Empty nose syndrome (ENS) is a rare condition that causes bigger gaps in the nasal cavities (turbinate bones).
It can happen particularly after having gone through nasal surgery, though most patients do not experience the side effects of ENS.
ENS can present with several signs and symptoms and it is important to raise any concerns with your doctor so you can receive a diagnosis, begin any appropriate treatment and avoid the complications of leaving the condition untreated.
Causes of empty nose syndrome
The invasiveness of the turbinectomy procedure can disrupt the nasal cavity and manifest symptoms such as:
- Dysfunction of mucosa production along the airway
- Obstructed airflow to the lung
- Respiratory failure 2
CT scans are often used to see the empty spaces being clogged in the turbinate bones. Unfortunately, ENS is highly under and late-diagnosed as the symptoms of ENS often make a delayed appearance after surgery (sometimes taking months or up to a year to appear).1
Specific examples of surgeries that can cause ENS include:
A beam of light used to remove cancerous cells from the nasal passage, sometimes causing side effects such as thinning of nasal tissue. 3
Interestingly, laser therapy side effects correlate with ENS symptoms which are nausea, drowsiness and dizziness that coincide with ens symptoms.
Surgery is performed to fix an unstructured (crooked) nasal septum by removing the faulty cartilage; a side effect of the procedure includes an ENS-inducing sinus infection.5
ENS also creates a risk of getting bacterial infection due to the open gap it creates in the nasal passage and low mucus levels which fail to protect the nasal mucosa lining and attract opportunistic pathogens.
Signs and symptoms of empty nose syndrome
There are several symptoms of ENS including:
- Nasal congestion
- Mucus production
- Absence of the sensation of inhaling and exhaling
- Impaired breathing pattern
- Post-op nasal pain and inflammation
- Dryness of the nasal cavity (atrophic rhinitis)
- Sensitivity to temperature (especially cold temperatures) 1
Patients may experience some or all of the symptoms of ENS depending on the results of the turbinectomy surgery, the recovery process and the extent of scarring.
There is also a considerable chance ENS sufferers will develop moderate to severe anxiety and depression as a result of dealing with the condition especially before any treatment begins.6
Does empty nose syndrome go away?
According to the Cleveland Clinic, there is no definite remedy that can treat ENS. Additionally, there is not enough ongoing research into the syndrome to enable advances in finding a cure-all treatment as the syndrome is so rare. Thus, ENS sufferers can only manage their symptoms and breathing rate with several methods.
Management and treatment for empty nose syndrome
The main approach to ENS treatment is to ease its symptoms and support optimal breathing.
- A continuous positive airway pressure (CPAP) device to aid breathing, especially during sleep
- Moistening the airways using a humidifier and/or consuming hot beverages
- GP-prescribed saline spray to reduce dryness and wash away bacterial residues
To compensate for the emptiness in the nasal cavity, another surgery like implanting tissues to the nasal cavity can limit and narrow down the wide openness of ENS and control airflow leading to rehabilitating the lung function can do the trick. Platelets-rich plasma injection does promote healing of the nasal passage site after the implant surgery is done.
There is no standard clinical test for ENS and doctors will rely solely on symptoms present. However, there are some diagnostic methods suggested by medical researchers that could be utilized including:
- Questionnaires - used as diagnostic criteria by counting the number of different symptoms present including nasal burning, suffocation, dryness, sensitivity and the size of the nasal cavity (assessed with a CT scan). 1,7
- Cotton test - involves taking a cotton plug and inserting it into the nose where the inferior lateral nose wall is: near the edge of the lining of the nose to restore the nasal turbinate bones and allow restored airflow. 8
How can I prevent empty nose syndrome?
Invasive surgery is the single most risk factor for ENS, therefore, less invasive laser techniques (such as radiofrequency turbinate reduction) may reduce the chance of developing ENS after a nasal procedure.
