Serious Consequences of Nasal Surgery: ENS, Breathing Issues, and Systemic Health Effects

Quick Overview of the Consequences of Nasal Surgery

Surgical Procedures in the Nose and Their Consequences:

Turbinate reduction (turbinoplasty), septoplasty, spreader graft surgery, and medial maxillectomy (a sinus surgery where the wall between the nose and maxillary sinus is removed) lead to excessive nasal opening, resulting in a loss of normal airflow resistance. Additionally, these procedures impair the filtration, warming, and humidification of inhaled air and cause damage to the nerves and receptors responsible for airflow perception.

Impaired Nitric Oxide Production:

• Epithelial cells in the nasal mucosa produce nitric oxide (NO), which mixes with inhaled air and contributes to bronchodilation, improved oxygenation, and protection against infections.
• Turbinoplasty amputates or damages epithelial cells, reducing NO production.
• ENS can lead to secondary atrophic rhinitis and further loss of NO-producing epithelial cells.
• Consequences: Impaired oxygenation, increased risk of infections, and worsening respiratory problems.

Sensory and Nerve-Related Effects:

• Nerve damage and loss of mucosa containing TRPM8 receptors (thermoreceptors) lead to:
  • Impaired sensory feedback to the brain.
  • Reduced natural pause between exhalation and inhalation.
  • Decreased airflow sensation, which can cause:
    • Air hunger → Feeling of suffocation → Feeling of drowning → Tension → Stress response → Severe sleep disturbance.
• Amputation or destruction of nasal structures and mucosa leads to:
  • Loss of part of the respiratory system.
  • Disrupted autonomic regulation of sympathetic and parasympathetic balance.
  • Reduced nasal resistance, affecting breathing depth and heart rate regulation.

Dysfunction in Breathing Regulation:

• Altered breathing rhythm and hyperventilation:
  • Without normal airflow resistance, air flows too quickly in and out of the nose → Overventilation → Abnormally high minute ventilation → Excessive loss of carbon dioxide from the blood → Hypocapnia → Alkalosis → Systemic effects.
  • Nerve damage eliminates the natural breathing pause between exhalation and inhalation. This leads to more breaths per minute and excessive minute ventilation → Hypocapnia → Alkalosis → Systemic effects.
• Loss of TRPM8 receptors can lead to:
  • Increased tidal volume (airflow per normal breath) – If airflow is not felt, breathing depth may increase → Overventilation of the lungs.
  • Inability to sense airflow also leads to air hunger and reduced pause between exhalation and inhalation → More breaths per minute → Increased minute ventilation → Excessive loss of carbon dioxide from the blood.
• Low carbon dioxide levels (hypocapnia) cause:
  • Alkalosis → Systemic effects.
  • Vasoconstriction → Impaired oxygenation.
  • Reduced oxygen uptake at the cellular level (Bohr effect).

Autonomic and Metabolic Stress Response:

• Chronic sympathetic dominance ("fight or flight").
• Increased lactate production and metabolic dysfunction.
• Compensatory increase in hematocrit (B-ERV) and MCHC to improve oxygenation.
• Alkalosis causes a compensatory decrease in blood bicarbonate concentration.
• Electrolyte disturbances, including low ionized potassium and calcium.
• Impact on the renin-angiotensin-aldosterone system (RAAS) → Blood pressure dysregulation and sodium/potassium imbalances.

Heart and Circulation:

• Oxygen deficiency (Bohr effect) leads to:
  • Compensatory increased blood pressure.
  • Stress and low carbon dioxide levels cause vasoconstriction.
  • Increased heart strain, impaired oxygen supply to the heart muscle, and sleep deprivation.
  • Risk of left ventricular hypertrophy.
  • Further reinforced sympathetic overactivity.

Neurological and Cognitive Impact:

• Reduced cerebral perfusion → Impaired oxygen delivery to the brain.
• Sleep problems, reduced deep sleep, and increased beta-amyloid accumulation.
• Increased risk of neurodegeneration and cognitive impairment.
• Mitochondrial dysfunction → Fatigue and brain fog.
• Impact on dopamine and serotonin balance → Increased risk of depression and anxiety.

