Can Fixing the Collapsed Internal Nasal Valve in a Person with Previous Turbinate Reduction Cause Empty Nose?

Question

I was wondering if it is possible that my collapsed internal nasal valve is preventing me from experiencing signs of Empty Nose Syndrome after submucousal inferior turbinate reduction and cuterization? I am thinking about revision rhinoplasty to fix the collapse but am worried about making matters worse and ending up with an empty nose.

Thomas A. Lamperti, MD · Answer

Your question boils down to whether improving your nasal airway with opening up your narrowed internal nasal valve will set you over the edge and cause excess nasal airflow.

	You should have an experienced nasal surgeon examine your nose to see how much inferior turbinate tissue you have remaining after your prior reduction. More conservative turbinate treatment that maintained as much normal turbinate skin lining as possible makes empty nose syndrome less likely

William Portuese, MD · Answer

An empty nose is caused from over resection of either the middle or inferior turbinates. This will have only minimal bearing on the nasal valve. If the nasal valve is collapsed, the most common way to correct it is with a spreader graft. This graft is often fashioned with cartilage that is harvested from the patient’s own nasal septum or ear.

Robert Mounsey, MD · Answer

If you have a collapse of the internal nasal valve this can create significant nasal problems. Turbinate reduction can be performed in many different ways. The longevity of these procedures can be varied. Revision rhinoplasty may be a very good option to correct these problems.

Steven Wallach, MD · Answer

A collapsed middle vault can be treated with a spreader graft and should improve the collapse and may improve breathing. It should not cause an empty nose syndrome.

Chase Lay, MD · Answer

What Dr. Vipond had explained is very accurate.  In your case you need to get a few consults with facial plastic surgeons who are ENT-trained to see if this could really be an issue for you.  Unless you are having problems with a dry nose and crusting now you may not after improving your valve collapse.  Is it possible you'd need a humidifier in your bedroom in the winter?  Yes, but true empty nasal syndrome is rare in cases where a submucosal resection of the turbinates was performed.  There was a time when ENT surgeons literally cut the turbinates out, partially.  It wasn't good.

	Make sure you get a few consults.

	Best of luck

	Chase Lay, MD

Gregory J. Vipond, MD, FRCSC · Answer

Empty Nose Syndrome refers to a nasal cavity that has lost the ability to adequate warm and humidify inspired air. Consequently, mucous becomes dried and the airways feel obstructed. The risk of empty nose syndrome is increased in surgeries that increase the amount and speed of air through the nose. While it is always possible that improving a narrow internal nasal valve will increase airflow and drying after having a prior septoplasty and inferior turbinate reduction, it is less likely if the inferior turbinate reduction was done conservatively and did not just involve amputation of the turbinate.

	A qualified rhinoplasty surgeon should definitely be able to evaluate your nose and help give a good assessment of your treatment options.

Richard W. Fleming, MD (retired) · Answer

As you know nasal breathing problems caused by collapsed internal nasal valves can be corrected by the placement of spreader grafts. A pre-op examination will determine if there is a risk of the empty nose syndrome with dry nasal lining. This is an excellent question but this problem only occurs after significant turbinate reduction which will be obvious on nasal examination.

Can Fixing the Collapsed Internal Nasal Valve in a Person with Previous Turbinate Reduction Cause Empty Nose?

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