Empty nose syndrome (ENS) is the feeling you get despite your nose being empty. ENS can happen if surgery takes out too much tissue inside your nose.
Empty nose syndrome is an uncommon and complex problem. The term "empty nose" explains the empty space inside your nasal cavity after surgery. Often, you'll slowly lose nasal tissue called mucosa.
Below your mucosa tissue are turbinates (nasal conchae). They help clean and moisten the air you breathe in. Blood vessels and mucus membranes surround these small bony structures.
Sometimes, allergies, infection, or irritation can swell or congest your turbinates. That's because mucus builds up to make breathing harder. Nasal surgery can widen your airways inside your nose. Procedures can also fix breathing issues.
With nasal surgery, you may get:
A partial turbinectomy
A complete turbinectomy
Turbinate reduction surgery
Ear, nose, and throat doctors (ENT specialists) perform these surgeries. They'll remove or shrink your turbinates to help you breathe better.
In most cases, nasal surgery successfully gets rid of your breathing issues. But after surgery you may get:
Breathing issues
Dryness in your nose
Headaches
Nosebleeds
Sometimes, the surgery can remove too much tissue or damage your turbinates. With ENS, you may still feel stuffy or clogged. But your nose is empty. This is called a paradox — it's a puzzle. Here's a look at empty nose syndrome causes, symptoms, and what to do if you have it.
What Causes Empty Nose Syndrome?
Many experts believe removing too much nasal tissue might cause ENS. But the exact cause is still unclear.
Empty nose syndrome can happen after the removal of your:
- Inferior turbinate, the largest of the turbinates and the most common reason for ENS
- Middle turbinate, which can involve pain when breathing
- Both your inferior and middle turbinates, which can also cause nasal cripple — your nose may not function correctly
There is also a type of empty nose syndrome called ENS-type. It can happen because of damage to your turbinate tissue.
Imaging scans might show plenty of space in your nasal cavity. You may have space to breathe in and out. But you might find it hard to inhale fully. After surgery, physical and functional changes can contribute to ENS.
Different levels of air pressure inside your nose
After surgery, your nose can detect temperature or pressure changes. This can make it hard to sense regular breathing patterns. And it could lead to feeling deprived of air.
Nasal receptor issues
Typically, you breathe in air that contains small molecules. The molecules contact special nerves in your nose. The nerves detect pressure, temperature, or smell changes. Some nerves are on your turbinates. After surgery, your nerves can get damaged or removed. Without the nerves, your brain may sense fullness.
Wider nasal passages
After nasal surgery, wider nasal passages can change your airflow. Your inhaled air can have little contact with your nasal mucosa. And the air doesn't cool down. The lack of air conditioning can cause your brain to sense fullness.
Bacterial infection
Nasal surgery can help get rid of excess mucus buildup. But it can also lower your healthy bacteria. Without healthy bacteria, bad bacteria can overgrow. This can cause an imbalance, leading to infections and ENS symptoms.
What Are the Symptoms of Empty Nose Syndrome?
Empty nose syndrome can show up a few weeks, months, or even years after surgery.
With empty nose syndrome, you may have:
- Trouble breathing
- Stuffy, congested nose
- Headaches
- Dizziness
- Severe dryness inside your nose and throat
- Nosebleeds
- A sensation of cold air when you breathe in
- Low mucus production
- Postnasal drip and nasal crusts
- Feelings of suffocation or drowning
- Pain
- Inflammation inside your nose
- Inability to smell normally (anosmia)
- Problems with sense of taste (ageusia)
- Fatigue
- Hard time sleeping
Empty Nose Syndrome and Mental Health
Empty nose syndrome symptoms can impact your quality of life. And breathing issues can raise your risk for mental health issues.
Empty nose syndrome can make it harder to focus at work or school. And some research shows about 7 in 10 people with ENS report depression.
With empty nose syndrome, you may have a higher risk for:
- Anxiety
- Depression
- Irritability
- Distractibility
- Trouble focusing and concentrating
- Suicidal thoughts
One study found people with ENS have a higher risk for suicidal thoughts. But the link between empty nose syndrome and suicidal thoughts is still unclear.
If you or your loved one has thoughts of self-harm, call or text 988 to reach a certified counselor at the Suicide & Crisis Lifeline; they're always open. Talk to your health care provider as soon as possible, call 911, or get medical attention immediately.
Is Empty Nose Syndrome Real?
Although uncommon, empty nose syndrome is a real medical condition. Experts are still learning more about ENS and how to avoid it.