Long-Term Systemic Complications:

• Chronic inflammation and oxidative stress.
• Weakened immune system → Increased susceptibility to infections (e.g., pneumonia).
• Higher risk of heart attack, stroke, and other circulatory diseases.
• Impaired gastrointestinal function → Reduced motility and nutrient absorption.

Quality of Life and Social Consequences:

• Severe impairment of functional ability.
• Social isolation and loss of relationships.
• Increased risk of suicide, statistically highest in years 1–2 after ENS onset and years 4–8.
• Inability to work and premature aging.
• Loss of career and colleagues.
• Financial ruin – Poverty.

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Potential Nocturnal Hypoventilation in ENS

In ENS, breathing regulation is disrupted, typically leading to hyperventilation. However, in some cases, nocturnal hypoventilation can occur, meaning inadequate ventilation of the lungs, resulting in excessive carbon dioxide buildup in the blood.

During sleep, breathing depth naturally decreases due to lower metabolic activity, reduced diaphragm movement, and altered central breathing regulation. In individuals with ENS, these normal changes may be exacerbated by the lack of nasal airway resistance and other physiological factors, further disrupting the breathing pattern at night.

Possible Causes of Nocturnal Hypoventilation:

• Reduced intrathoracic pressure → Decreased airway resistance can affect pressure conditions in the chest, impairing lung expansion.
• Reduced intra-abdominal pressure → Impact on diaphragm movement can lead to reduced stability and inefficient breathing.
• Impaired lung expansion → Reduced diaphragm resistance (air resistance) during inhalation can result in shallower breaths, especially during sleep.
• Premature lung collapse during exhalation due to lack of nasal resistance → Normally, nasal resistance creates a certain backpressure during exhalation, helping keep airways open longer and maintaining optimal gas exchange. In ENS, the absence of this resistance can lead to faster lung emptying and potentially premature collapse of smaller airways (atelectasis), reducing the time required for effective carbon dioxide clearance and alveolar gas exchange.

Impact of nasal surgery and turbinate reduction on mucosal temperature and cooling

The mucosal temperature postop has been shown to increase by average 0.9C (+3.0%) on both nasal expiration and inspiration, with the T°C difference between the nasal expiration and nasal inspiration being a constant 4C both preop and postop. This finding was true for all intranasa compartments: internal nasal valve, nasal cavity and inferior turbinate (Seresirikachorn 2024).

An ENS patient who is a member of the ENS fb group, has previously undergone both an aggressive turbinate reduction and aggressive septoplasty. He performed his own T°C measurements of the internal nasal valve (INV), using FLIR One Gen 3 thermal camera similar to the one used in Seresirikachorn 2024 study. His study showed that, on mouth breathing, there was a significant leak of air from the nose and that placing intranasal cotton plugs helped both reduce that air leak by about 60% and lower intranasal temperature by about 4%, with the difference between inhalation and exhalation being a constant 4.5C both with cotton and without. On nasal inhalation, this ENS patient used cotton plugs to effectively lower the intranasal T°C by about 0.6C (2.1%). However the exhalatory intranasal T°C stayed at 33.3C despite the cotton placement.

Seresirikachorn 2024 set the preoperative normal T°C for INV at 31.50C on nasal exhalation and 27.7C on nasal inhalation. This ENS patient with nasal cotton plugs in place, experienced 33.3C on nasal exhalation and 26.5C on nasal inhalation. While cotton plugs helped lower inhalationary T°C, they seemed ineffective with exhalatory T°C, leading to chronically high and damaging T°C on nasal exhalation, in absence of normal mucosal function and secretions. While +3-4% intranasal T°C increase may seem insignificant, that T°C increase appears to be detrimental to the histological structures of nasal mucosa, including cilia, ciliated cells, respiratory epithelium, goblet cells and basal cells. High Intranasal T°C leads to more mucosal dryness and atrophy, overheating of nasal cavities, septal burning, trigeminal pain and, ultimately, respiratory distress. Though there is no permanent solution to the destructive overheating of the nasal cavities from ENS, some patients find some relief in breathing clean cold air and/or refrigerator cooled supplemental oxygen. This shows again that nasal airflow resistance and intact mucosa are critical for adequate cooling of the nasal cavities and adjacent parts of the nervous system (e.g. ganglion block) and possibly even frontal parts of the brain.

