HomeArticlesWhat is ENS ?ProductsServicesStudiesFind a doctorTools and othersAboutContact
Facebook
YouTube

How to prevent Empty Nose Syndrome

Written by 
Richard MAASSEN

Nasal Obstruction: Cutting Should Be Your Last Option

Chronic nasal obstruction can ruin your quality of life, but getting nasal surgery like turbinate reduction carries a lot of risk. Before you agree to any procedure, you need to be sure the turbinates are actually the cause of your problems and all conservative treatment options have been tried.

Here is how to navigate your treatment safely to avoid complications like Empty Nose Syndrome (ENS).

1. Find out: Are the turbinates really the cause of your problems?

A mildly deviated septum or enlarged turbinates on a CT scan are very common and often _not_ the primary cause of breathing issues. Your nose is a functional organ, not just a set of pipes.

Before considering surgery, evaluate these factors:

  • Allergies & Inflammation: Is the swelling reversible?
  • Reflux (LPR): Many cases of nasal obstruction are actually caused by reflux
  • Nasal Valve Collapse: Does your nose collapse when you breathe in deeply? If the valve is the issue, cutting the turbinates won't help.
  • Jaw & Palate Development: A narrow palate or small jaw can lead to a narrow nasal canal. Palate expansion may be a structural solution that preserves your tissue.
  • Breathing Patterns: Chronic mouth breathing or dysfunctional patterns (like over-breathing) can cause turbinates to swell as a protective mechanism.
  • Nervous System: Chronic stress or dysregulation can lead to vasomotor rhinitis (swelling without allergy).
  • Hormones: Hormone dysbalances (especially but not only in women) can be the cause of nasal obstruction

Important: A CT scan shows structure, not function. It cannot tell you how your brain perceives airflow.

2. Try a Conservative Approach first

The National Health Authority of France (HAS) and most international guidelines recommend a conservative approach first.

  • Trial Period: Try appropriate medical treatments (nasal steroids, antihistamines, rinses) for several months before considering surgery.
  • Culture Tests: If you have a chronic infection, ensure a culture was taken to get the right antibiotic. Don't guess.
  • Breathing Retraining: Try the Buteyko breathing test to see if your "obstruction" is actually a functional breathing habit.
  • The following video shows you instructions for a quick exercise, that you do to unblock your nose in just five minutes.

3. If Surgery is Necessary, do it as Safely as Possible

If conservative treatments fail and the obstruction is truly structural, follow these international safety guidelines to minimize risk:

French and German Health Authorities recommend the following:

  • Septoplasty First: Consider fixing the septum alone first. Only add turbinate surgery later if symptoms persist.
  • Preserve the Mucosa: The turbinates are NOT "extra tissue." They contain vital sensory receptors that signal to your brain that you are breathing.
  • The 2/3 Rule: Surgeons should preserve at least 2/3 of the turbinate structure whenever possible.
  • Avoid Aggressive Resection: Full turbinectomies (total removal) should generally be reserved for cancer cases only.

Modern Techniques Matter

  • If you have a narrow jaw, consider getting palate expansion surgery instead. It adresses the actual source of the problem and widens the nasal airway.
  • ENS has been reported even after "mild" procedures like radiofrequency, coblation, or laser. The goal should always be submucosal reduction (reducing the volume inside while keeping the sensitive mucosa intact).
  • ENS can also happen after cosmetic rhinoplasty.

4. What to ask your Surgeon

Don't let a surgeon "vaguely" describe the procedure. Ask these specific questions:

  1. Is the enlargement inflammatory (reversible) or structural?
  2. Do I have a narrow naw / dome-shaped upper palate? Should I consider expansion first?
  3. Exactly how much tissue will be reduced, and where?
  4. Will the mucosa (the surface layer) be fully preserved?
  5. Are you aware of the risk of Empty Nose Syndrome (ENS) with this technique?
  6. What happens if the nose becomes "too open" (loss of resistance)?

5. Resources & Second Opinions

Never settle for one opinion, especially if the surgeon does not take your worries seriously, or tells you he has never had an ENS case before. Seek out an ENS-aware doctor for a second opinion.

Summary: Turbinate surgery helps many, but it is irreversible. The turbinates are essential for humidification, temperature regulation, and the perception of breathing.

Copyright ©ENS Tips
facebook-squarefacebookyoutube-play