Empty nose syndrome is not widely understood. Some doctors may not know about empty nose syndrome. And the symptoms for empty nose syndrome can look like other health conditions.
How do you diagnose empty nose syndrome?
Your doctor may ask questions to find out more about your empty nose syndrome. You may take the:
Sino-nasal outcome test (SNOT-25), a five-question survey with ENS-specific questions.
Empty nose syndrome 6-item questionnaire (ENS6Q), the test asks you six questions about your ENS.
Your doctor may also use an endoscope. It's a flexible, wire-like tube with a light at the tip. They'll insert it through your nostrils to look at your nasal cavity. Your doctor looks for signs of crusting and dry, pale mucosal tissue.
To diagnose empty nose syndrome, your doctor may:
- Review your history for nasal surgery
- Check for acid reflux, can cause a cough or postnasal drip
- Look for spinal fluid leaks, they can cause nasal discharge or inflamed mucosa
- Order imaging scans, can rule out other breathing problems like structural issues, nasal polyps, or tumors
- Look for an abnormal breathing pattern called paradoxical airway obstruction
- Check for shortness of breath, a suffocation feeling, or nasal dryness
- Ask if you feel your nose is too open or burning
- Ask if you have depression, a lack of air, or lower sense of smell
- Perform a "cotton test"
Empty nose syndrome can be hard to diagnose. That's because your nose imaging scans usually don't show blockages. Diagnosis is made from clinical symptoms and an exam.
What is the cotton test for empty nose syndrome?
The cotton test can help your doctor measure your nasal implants for surgery. They'll wet some cotton with salt water and place it in each nostril. After 20-30 minutes, you'll tell your doctor if your symptoms get better. If your empty nose syndrome improves, a submucosal implant may offer long-term help.
How Do You Treat Empty Nose Syndrome?
There's no cure for ENS. But you can manage your empty nose syndrome symptoms.
Home remedies for ENS
You can try remedies such as:
Topical moisturizers. Saline sprays or gels can moisten your nasal passages. But saline likely has limited benefit. And some experts think it may wash away good mucosa proteins.
Drink plenty of fluids. This will keep your mucosal surfaces moist.
Use a humidifier when you sleep. But clean it often to prevent fungal growth and illness.
Use a continuous positive airway pressure (CPAP) machine when you sleep. The machine can help add back moisture and maintain your airflow.
Medications for empty nose syndrome
Your doctor may also prescribe medication to help enlarge your nasal passages. Medicines such as estrogen or viagra may help your ENS symptoms.
Surgery to treat ENS
In some cases, your doctor may suggest a turbinate implant. This can help ease ENS symptoms. But implants can't moisten your air or provide immunity.
The implant surgery adds tissue inside your nose. The added material can bulk up the empty space. This may help reduce your symptoms.
Your doctor may use:
- Gore-Tex, a man-made material to provide volume inside your nose
- Acellular dermis, a human collagen matrix to give structure and support
- Platelet-rich plasma combined with acellular dermis, adds platelets (blood clotting particles) from your blood to help tissue repair
How to Prevent Empty Nose Syndrome
The key to prevent ENS is keeping enough nasal tissue. Your nasal mucosa helps with air conditioning. So it's important to keep this tissue during surgery. Some surgeons use computers to look at the air flow in your nose.
This virtual surgery can help your doctor make the most minimal change. They'll remove the smallest amount of turbinate tissue to improve your airflow.
Takeaways
Empty nose syndrome (ENS) can happen after a nasal surgery takes out too much tissue inside your nose. With ENS, you may have abnormal breathing patterns, shortness of breath, decreased smell, or depression. This rare medical condition can also impact your mental health. Talk to your doctor about the best treatment for your empty nose syndrome.
FAQs About Empty Nose Syndrome
How common is empty nose syndrome?
Empty nose syndrome is uncommon. It's not known how often it happens. But some studies report that about 8 to 22 out of every 100 people get ENS after turbinate surgery. With inferior turbinate removal, one study reported about 2 in 10 people get ENS.
Is turbinate reduction surgery useful in ENS?
Turbinate reduction surgery isn't useful if you have empty nose syndrome. In fact, this procedure is one of the causes for ENS.
How do you sleep with empty nose syndrome?
With ENS, you may have sleep problems. You can have daytime sleepiness. One study reported sino-nasal outcome test-25 (SNOT-25) scores 69 or higher predicted sleep problems in people with ENS.