Humidification of Lungs and Nasal Mucosa via water/vapor recycling in the nasal cavities

The nose provides 60-70% of total air humidification for the lungs, including 15% from inferior turbinates (Naftali 2005). On expiration, as air passes through the nose, it gives up heat to the cooler nasal mucosa. This cooling causes water vapor condensation and 33% return of both heat and moisture to the mucosal surfaces (White 2015). The sensation of pharyngeal dryness often reported by ENS patients is due to an airflow that is insufficiently humidified obviously yielding a drying of the airway mucosa (Scheithauer 2010). Intranasal dryness triggers the mucosal degradation and atrophy that leads to deterioration of the ENS condition and, ultimately, death. Additionally, dryness in the lungs leads to formation of more alveoli dead space, further hindering proper gas exchanges in the lungs.

Empty nose Syndrome - Bente Van de Veerdonk: A Life Interrupted by Septoplasty and Turbinate reduction

Instagram   Facebook   Linkedin   Bentes posts in an ENS group   This page in word

Empty Nose Syndrome yet a tragic story -Introduction

Bente Van de Veerdonk was a vibrant and determined young woman from Oss, Noord-Brabant, in the Netherlands. Born on December 28, 1997, she had a promising future, skillfully balancing her aspirations in marketing and communication with a career in childcare. Tragically, her life was cut short in November 2024, just 1.5 months shy of her 27th birthday, after a devastating struggle with health issues related to septoplasty and turbinate reduction.

During the septoplasty, Bente's inferior turbinates were reduced using coblation, a method that burns the nasal turbinates. This procedure ultimately led to Empty Nose Syndrome (ENS). Alongside ENS, Bente also battled Crohn's disease and thyroid imbalances, which further compounded her significant health challenges.

A Life of Ambition and Dedication

Bente’s educational journey reflected her passion for learning and personal development. She pursued childcare studies at ROC de Leijgraaf from 2014 to 2017, earning qualifications as a pedagogical employee. Her dedication to children shone through her work at Avem Kinderopvang from July 2019 to November 2021, where she provided care and early childhood education. She later decided to further her education, studying marketing and communications at LOI (Leidse Onderwijsinstellingen) in 2023, aiming to broaden her professional horizons.

A Multifaceted Health Struggle

In addition to her professional and academic pursuits, Bente faced chronic health challenges. She was diagnosed with Crohn’s disease, an inflammatory bowel condition. She also battled thyroid imbalances that left her body in a fragile and unpredictable state. Despite these challenges, she remained hopeful, seeking alternative therapies such as homeopathy and consulting with specialists to find relief.

The Nose Surgery That Changed Everything

In early 2024, Bente underwent nasal surgery to correct a deviated septum and reduce enlarged turbinates. The procedure included septoplasty and bilateral turbinate reduction performed using coblation, a technique often described as low-risk and intended to improve nasal airflow. However, as in many other cases, the surgery led to immediate complications that progressively worsened over time. Her post-operative care involved the use of corticosteroid nasal sprays, which Bente believed further damaged her nasal mucosa.

Brentes symptoms were severe and unrelenting:

Feeling of excessive airflow through the nose.

A persistent burning sensation in her nostrils. The nasal pain was described as severe and unrelenting.

Severe nasal dryness and crusting, worsened by corticosteroid nasal spray prescribed post-surgery.

Slept with her mouth open due to nasal discomfort, which exacerbated dryness.

A sensation of hyperventilation and inability to sense airflow during exhalation. Hyperventilation was worst at night.

Sleep deprivation, including periods of up to five days without rest.

Constant awareness of breathing, leading to severe hyperfocus on it.

Difficulty focusing on everyday tasks, as even watching television became unbearable.

Systemic effects such as dry eyes, a lump in her throat, painful ears, and burning sensations in her chest and limbs.

These symptoms pointed to Empty Nose Syndrome (ENS), a condition where the nasal passages feel overly open, disrupting normal breathing and airflow sensation.

Experimented unsuccessfully with nose clips, tape, and other methods to block excessive airflow.

Other Symptoms Likely Related to ENS:

Dry eyes and mouth.

Difficulty swallowing and a persistent feeling of a lump in her throat.

Ear pain.

Burning sensations across her chest, arms, and back.

Other Medical Conditions:

Reported her thyroid was "close to being too hard," indicating hyperthyroidism or another form of thyroid dysfunction.

