Worried about"empty nose syndrome". How much of the turbinate is normally removed during surgery and how much is too much?

Question

I have had 4 nasal surgeries, and 3 in office radiofrequency coblation procedures. I ended up having nasal valve collapse, and then had that revised 3 times. For the first time, I have been told that my airway is wide open, but I can't seem to feel like I am getting enough airflow, especially through one side. My current doctor told me that I have 1/3 and 1/2 of my turbinates left (right and left side). Could I have empty nose syndrome? Do I have enough turbinate left? Can this ever resolve?

Garrett Griffin, MD · Answer

Ahimsa: I have seen people develop empty nose syndrome after their nasal valve is finally fixed.  Firstly, I would see if your current surgeon can show you endoscopically that your nose is truly wide open.  Do this without spray first because the decongestent spray will open everyone's nose up.  If you are convinces your airway is widely open, and still feel it is blocked, that is probably empty nose syndrome.  In that case, the first thing to do is to maximally moisturize your nose with saline gel (ayr) and even some vaseline.  If that doesn't help you can try estrogen nasal drops which will make your nasal lining swell (like how pregnant women have difficulty breathing through their nose), but there are risks of estrogen, especially for a man (can't tell from your name if you are male or female).  Lastly, you could have another surgery to try to worsen your nasal valve, but that would be a last resort and only if you think your empty nose symptoms are worse than when you truly couldn't breathe through your nose. Best of luck.

Kimberly Lee, MD · Answer

Empty Nose Syndrome is possible given the concerns you describe.  The best recommendation is to consult with a board certified specialist (ENT or facial plastic surgeon) who can assist you with diagnosing the problem first before making any treatment recommendation.

Mark Loury, MD, FACS (retired) · Answer

It is likely that you have ENS.  Normally there is some degree of resistance to airflow through the nose especially at the nasal valve which provides 50% of all resistance.  Some estimate that the valve is responsible for 25% of airflow resistance from the nasal tip to the smallest lung airways.  This resistance is important because it requires the lungs to work a little harder which opens up these distal bronchial tubes.  In ENS therefore patients feel as if they aren't getting enough air and sense shortness of breath.  Some think that overresection of intranasal structures damages the nerves so that people with this condition don't feel that air moving through their noses.  Once present it is nearly impossible to resolve.  Some have tried submucosal implants to reduce the intranasal volume but I don't know how successful have been those attempts.  Any further surgery only puts you at risk for more problems particularly atrophic rhinitis.  Not that it is any consolation but this condition is more annoying than life-threatening.

Worried about"empty nose syndrome". How much of the turbinate is normally removed during surgery and how much is too much?

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Worried about"empty nose syndrome". How much of the turbinate is normally removed during surgery and how much is too much?

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