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⚠️ This page is work in progress (2024-02-27)

Understanding ENS Symptoms
ENS symptoms can vary, and if you have specific questions about pain, airflow sensations, mucus, or other symptoms, please consult a healthcare professional. While I don't personally experience these symptoms, I'm here to provide information and support.

The Causes of ENS Symptoms
ENS often results from structural changes in the nose during surgery, altering airflow patterns. Contrary to some beliefs, a lack of resistance is a symptom rather than a cause. Learn more about these changes in airflow patterns in ENS patients. Scientific study on airflow changes in ENS

The Role of Nitric Oxide
Nitric oxide (NO) plays a vital role in our bodies, despite being underestimated for a long time. It's produced in the sinuses' mucosa and delivered to the lungs when breathing through the nose. A reduced NO level may be connected to depression and anxiety scores in ENS patients. Scientific study on NO in the body

How NO Affects Mental Health
NO acts as a gasotransmitter and vasodilator, improving tissue perfusion without affecting blood oxygen saturation. Inadequate oxygen supply to organs can lead to muscle tension and chronic stress, potentially causing symptoms of depression. Scientific study on the link between NO and depression

⚠️ DISCLAIMER: I am not a medical professional. Everything here is based on my own experience and you should consult with your doctor before trying these methods.

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Who is this guide for?

This guide is aimed at patients, who have been diagnosed with Empty Nose Syndrome by a qualified doctor. Everything in this guide has been tested by me personally and at least a handful of other patients. The symptoms of ENS patients vary widely. You might get the most benefit from this guide, if these symptoms apply to you:

You might benefit less, if you have these symptoms:

Not sure if you have Empty Nose Syndrome? Read here: Do I Have Empty Nose Syndrome?

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Menthol inhalation

Menthol has been shown in a study to ease the feeling of suffocation and calm the overexcited nervous system in ENS patients. It stimulates the TRPM8 nerve receptors in the nose, which signal your brain that you are breathing.. You can try products like VICKS inhaler sticks or VapoRub (called WICK in Germany), Tiger Balm White, or menthol oil.

As you can probably tell from the picture, I always carry one of those inhaler sticks around with me and have several scattered around my apartment, so they are always at hand. Just be careful to not over-use them, or you might lightly irritate your nasal mucosa. If it gets uncomfortable, just take a break for a few minutes.

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Nose Pinching + Swimmer's Nose Clip

Some patients experience relief by changinge the airflow at the point of the outer nose. You can try this very easily by carefully pinching the bridge of your nose. You want to change the flow of air, not cuttin it off. Try to find find the upper bony part of your nose, the cartilageous area you are looking for is right under there. Use only the tips of your fingers to apply pressure. The idea is to direct the airflow downwards. If this works for you, you can also buy a swimmer's nose clip for a hands-free solution. I have tried half a dozen products and this one was significantly better than the others. The pressure can be adjusted precisely and it stays in place better than other models.

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Cotton Pad Rolls

Cotton inserts were the first treatment I tried for my ENS. They were a siginifcant improvement for me and should be easy and cheap to try out for most people. The main drawback is, that the cotton gets soaked and moves around in the nose. It might also happen that you swallow it by accident. Always be careful when wearing this and don't wear it during sleep.

ℹ️ Synthetic Cotton Inserts are far superior that natural cotton.

I wanted to include them for their ease of use and accessibility, but have since moved on to use strips of polyester cotton inserts, which are a lot more effective and also safer to use.

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Synthetic Cotton Strips

Using synthetic cotton strips has been a complete game-changer for my symptoms. It is the single most effective treatment I have encountered. It gives me almost the same great effect as a cotton-test performed by my ENT. In my personal opinion, you should make it a priority to try out this method, since it can alleviate your symptoms to a degree, that no other treatmenrs are necessary anymore.

It was developed by my German ENT. He used "Hartmann Rolta soft" polyester cotton, which has two huge advantages over rolled-up cotton pads: Because of the special material, they adhere/stick to the mucosa and do not get soaked! This means they mostly stay in place, don't move around in the nose, and you are not at risk of swallowing them (as long as you let them stick out a bit). I have been wearing these 24/7 for over a year.