A Desperate Search for Relief

Bente sought help tirelessly, consulting with specialists, including plans to visit Dr. Dixon, an ENS expert in Rotterdam. She explored treatments ranging from nasal ointments and warm beverages to alternative therapies like homeopathy. Despite her efforts, the relief was fleeting or nonexistent. On online forums, she vulnerably shared her experiences and sought advice, expressing both hope and despair.

In one poignant post, she wrote:

"I can’t focus on anything else but my breathing. Sleeping is a BIG issue... I really need help to make it a bit more bearable because now I can’t even focus on the TV. You have to imagine."

Her desperation was palpable as she detailed her struggles with insomnia, dependence on lorazepam, and her declining mental health. She expressed fear, isolation, and a longing for a solution that never came.

Bente Van de Veerdonk - The Final Days

In the ten months following her surgery, Bente’s quality of life deteriorated drastically. Once manageable, her health challenges became insurmountable. By the time of her death in november 2024, she had endured sleepless nights, chronic pain, and the emotional toll of feeling her body "failing in every way." Despite her relentless search for hope and support, her suffering became too great to bear and she ended it herself.

A Legacy of Awareness

Tragically, Bente became the sixth individual in 2024 to take her own life as a result of the unrelenting suffering caused by Empty Nose Syndrome (ENS).

Earlier this year, others suffering from ENS also took their own lives, including Charly Audes (France), Tyler Kuckelman (US), Océane Flavigny (France), Sam Treffry (Australia, 2024), and a 54-year-old Canadian man (name withheld).

Please note that these names are based on reports from three online ENS support groups on Facebook, with approximately 5,000 to 6,000 members. It is important to emphasize that this number does not reflect global statistics, as the actual number of ENS-related deaths worldwide is likely much higher.

Bente's death was a direct consequence of complications from a septum and turbinate surgery performed by her surgeon. How many more lives must be lost before authorities intervene? When will these dangerous procedures be banned, and when will the medical community be held accountable for the harm they cause?

Empty Nose Syndrome - Jack Ackland's Silent Struggle: The ENT Surgeon Who Took Down a Combat Pilot

Jack, a devoted Air Force veteran, served his country with immense personal sacrifice. His struggles began with sinus issues that worsened during flight training. In search of relief, Jack underwent several sinus surgeries over the years. Under pressure from superiors, he also had a turbinectomy performed, a procedure that left him disabled and ultimately ended his military career. Read Jacks PDF file here.

Initially, Jack held onto hope that these surgeries would ease his sinus issues and allow him to continue flying, but the outcome was far from what he had envisioned. Each surgery brought complications and did not ease his pain. Instead, they led to a condition known as Empty Nose Syndrome (ENS). This syndrome occurs when excessive tissue is removed from the nasal passages, leaving the patient with a feeling of nasal obstruction, despite the physical space being open. Jack felt suffocated by the very air that was supposed to relieve him, leading to profound emotional and psychological distress.

The impact of ENS on Jack’s mental health was devastating. He experienced a significant change in personality, becoming withdrawn and depressed. The physical pain he endured was intensified by the emotional toll of feeling trapped in a body that had been butchered. Jack struggled to articulate his suffering to those around him, which only added to his sense of isolation. His family noticed the changes in him—he became irritable and distant, unable to engage with his loved ones. They could only watch as he battled a silent torment, feeling helpless to alleviate his pain.

In the spring of 1961, overwhelmed by his suffering Jack could no longer endure the pain. He left the house with a .22 caliber handgun and never returned. His suicide was not an impulsive act but rather a culmination of years of physical and emotional struggle, as he felt that his condition had robbed him of his dignity and quality of life.

Initially, the Department of Veterans Affairs (VA) ruled that Jack’s suicide was not connected to his military service or his chronic disability. However, his wife, determined to secure recognition of Jack’s struggles and the impact of his service, appealed the decision. In her appeal, she emphasized her inability to support their children on her meager salary of $4,040 a year (equivalent to about $34,000 today) and argued that she was not seeking to defraud the government but simply wanted to ensure her children could pursue their education.

