Why Does Sticky Nasal Secretion Occur in Empty Nose Syndrome?

Understanding Thick Nasal Mucus in Empty Nose Syndrome: Causes and Management

Empty Nose Syndrome (ENS) is a condition characterized by impaired nasal physiology, usually occurring after excessive concavity or turbinate resection. Nasal obstruction is a persistent condition and involves an abnormally enlarged intranasal airspace. The most common symptoms reported in these patients are dryness and sticky nasal secretions. In some patients, although turbinate volumes are not significantly reduced, excessively functional turbinates have been observed due to excessive radiofrequency exposure.

Why Might Secretions Become Viscous and Sticky in Empty Nose Syndrome?

The normal nasal mucosa is protected by ciliated epithelium and a mucus layer, which moisturize, warm, and filter inhaled air. However, excessive turbinate tissue removal disrupts this physiological process, leading to mucosal drying and decreased ciliary activity. In this case, mucus cannot contain sufficient fluid and accumulates as a viscous (sticky) secretion. The flow direction within the nose is altered, the flow rate slows, and the secretions, which accumulate more like a dried-out, pooled structure, become more viscous over time.

Airflow and Moisture Imbalance

In the ENS, the direction and speed of airflow change. Air, which normally flows regularly over the turbinate surfaces, is directed directly into the nasopharynx after turbinate loss. This turbulent flow causes local drying of the nasal mucosa and thickening of the secretions. The enlarged nasal cavity increases mucus evaporation, exacerbating moisture loss. Instead of air traveling through the nose in a slow, rotational manner, linear and accelerated airflow impinging on specific areas results in increased moisture loss in the nasal mucosa, and structural changes may occur over time.

The turbinate tissues normally direct and circulate air through the nose, evenly moistening the mucosal surfaces. With the removal of the turbinates in the ENS, airflow becomes turbulent and direct. This causes drying and irritation in some areas of the mucosa and secretion accumulation in others.

Because the nasal passages in patients with ENS are wide, airflow is accelerated and moisture in the nose evaporates more quickly. This reduces the water content of the mucus and causes the secretions to take on a "sticky" or "stringy" consistency.

Mucosal Epithelium and Ciliary Dysfunction

Following loss of turbinate mucosa or surgical trauma, ciliary movement (mucociliary clearance) in the remaining mucosa is impaired. In this situation, mucus in the nose cannot be transported properly, accumulates, and becomes thick and sticky.

Neural Regulation Disorder

Trigeminal nerve receptors located in the turbinate mucosa play an important role in secretion and vascular tone. Damage to these receptors after surgery can lead to a weakening of mucosal reflexes and a deterioration in the quality of secretions. This manifests itself as mucus taking on a "stringy" or "sticky" consistency. This condition is more common in tubinate reductions performed with excessive thermal damage.

Adjunctive Treatment Options for Empty Nose Patients with Sticky Nasal Discharge

In empty nose syndrome, mucosal dryness and sticky secretions can cause patients to feel short of breath, experience nasal congestion, and experience nasal irritation.

Treatment approaches are generally based on moisturizing the mucosa and restoring physiological airflow:

• Isotonic or hypotonic saline sprays
• Moisturizing nasal gels and oil-based drops (this recommendation is not very helpful for some of my patients; oil-based nasal humidifiers can even cause infection in the already unhealthy and dry nasal mucosa. Humidifiers containing petroleum products can also be irritating for my patients when they dry out)
• Increasing ambient humidity (using a cold mist spray)
• Turbinate reconstruction or implant placement in necessary cases
• Restricting the nasal airway with cotton balls, tape, masks, or clips (reducing rapid airflow can slow the progression of the disease).

Stickly secretions in empty nose syndrome are not merely a sign of dryness; they indicate impaired mucosal integrity, neural balance, and airflow physiology. Therefore, treatment should not only target moisturizing but also restructuring intranasal biomechanics.

Mucus Hypersecretion and Allergic Rhinitis May Be Protective in Patients with ENS (Empty Nose Syndrome) - Video

In the video above, despite the patient having had both inferior turbinates resected almost completely, the intranasal mucosa appears to be mostly moist and healthy, pink in color due to the presence of abundant allergic secretions. In some ENS patients with allergic rhinitis attacks, even mild allergic symptoms can contribute to a more tolerable symptomatic response and protect the intranasal mucosa.

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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