However, the way ENS develops is relatively unclear and occurs on a case-by-case basis. Therefore, ENS prevention is only after sinus surgery is performed - namely supporting and monitoring the patient’s recovery. If the patient is beginning to experience signs of ENS, the syndrome can be controlled with diagnosis and symptom treatment.
How common is empty nose syndrome?
ENS is considered a rare condition, however, not all people going through nasal surgery will automatically have empty nose syndrome.
Who are at risk of empty nose syndrome?
Anyone having any type of nasal surgery that involves excess removal of nasal tissue is at risk of developing ENS as a delayed reaction. People of all ages and genders can experience ENS.
When should I see a doctor?
You should see your doctor if you are finding it difficult to breathe along with signs of nasal mucosa dryness or nosebleed after nasal surgery. Surgeons may not always make the patient aware of the risk of empty nose syndrome (ENS) before completing a nasal surgery, so it will be up to your GP or other health service provider to make a diagnosis.
You should also see your doctor if you are struggling with your mental health as a result of ENS as getting a proper diagnosis can ultimately ease any stress, anxiety or depression associated with dealing with the symptoms of the condition.
Empty nose syndrome (ENS) is a condition that presents after undergoing nasal surgery, often many months into/after recovery. As it is a rare condition, it is not regularly talked about within the healthcare space, however, it is a condition that should be taken seriously and given the proper diagnosis. ENS can be treated by relieving good airflow through the nasal passage and prevented by opting for less invasive surgeries/procedures. Overall, it is important that you see your doctor about ENS to mitigate any risks and side effects to your health and you should be informed of all of the risks (including developing ENS) before going through with any surgical procedures within the nose (such as a turbinectomy).
- Gordiienko IM, Gubar OS, Sulik R, Kunakh T, Zlatskiy I, Zlatska A. Empty nose syndrome pathogenesis and cell-based biotechnology products as a new option for treatment. World J Stem Cells [Internet]. 2021 Sep 26 [cited 2023 Jun 16];13(9):1293–306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8474723/
- Hurley JJ, Hensley JL. Physiology, airway resistance. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jun 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK542183
- Khalkhal E, Razzaghi M, Rostami-Nejad M, Rezaei-Tavirani M, Heidari Beigvand H, Rezaei Tavirani M. Evaluation of laser effects on the human body after laser therapy. J Lasers Med Sci [Internet]. 2020 [cited 2023 Jun 16];11(1):91–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008747/
- Saafan M. Empty nose syndrome: etiopathogenesis and management. Springer [Internet]. 2016;119–129:119–27. Available from: https://link.springer.com/content/pdf/10.4103/1012-5574.186540.pdf
- Hosokawa, Yu, et al. ‘Surgical Treatment for Empty Nose Syndrome Using Autologous Dermal Fat: Evaluation of Symptomatic Improvement’. Ear, Nose, & Throat Journal, Sept. 2022, p. 1455613221130885. PubMed, https://doi.org/10.1177/01455613221130885.
- Lee, Ta-Jen, et al. ‘Evaluation of Depression and Anxiety in Empty Nose Syndrome after Surgical Treatment’. The Laryngoscope, vol. 126, no. 6, June 2016, pp. 1284–89. PubMed, https://doi.org/10.1002/lary.25814.
- Velasquez, Nathalia, et al. ‘The Empty Nose Syndrome 6-Item Questionnaire (ENS6Q): A Validated 6-Item Questionnaire as a Diagnostic Aid for Empty Nose Syndrome Patients’. International Forum of Allergy & Rhinology, vol. 7, no. 1, Jan. 2017, pp. 64–71. PubMed, https://doi.org/10.1002/alr.21842
- Malik J, Thamboo A, Dholakia S, Borchard NA, McGhee S, Li C, et al. The cotton test redistributes nasal airflow in patients with empty nose syndrome. Int Forum Allergy Rhinol [Internet]. 2020 Apr [cited 2023 Jun 16];10(4):539–45. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182493/