After nearly a year of appeals, the VA reversed its initial ruling and acknowledged the severe impact of Jack's chronic pain and subsequent mental health issues. They ultimately granted his widow a monthly Dependency and Indemnity Compensation payment of $122 (approximately $1,000 today). This decision marked a small victory in recognizing the Empty Nose Syndrome that took Jack's life, though it came too late for him.

Read the full article about jack Ackland here. The article can also be found in this PDF file

Excerpts from the Article:
"In this hospital, I was placed under the care of Major RW Wright, MD, head of the ENT department. I was determined not to undergo surgery on my sinuses, but after considerable pressure, I ultimately consented to a 'submucosal' operation... referring to a submucosal resection that removes the cartilage and bone from the nose."

"Wright hypothesized that a set of tiny nasal bones called 'turbinates' are often infected and could contribute to ear problems. During Jack's first surgery in March 1943, Wright cut nasal cartilage and bone. He then operated on Jack's turbinates, performing a turbinectomy. Not only was too much of the nasal structure removed, leading to a collapse of the nose, but the ends of the turbinates were resected, resulting in excessive airflow due to an enlarged nasal cavity and atrophic rhinitis. Other doctors criticized the surgery... examining him and deeming the operation 'unnecessary.'"

"Majors Wilucki and Neff in Tucson made very complacent remarks about the well-done work on my nose and expressed doubts about my ability to continue flying but said I deserved a chance to try, Jack recalled in his letter from March 1952. Jack did indeed try, and he failed."

"The symptoms were the same as before hospitalization in Santa Ana, and the pain was exacerbated by flying... The symptoms were so severe that he was unable to fly. Jack was grounded, demoted to private with 'no prejudice,' and sent to Amarillo Air Force Base for assignment," he wrote in his 1952 letter.

Len writes: "I now knew the details of his surgery, but I still had a significant unanswered question: why did Wright, an experienced surgeon, perform such a radical operation that left my father too disabled to continue his service? Did he, in the eyes of other doctors, botch the surgery? Were his resections intentional or the mistakes of an overworked military surgeon?"

"While I could not determine Wright's surgical rationale for my father, the results of the operation are indisputable. I asked Dr. Robert M. Meyers, an ENT professor at the University of Illinois in Chicago, to review the details of Jack's surgery and its consequences. Meyers stated that surgical procedures in the 1940s were 'performed coarsely compared to today.' Today, he said, Jack's condition would be referred to as 'Empty Nose Syndrome.'"

"In November 1946, he was hospitalized for sinusitis and streptococcal sore throat... resulting in 'specific arthritic infection and acute rheumatic fever with almost septic temperatures and significant swelling in each joint, to the point that his wife did not recognize him.' Jack wrote, 'It is thanks to the care of Dr. Brenann and his colleagues... that I finally pulled through, and on Christmas Day, my wife was informed that I was expected to live.'"

"After 1946... Jack filed a claim with the VA for an increase in his disability rating, seeking more benefits. He and his civilian doctors argued that the chronic bronchitis caused by the aftereffects of his sinus issues should be considered alongside the disability for sinusitis. The following September, the VA rejected his claim... His unsuccessful appeal to the VA included a supporting letter from Dr. E.R. Fenton of Washington: 'Mr. Ackland came to see me on December 31, 1943, and I have seen him regularly since. He has constant drainage from his posterior sinuses and an acute bronchial cough from bronchial pneumonia and pleurisy. He has been thoroughly examined... and there is nothing we could do to clarify this situation. Following these infections, the patient has suffered from infectious arthritis. In my opinion, the disability is permanent and total. I have recommended his retirement from official duties and that he seek a warm, dry climate in which to live.'"

Jack writes: "It is often necessary for me to lie down immediately after work so that I can show up the next day... However, violent headaches, many sore throats, arthritis attacks, weight loss, general debility, and sensitivity to pneumonia and similar respiratory illnesses are all the result of my disability."

His colleagues write: "He often seemed on the verge of collapsing when he left the office to go home or to the hospital... to be treated. There were times when the pain brought him down, and Mrs. Ackland had to come and drive him home." Jack "was hospitalized again in March 1961. This time, he was placed in isolation, which broke his heart as he felt contagious to his family and friends, leading to significant psychological distress... Jack said he felt 'a burden to his family.'"

