterior and caudal portions of the left inferior turbinate were quite small. The distance between the septum and the left inferior turbinate was greater than normal, and the sensation of cold air and nasal dryness were particularly pronounced on this side. A leftward septal deviation was observed, which narrowed the left airway. Therefore, it was thought that the symptoms were not exacerbated in the left nasal cavity. The right inferior turbinate was very close to normal size. Because the patient also had minor symptoms on the right side, we planned to inject 6 ml of PRP into the anterior portion of the right inferior turbinate, 12 ml into the anterior portion of the left inferior turbinate, and posteriorly into the middle and posterior portion. I have included pre- and post-procedure images below.

Left Inferior Turbinate, Before, After 6 ml and 12 ml PRP Injection. 

Left Inferior Turbinate, Before, After 6 ml and 12 ml PRP Injection. The volume increase in the left inferior turbinate is easily visible.

Left Inferior Turbinate, Before, After 6 ml and 12 ml PRP Injection.

Left Inferior Turbinate, Before, After 6 ml and 12 ml PRP Injection.

Right Inferior Turbinate, Before and After 6 ml PRP Injection

Right Inferior Turbinate, Before and After 6 ml PRP Injection

Right Inferior Turbinate, Before and After 6 ml PRP Injection

Patient 3 - We Injected 6 + of PRP into the Right Turbinate of a Patient with Empty Nose Syndrome Symptoms

The patient had previously undergone a turbinate resection at a different clinic. Symptoms of empty nose syndrome subsequently developed. The patient underwent a right lateral submucosal nasal implant at a different clinic. The patient received a 6 ml PRP injection in the office. Pre-procedure and pre-procedure photos are included below.

Right Inferior Turbinate, Before and After 6 ml PRP Injection

Right Inferior Turbinate, Before and After 6 ml PRP Injection

How is PRP Obtained?

PRP (Platelet-Rich Plasma) is obtained by centrifuging venous blood drawn from the patient. After being collected into special tubes, the blood is subjected to a two-stage centrifugation process. In the first stage, erythrocytes are separated, while in the second stage, platelet-rich plasma is collected from the top. This method allows for the intensive use of cellular growth factors.

Which Part of PRP is Most Beneficial?

The plasma obtained after centrifugation has different layers:

• PPP (Platelet-Poor Plasma): The upper, platelet-poor layer
• PRP (Platelet-Rich Plasma): The middle, most commonly used layer
• Buffy Coat PRP: Leukocyte-rich layer

From a therapeutic perspective, the platelet-rich layer (PRP layer) is the most beneficial due to its high concentration of growth factors.

How Much Blood Can Be Obtained as PRP?

Approximately 1–2 ml of PRP can generally be obtained from 10 ml of blood. This means that approximately 10–20% of the total blood can be used as PRP. If Platelet Poor Plasma, Platelet Rich Plasma and Buffy Coat sections are also taken after centrifugation, almost half of the total blood taken can be used as PRP.

Benefits of PRP Injection in Empty Nose Syndrome

• Regeneration and tissue healing in the turbinate mucosa
• Increased hydration and moisture balance of the mucosal surface
• Partial restoration of sensitivity in nerve endings
• Improvement of the subjective perception of airflow
• Long-term symptom reduction and improved quality of life

How is PRP Injected into the Turbinate?

I usually just spray lidocaine spray into the nose and follow these steps:

PRP is generally administered as follows:

• A locking syringe is used to prevent fluid reflux.
• A blunt-tip cannula is preferred for administration.
• Small volumes of PRP are slowly injected into the submucosal layer of the turbinate mucosa.
• Injections are usually administered into the inferior turbinate region.

How Much PRP Should Be Injected into the Turbinates? How Is It Determined?

An average of 6–12 ml of PRP can be administered, depending on the turbinate volume and the patient's symptoms.

When making the decision:

• Symptom severity (difficulty breathing, nasal dryness)
• Endoscopic examination findings
• Previous surgeries and extent of resection are taken into consideration.

Comparison of Turbinate Gel Filler Injection and PRP Injection

Gel filler injection and PRP (Platelet Rich Plasma) injection, two methods used in the treatment of empty nose syndrome, differ significantly in terms of their mechanism of action, durability, cost, and side effect profile. Gel filler injection is a mechanical filling procedure that primarily aims to improve airflow by adding volume to the turbinate. This method provides rapid effects immediately upon application and can quickly alleviate nasal congestion symptoms. However, while this effect lasts longer than the volumizing effect of PRP, it is generally temporary, lasting an average of 6–12 months depending on the filler material used, requiring repeated applications. Fillers containing hyaluronic acid, in particular, can increase natural water molecule retention and edema within the turbinate. In contrast, PRP injection involves injecting plasma, derived from the patient's own blood and rich in growth factors and regenerative cellular components, into the turbinate tissue. This procedure not only creates a mechanical volume effect but also enhances mucosal regeneration, functional activation of nerve endings, and tissue nutrition, resulting in biological healing. Therefore, the healing effect of PRP is based on a longer, natural healing process. Its volumizing effect, however, is shorter than that of filler injections. From a cost perspective, PRP is generally considered more economical because it uses the patient's own blood, while gel fillers, being ready-made medical products, are more expensive. Regarding the side effect profile, PRP, being an autogenous material, carries a very low risk of immune reactions or allergic side effects. However, complications such as foreign body reactions, granulomas, or infections can rarely occur with gel fillers. Therefore, in clinical practice, PRP is the preferred choice if long-term functional recovery and natural tissue repair are the goal. Gel filler injections may be preferred for patients who desire rapid results and require a short-term solution.

Left Inferior Turbinate, Before - After 16 ml PRP Injection

Left Inferior Turbinate, Before - After 16 ml PRP Injection

Left Inferior Turbinate and Nasal Floor, Before - After 6 ml PRP Injection

Left Inferior Turbinate and Nasal Floor, Before - After 6 ml PRP Injection

Similar links related to empty nose syndrome >> Empty Nose Syndrome

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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