The only downside is, that it is a bit more complicated to apply. You need to buy some special products and need to learn the technique. If this seems daunting to you, you can make an appointment with your ENT and show them the video. They can help you learn how to apply the strips to the nose and safely use the bayonet tweezers.

The strips are applied in a way that they augment the natural shape of the inferior turbinate. You might need to experiment a bit with the dimensions of the strips. I would start with a width of 7-10mm and a length of 40-60mm. If your nose is really tight, you can also try a strip of only 30mm length, just in the front part of the nose.

Here are some links so you can buy the products:

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Enovid Spray

ENS patients have been shown in a study to have lowered nasal nitric oxide (NO). Not to be confused with nitrous oxide (N2O).
For instant suffocation relief, you can increase nasal nitric oxide with a nasal spray called SaNOtize Enovid ("VirX" in Germany). It is avaliable for prescription-free for purchase in Israel and Germany. But you can order it from international sellers on eBay for around $30.
Be careful: This spray contains the preservative benzalkonium chloride, which can cause a rebound effect of rhinitis medicamentosa, if used too much. I personally have not yet experienced this after 1-2 daily use for a few weeks.
Scientific study on Enovid
Here are some reports from other users

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Natural Medicine & Supplements

  • L-Tryptophan 500mg under the tongue can help calm you down immediately and help feel asleep at night. It is the basic building block that serotonin and melatonin are created from.
  • Omega 3 fish oil capsules
  • Melatonin 1mg for sleep; it may take 3-4 days to start working.
  • Curcumin (from Turmeric) has a vasodilatory effect, can bei either consumed thorugh food, or for extra effect as a supplements. Liposomal curucumin is especially potent.
  • Capsaicin (from Chili or Cayenne Pepper) has a vasodilatory effect and also increases mucus production. I like eating srirache or sweet chili sauce at least once per day.

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Gelum

Gelum-drops reduce lactate levels in the body. Lactate is connected with anxiety and known to be elevated in people with breathing issues like obstructive sleep apnea or (chronic) hyperventilation. Hyperventilation is a common symptom in ENS patients.

Effects: I have been taking them for six weeks now as prescribed, 3x daily 1ml. The effect has been noticeable immediately for me. I feel more relaxed, more focussed, have better mood. There have been no changes in breathing, dryness or sleep so far. But I am really amazed, this is one of the most effective things I have taken so far. It basically saved Christmas for me, because for the last weeks I had been suffering really badly, as every year during wintertime. My family also noticed the change immediately.

I also spoke to a doctor about it, who knew these drops. Told him how after taking it for the first time, my tense back muscles started tingling and after some stretching I felt relaxed and clear-minded again for the first time in weeks. And he confirmed for me, that this is an expected effect when lactate gets removed.

Side effects: They list gastrointestinal discomfort as a possible side effect. I have noticed a bit of bloating and gas maybe, but not a huge issue.

How they work: The drops contain a "potassium-iron-phosphate-citrate complex" and are usually used for people who are suffering from liver issues. The aim is to ease the burden on the liver, by binding ammonium in the gastrointentinal tract. This frees up capacity in the liver to process more lactate and turn it into glucose, which gives us new energy. And if you have heard about lactate before you probably know, that it is produced in the cells, when not enoug oxygen is present. This is a well-known phenomenon in patients with sleep apnea or hyperventilation and connected with anxiety/panic.

One study showed it helps in liver disease and how it improves symptoms of exhaustion and depression in liver patients.

And one German study about how they achieved to improve the lactate curve of healthy athletes (PDF auto-translated).

Where to get them: They are prescription-free in Germany. A small bottle of 30ml to try it out costs 8€. There are also international sellers.

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Pregabalin/Lyrica

Pregabalin/Lyrica is the prescription medication that has helped me best so far. It is usually prescribed for anxiety, restless legs or nerve pain. From taking it for the first time, I had the experience "I finally feel like myself again!". I have been taking it for several months, at a low dose of 3x50mg daily.

