Empty Nose Syndrome
| Classification according to ICD-10 | |
|---|---|
| T81.9 | Unspecified complication of an operation |
| J34.8 | Other specified diseases of the nose and sinuses |
| ICD-10 online (WHO version 2019) | |
The Empty Nose Syndrome (ENS) (" Empty Nose Syndrome ", also "Open Nose") is the result of excessive removal of tissue from the turbinates , which makes the interior of the nose "too empty". As a result, the inhaled air can no longer be sufficiently humidified, so that the nasal mucus also thickens and crusts form. The thickened nasal mucus then no longer fulfills its purifying function of the nasal cavity adequately and can thus be the cause of infections.
Emergence
The conchotomy ( conchotomy ) is carried out by ear, nose and throat doctors or cosmetic surgeons for various reasons. The main reason for the surgery is a chronic enlargement of the turbinates , which can obstruct the nasal air passage. The main causes of such turbinate enlargements are allergies , hormone fluctuations, the inhalation of dust, smoke or other irritants, structural defects of the nose such as curvature of the septum and the long-term use of decongestant nasal drops.
The term "Empty Nose Syndrome" was originally coined by EB Kern, who was formerly the head of the ear, nose and throat department at the Mayo Clinic in Rochester, Minnesota . He and his colleagues noticed that an increasing number of patients who had had turbinate surgery had symptoms of difficulty breathing and shortness of breath even though their nasal passageway was greatly dilated. Other symptoms were dryness in the nose, mouth and throat, dry eyes, shallow, restless sleep, impaired sense of smell, difficulty concentrating and depressive moods. The MRI showed in all patients that they extended strong or almost completely empty nasal cavities had, so they called these complaints "Empty Nose Syndrome". Kern then gave a series of lectures on the ENS, which he later summarized in a medical article.
Effects
If too much of the turbinates is removed, the nose loses its ability to sufficiently heat, moisten, filter, and smell the airflow. The nose feels dry and empty. The natural interaction between the nose, throat and lungs when breathing is impaired.
ENS results in a number of changes:
- The air flow becomes turbulent , the flow resistance is increased and less air is transported through the nose. The result is the feeling of a stuffy nose.
- The changed aerodynamics in the nose causes the airflow to be directed into the lower, empty nasal cavities, which then prevents adequate ventilation of the upper part of the nose. This leads to a partial loss of the sense of smell .
- The atrophy of the nasal mucosa leads to a dry runny nose, hardly any more mucus is produced. Inhaled pollutants are no longer transported away and accumulate in the nasal cavities.
- The quality of life can be impaired. Patients often withdraw when they feel uncomfortable because of the difficulty in breathing through the nose.
Symptoms
The main complaints with ENS are:
- Paradoxical difficulty breathing, shortness of breath , the feeling of not getting enough air, although enough or even too much air is being inhaled, the airflow is no longer felt. It is difficult to breathe calmly and slowly through your nose.
- The air you breathe and the nasal mucous membranes feel too dry and cold. Irritating feeling of an empty nose.
- Either too little or too much mucus is produced, or a constant, uncontrollable nasal drop. Thick mucus constantly drips from the back of the nose into the throat.
- Crust formation on the nose
- Decreased sense of smell and / or taste , along with an oversensitivity to volatile chemicals such as paint, perfume, detergents, and gasoline.
- Depressive mood
- Occasionally severe concentration disorders
- The voice often sounds nasal.
- Sinus pressure and pain, even if sinusitis has not been diagnosed.
- a headache
- Sometimes nosebleeds
- Putrid smell in or out of the nose, bad breath ( halitosis )
- Difficulty sleeping due to obstructed nasal breathing
treatment
Conservative treatment
There are several treatment methods for ENS. Isotonic saline (0.9% saline) or lactated Ringer's solution can be used to flush out dry mucus and moisten the nasal cavities - this could also reduce infection . Some people feel better when they consume large amounts of dairy products , which increases secretion . The vitamins A , E and D can improve the mucosal condition. Humidifiers can help with dryness, and if you have trouble sleeping, a ventilator (CPAP) with a built-in humidifier can be used. Nasal ointments can moisten the mucous membrane and reduce susceptibility to disease. Various oils, such as sea buckthorn oil , sesame oil or olive oil , are also helpful.
All of the non-surgical measures mentioned will help reduce dryness and maintain the health of the remaining mucosal areas, but they cannot restore the lost functions or normal sensation in the nose.
Surgical treatment
ENS can be improved more or less successfully by trying to restore the structure and quality of the missing turbinates. Implants can be made from various materials; either from bones or cartilage fragments removed from the body or from artificial materials such as Plastipore and hydroxyapatite cement, and recently also from materials such as Alloderm (collagen matrix from foreign human dermis) or silicone.
literature
- D. Passali et al: Treatment of hypertrophy of the inferior turbinate: Long-term results in 382 patients randomly assigned to therapy. In: Ann. Otol. Rhinol. Laryngol. volume 108, 1999.
- D. Becker: Septoplasty and Turbinate Surgery. In: Aesthetic Surgery Journal . September / October 2003, volume 23, number 5.
- GF Moore et al .: Extended follow-up of total inferior turbinate resection for relief of chronic nasal obstruction. In: Laryngoscope. volume 95, September 1985.
- M. May, BM Schaitkin: Erasorama surgery. In: Current Opinion in Otolaryngology & Head and Neck Surgery. 2002, volume 10, pp. 19-21.
- HO Oburra: Complications following bilateral turbinectomy. In: East African Medical Journal. volume 72, number 2, February 1995.
- L. Berenholz et al .: Chronic Sinusitis: A sequela of Inferior Turbinectomy. In: American Journal of Rhinology. July-August 1998, volume 12, number 4.
swell
- ↑ R. Metson include: The Harvard Medical School guide to healing your sinuses. Verlag McGraw-Hill Professional, 2005, ISBN 0-07-144469-6 , pp. 162-163, (online)
- ^ DH Rice et al: The turbinates in nasal and sinus surgery: A consensus statement. In: Ear Nose Throat J. 2003 Feb; 82 (2), pp. 82-84.
- ↑ EJ Moore, EB Kern: Atrophic rhinitis: A review of 242 cases. In: Am J Rhinol. 2001 Nov-Dec; 15 (6), pp. 355-361.
- ↑ a b C. Martin: Having Nasal Surgery? Don't You Become An Empty Nose Victim! Cold Tree Press, Nashville 2007, ISBN 978-1-58385-197-5 .
- ↑ a b S. M. Houser: Empty nose syndrome associated with middle turbinate resection. In: Otolaryngology - Head and Neck Surgery . 2006 Dec; 135 (6), pp. 972-973.
- ↑ S. Grutzenmacher, C. Lang, G. Mlynski: The combination of acoustic rhinometry, rhinoresistometry and flow simulation in noses before and after turbinate surgery: A model study. In: ORL J Otorhinolaryngol Relat Spec. 2003 Nov-Dec; 65 (6), pp. 341-347.
- ^ DH Rice: Rebuilding the inferior turbinate with hydroxyapatite cement. In: Ear Nose Throat J. 2000 Apr; 79 (4), pp. 276-277.
- ↑ SM Houser: Surgical Treatment for Empty Nose Syndrome. In: Arch Otolaryngol Head Neck Surg. 2007 Sep; 133 (9), pp. 858-863.