"On Father's Day, and my brother's sixth birthday, Dad was too ill to accompany the rest of the family to Elitch Gardens amusement park. The next morning, at dawn, Mom woke me and said, 'Len, Len, your father is gone; he didn’t come home, and he has a gun.' It was a .22 caliber handgun he had purchased a year earlier... I jumped out of bed, quickly dressed, and took the little Pontiac Tempest to look for him. He had taken our second car... I drove north for a few miles to our usual shooting spot. Nothing. Then, on the way back, I spotted the Buick in the line of parked cars... a place where he undoubtedly expected a stranger to find him. Instead, it was me."

"Eleven months after Dad's death, the VA reversed its decision. Based on the evidence of the case, the agency clinically noted that Jack's pain had a psychological impact. They 'determined that there was a definite change in personality with behavioral disturbances and psychiatric manifestations symptomatic of an acquired mental disorder that caused psychological distress. This mental disorder existed at the time of the suicide. This mental disorder was recognized as being directly related to the consequences of sinusitis and bronchitis.'"

This article, written in 2018 by Len Ackland, a journalist and the son of a World War II veteran, recounts the journey and suffering of his father, Jack Ackland, who fell victim to Empty Nose Syndrome. The journalist investigates the causes of his father's suicide, who underwent a turbinectomy performed by the same ENT surgeon in 1943, followed by a Caldwell-Luc operation. Jack Ackland aspired to become a fighter pilot but suffered from barometric sinusitis, leading to frontal pressure, neuralgia, and sinus problems. Under pressure from his superiors, Jack underwent a turbinectomy, a procedure that left him disabled and ultimately ended his military career. Len Ackland describes the ordeal his father courageously endured for 18 years until he took his own life in 1962 at the age of 42. Terms such as "atrophic rhinitis," "empty nose syndrome," "submucosal resection," "removal of nasal cartilage and bone," "turbinectomy," "disability," and "psychological distress" are mentioned. Although his disability was linked to these surgeries, he was repeatedly denied the benefits he was owed. Seventy-five years later, what has changed? Turbinectomies are still being performed today. In April 2020, Marcio Goulart committed suicide following a turbinectomy performed two years earlier, during which the ENT surgeon resected nearly all of his turbinates. Marcio Goulart took his life because he could no longer endure his suffering; he was born on October 9, 1988, and was only 32 years old. On the Empty Nose Syndrome Awareness Forum, on April 26, 2020, Mari Garb wrote: "Hi, I come to inform you that the funeral of our dear friend Marcio is scheduled for 3 PM in the state of Minas Gerais in Brazil. May we bring prayers and a lot of light to him and his family in this sad moment of farewell."

The Story of Stéphane Spinhirny: A Cautionary Tale of Rhinoplasty and Empty Nose Syndrome (1982-2013)

Stéphane Spinhirny’s journey is yet another sad story that highlights the consequences associated with rhinoplasty, particularly the development of Empty Nose Syndrome (ENS). Stéphane´s experiences offer valuable lessons for anyone considering such procedures, emphasizing the importance of informed consent and careful selection of medical professionals.

Stéphane Spinhirny ended the suffering inflicted on him by his surgeons in 2013 and is no longer with us. His YouTube account can be found here   View Spinhirny´s PDF file here

Link to  Stéphane Spinhirny´s blog

A Quest for Change

Initially, Spinhirny sought rhinoplasty to address aesthetic concerns and alleviate functional breathing issues caused by a deviated septum. He believed that surgery would enhance both his physical appearance and his overall quality of life. However, as he began his search for a qualified ENT specialist, he encountered numerous challenges that would lead him down a troubling path.

The Surgical Journey
Spinhirny consulted multiple surgeons, each with varying degrees of expertise and reputations. One of the most significant figures in his narrative is Gilles Ayoun, whom Spinhirny describes as “a real idiot to avoid; a liar, incompetent and dangerous.”

Despite his initial hopes, Spinhirny soon realized that many surgeons were more focused on financial gain than on patient care. He stated, “the liberal professions benefit from protection and the right to censor those who do not suit them,” reflecting his frustration with the medical community's lack of accountability. This disillusionment deepened when he received inadequate responses to his concerns about the surgery’s impact on his health.