It clears my mind, calms my body (no more restless legs!), takes me from irritable to more social, and also allows me to breathe a little deeper. My diaphragm relaxes a little bit.

It works by targetting GABA receptors in the brain, which cause calm and relaxation. Those are the receptors that are also targetted by alcohol or benzodiazepines. So far, at this dosage, I have not experienced any side effects.

It is non-addictive, but needs to be tapered off if taken at higher doses. I felt the effects immediately after the first dosage, others have reported feeling the effects after one week. Please consult with your doctor.

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Nara-Triptan and other triptans

Triptans are usually prescribed as migraine medication. Since I got ENS in 2019, I have developed migraines myself and started taking triptans. One thing I noticed was, that it does not only cure my headache, but also allows me to breathe easier and deeper. They also help my body relax and calm down, but it might take 2-3 hours for the effect to fully develop. I don't understand how this effect is created, but sometimes the inside of my nose starts tingling when taking them, as if it increases blood flow in there.

Watch out: Triptans are very potent and one of the most effective treatments I have found, but they should be taken very carefully. Migraine patients are told to take at most 10 doses per month.

Nara-Triptan is prescription-free in Germany, other triptans need to be prescribed by your doctor. I have also tried Riza-Triptan, which seems to have a stronger, more short-lasting effect, wheres I feel the effect of Nara-Triptan for about 24 hours.

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Medical Cannabis

coming...

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Surgical Treatments

Cartilage implants are often considered the most promising long-term solution to rebuild turbinates. These implants can use your cartilage from the ear or rib or donor cartilage. While other materials are used, they may be absorbed over time. Scientific study on cartilage implants
For a less invasive but more experimental approach, consider adipose-derived stem cell (ADSC) injections. Although only one study has been conducted, it shows promise in treating ENS. Clinics offering ADSC injections are located in San Marino (Italy) and Kyiv, Ukraine. Scientific study on ADSC treatment

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Further Resources

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Share Your Experience

Please report back if you try any of the methods here, whether successful or not. Your feedback can be valuable to others dealing with ENS.

We get many questions of people asking whether they have ENS.

ENS6Q

That being said, if you are asking yourself, if you should go see an ENT, please take the ENS6Q:

The "The Empty Nose Syndrome 6-Item Questionnaire (ENS6Q)" is a scientifically validated diagnostic aid and checks for the symptoms that makes ENS distinct from others nose diseases. Rate each symptom from 0 (not at all) to 5 (very severe).

  1. Dryness
  2. Sense of diminished nasal airflow
  3. Suffocation
  4. Nose feels too open
  5. Crusting
  6. Burning

Then add up the scores, the sum should be between 0 and 30. If you have a score of 11 or higher, you should consider seeing an ENT for proper diagnosis. Please be aware, that you might score unusually high in the early days and weeks after surgery. This is normal and expected, and will most likely disappear again after some times has passed and healing has progressed further.
Many doctors wait 6-12 months till making an official ENS diagnosis, because so much healing can still potentially happen during this time.

CP-Test

Please also check yourself for chronic overbreathing (the correct medical term is chronic hyperventilation). You can try the so called CP-test to check yourself. A healthy result would be 40 seconds or higher, below 20 seconds usually presents as noticeable health difficulties.
There is a study which showed that 77% out of 22 ENT patients were suffering from hyperventilation. But there are also anecdotal reports of ENS patients experiencing the opposite symptom of hypoventilation ("under-breathing"). Those might experience almost forgetting to breathe, for example.

If you have a low score and want to raise it, there are breathing exercises which can help you improve it. health difficulties. This video explains the concept and shows an exercise. Please try the exercise for a full 10 minutes and see if it improves your symptoms. It should provide relief for many nasal and breathing conditions. You can also check your CP score again afterwards and see if it is higher now. The exercise should provide relief for many people, whether they have ENS or not. The main difference is, that ENS patients will only have immediate, but not lasting effects from this.

What's next?

If you suspect, that you might be suffering from ENS, then please make an appointment with an ENT to get diagnosed. We have a list of doctors around the world which might be able to help you.

You might also want to take a look at our Self-Help Guide, to find something to give you relief in the meantime.

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