⚠️ This page is work in progress (2024-01-22)
⚠️ 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.
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?
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.
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.
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.
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:
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
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.
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.
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.
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
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.