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Empty Nose Syndrome.pptx

  2. Definition • Empty Nose Syndrome (ENS) is an iatrogenic disorder - a complication of nasal surgery - where the nasal turbinates, especially the inferior turbinates, have been excised or damaged as a result of turbinate surgery causing the destruction of normal nasal physiology. • ENS can be considered a nasal breathing disorder (characterized by paradoxical obstruction) along with concomitant nasal dryness (atrophy).
  3. Epidemiology • Empty Nose Syndrome affects a small number of the population and the incidence is not known because there are no specific studies which have investigated the incidence of ENS. • The absence of incidence-related studies is directly related to the lack of awareness about ENS among medical professionals. • This has resulted in the absence of diagnostic criteria and omission of a diagnosis of ENS in patient records.
  4. Etiology • ENS occurs following turbinate surgery and can emerge months to years afterward. • Some turbinate procedures increase the likelihood of ENS, such as partial or total resection of the inferior nasal turbinates, or mucosal surface cautery. • Risk of ENS increases the greater the turbinates are excised or damaged.
  5. CT before inferior turbinate resection CT after inferior turbinate resection
  6. Clinical Presentation • Nasal congestion, even though your passageways are clear. • Nosebleeds. • A sensation that the air you inhale is too cold or dry. • Dizziness. • Reduced mucus production. • Severe nasal dryness. • Reduced sensation of breathing. • Headaches. • Sensation of drowning. • Post-nasal drip. • Pain. • Inflammation. • Problems with taste (ageusia) or smell (anosmia). • Insomnia and daytime sleepiness. • Tiredness.
  7. Classification Four types have been proposed: • ENS-IT: Inferior turbinate (IT) was fully or partially resected. • ENS-MT: Middle turbinate (MT) was fully or partially resected. • ENS-both: Both the IT and MT were both at least partially resected. • ENS-type: Patient appears to have adequate turbinate tissue but suffers ENS symptoms due to damage to the mucosal surface of the turbinates.
  8. Diagnosis • Diagnosing ENS can be difficult. There is still no definitive diagnostic criteria or reliable tests for the syndrome. • ENS is usually diagnosed by ruling out other conditions that can cause similar symptoms. • Some ENT specialists will diagnose it based on a person’s symptoms and by checking turbinate damage on a CT scan. • A person’s nasal passage airflow may also be tested. The specialist may find that a person’s nose is too open, causing a low rate of airflow • If a doctor suspects ENS, they may perform a cotton test. This is where a small piece of moist cotton is held where the turbinate would be. If it provides relief, the person may be suffering from ENS. However, the cotton test is not a recognized diagnostic tool, and it should not replace a full diagnosis.
  9. Management Some common treatments include: • Using a humidifier at home. • Saline sprays to moisturize nasal passages. • Antibiotic nasal applications for infections. • Applying hormonal creams to the inside of the nose to increase turbinate tissue size. • Sildenafil and other phosphodiesterase inhibitors to increase nasal congestion. • Nasal reconstructive surgery and regenerative medicine treatments can result in some improvement in symptoms.
  10. Prognosis • Moderate relief may be found through surgery or medication. Controlling symptoms as much as possible can help improve the person’s quality of life. • Mental health can also play an important role in recovery for some people. Regular checkups can help relieve the mental stress and anxiety associated with the disorder. • There is currently no cure for ENS. Working with qualified ENT (ear, nose, and throat) specialists and mental health professionals gives a person the best chance of treating or reducing the symptoms of ENS.