Will you feel short of breath after nose surgery? Let's talk about Empty Nose Syndrome (ENS)

Imagine that you had surgery for a blocked nose, and you thought that you would be able to breathe better now. But even after the surgery, you still feel blocked and it is very difficult to breathe. When the doctor examines you, he says that there is no blockage inside your nose, and that the passage is perfectly open. This strange, contradictory feeling is what we are talking about today, Empty Nose Syndrome (ENS). As the name suggests, this condition called 'empty nose' is very rare, and it is also something that causes a lot of stress for many people.

What is this condition called Empty Nose Syndrome?

Simply put, Empty Nose Syndrome (ENS) is when you feel like your nose is blocked and you can't breathe, even though there's plenty of room to breathe through your nose. This can usually occur after nasal surgery.

There are three small, shelf-like structures inside our nose called 'Turbinates'. Their main function is to clean, moisten, and warm the air we breathe in and send it to the lungs. Sometimes, due to things like allergies and infections, these turbinates can become swollen and cause nasal congestion. In that case, doctors perform a surgery to reduce the size of these turbinates (Turbinate reduction surgery). Sometimes, it is necessary to remove part of these turbinates (Partial turbinectomy) or completely (Complete turbinectomy).

Most of these surgeries are successful. However, very rarely , if too much of the turbinate tissue is removed or damaged during the surgery, ENS can occur. This can cause you to feel like you're suffocating, even though your nasal passages are still open. It's like a puzzle.

What causes ENS?

The exact cause of ENS is still being researched, but it is believed to be caused by excessive removal of turbinate tissue during nasal surgery.

Think about it, our nose is not just a tube that lets air through. It's a very complex system.

• Nerve damage: There are tiny nerves on the surface of these turbinates that detect things like air pressure and temperature. When we breathe, these nerves send the signal to the brain that "breathe in now." If these nerves are removed or damaged during surgery, the brain doesn't receive that signal. The brain interprets it as "I can't breathe, my nose is blocked."
• Airflow changes: When the space inside the nose becomes too large after surgery, the airway simply goes straight. It hits the turbinates, swirls, and doesn't get wet. This can cause the brain to not feel like it's breathing properly.
• Bacterial imbalance: The mucous membrane lining the nose helps to protect healthy bacteria. When this layer is damaged by surgery, healthy bacteria can decrease and harmful bacteria can grow. This can increase the risk of infections and ENS symptoms.

What are the symptoms of Empty Nose Syndrome (ENS)?

ENS symptoms can appear weeks, months, or even years after surgery. These symptoms can vary from person to person.

The relationship between ENS and mental health

This is a very important point. Feeling like you're constantly having trouble breathing and not being believed can have a big impact on a person's mental health . Among those with ENS:

• Anxiety
• Depression
• Inability to concentrate
• Frequent anger

Conditions such as: are common. Some studies have shown that up to 70% of people with ENS suffer from depression.

Is ENS a real disease? How does a doctor diagnose it?

Yes, ENS is a real, but not very common medical condition. This is why it can sometimes be difficult to diagnose because a scan doesn't show any blockage inside the nose.

A doctor will mainly use your symptoms and surgical history to diagnose ENS. In addition,

• An endoscope, a small tube with a camera, can be used to examine the inside of the nose.
• A CT or MRI scan may be done to rule out other causes (e.g. nasal polyps, cancer).
• "Cotton Test": This is a very simple, yet important test. The doctor places a cotton ball soaked in saline solution inside your nostril, in the area where the turbinates used to be. After about 20-30 minutes, they will check to see if your symptoms such as shortness of breath and dryness improve. If such symptoms improve even temporarily, it is a strong indication that you have ENS.

What are the treatments for ENS?

There is no cure for ENS, but there are many ways to manage symptoms and improve quality of life .

• Moisturize the nose: Using saline sprays or gels, drinking plenty of water throughout the day, and using a humidifier in the bedroom can help reduce nasal dryness.
• CPAP machine: Some people find that using a ``CPAP'' machine while sleeping helps maintain humidity and airflow.
• Medication: Your doctor may prescribe medications that dilate the blood vessels in your nose and help reduce swelling of the mucous membranes.
• Surgery: If symptoms are severe, surgery may be performed to replace the removed turbinates with an implant. This may involve using synthetic materials such as Gore-Tex or human tissue derived materials such as acellular dermis or platelet-rich plasma (PRP). This works by reducing the space inside the nose, narrowing the airway, and attempting to restore the sensation of breathing to the brain.

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