The Aftermath: Empty Nose Syndrome
Following his rhinoplasty, Spinhirny unfortunately developed Empty Nose Syndrome, a condition that can manifest after nasal surgeries, particularly those involving the turbinates. ENS is characterized by a sensation of nasal obstruction despite clear nasal passages, leading to significant distress. Spinhirny described how the surgery he underwent, which was initially meant to alleviate his issues, instead left him with permanent breathing problems and a profound sense of despair.

His experience with ENS was not limited to breathing difficulties; it also profoundly affected his sleep quality. He reported issues such as insomnia and disrupted sleep patterns, which are common among those suffering from ENS. The inability to breathe comfortably through the nose at night made it challenging for him to achieve restful sleep, exacerbating feelings of fatigue and mental fog. This chronic lack of sleep further impacted his emotional health, leading to increased anxiety and frustration.

Spinhirny recounted how he encountered a troubling pattern with various ENT specialists. Many seemed to dismiss or overlook the complexity of his condition. He noted, “do not believe surgeons who promise you to only touch your septum; it is Russian roulette.” This statement reflects his frustration with the surgical community's understanding of the intricate relationships between the nasal structures and the potential consequences of surgery.

The psychological impact of ENS was severe for Spinhirny. He felt a deep sense of loss and frustration as he navigated the complications arising from what was supposed to be a transformative procedure. The condition not only affected his physical health but also took a toll on his mental well-being. He lamented, “in medical matters, I can say that paranoia is a virtue that saves lives,” underscoring the need for vigilance when undergoing medical treatments.

Health and Psychological Challenges after Septoplasty

Spinhirny's struggles with ENS were compounded by feelings of isolation and misunderstanding. He noted that many medical professionals lacked the empathy needed to address the emotional distress experienced by patients suffering from this syndrome. His reflections on various consultations reveal a pattern of skepticism and disappointment. He recounted encounters with doctors who seemed dismissive of his concerns, stating, “health is a business,” which only heightened his mistrust.

Moreover, the constant discomfort and disrupted sleep contributed to significant anxiety and depression. Spinhirny's quality of life drastically diminished, leaving him feeling hopeless. He described his experience as a nightmare, stating, “I am beginning to believe that French medical schools have fallen to the level of sociology or law schools and that the title of surgeon is obtained through corruption or cheating.” This reflection highlights his disillusionment not just with individual practitioners but with the broader medical system as a whole.

Through his trials, he emphasized the importance of thorough research and careful consideration before undergoing any surgical procedure. He cautioned others against hasty decisions, particularly when dealing with surgeons who do not belong to recognized medical societies, such as the EAFPS, which signifies a commitment to standards in the field.

Quotes from Stéphane Spinhirny´s blog: 

"The person most likely to kill you is not a relative or a friend or a mugger or a burglar or a drunk driver. The person most likely to kill you is your doctor"; Professor Even estimates that 100,000 deaths occur accidentally in hospitals each year; "doctors have a lower intellectual level than the rest of the population; they are stupid, narrow minded, speak in a pseudo-initiate dialect, t, and are prisoners of an autocratic way of thinking that makes them believe that they hold the exclusive truth"

To wrap it up:

The psychological and physical toll of conditions like Empty Nose Syndrome should not be underestimated, and those seeking surgical interventions must be fully aware of the potential consequences of their choices.

Summary:

Name: Stéphane Spinhirny

Gender: Male

Year of Birth: 1982

Year of Death: 2013 (age 30)

Country: France

First Surgery:

Year: October 2011

Surgeon: Gilles Ayoun

Type: Septoplasty

Details: Removal of septal cartilage

Second Surgery:

Year: October 2012

Surgeon: Dr. Miriam Bönisch

Type: Rhino-septoplasty

Details: Reconstruction of the nasal septum using cartilage from the ear, secured with a PDS plate

Surgery Details:

Ayoun removed septal cartilage; Bönisch removed part of the cartilage from 

the ear and sutured it with the rest of the nasal septum via a PDS plate. 

Informed Consent:

Not informed about the potential consequences of the procedures

Symptom Onset:

Immediately following the initial septoplasty

Symptoms:

Constant sensation of nasal blockage 

Dry nose, crusting
Insomnia (required medication for sleep)
Depression
Referred to surgical outcome as a "massacre"

Late symptoms:

Persistent insomnia

Severe depression

Treatments Attempted:

Nasonex

Derinox

Impact on Quality of Life:

Post-operation: Unlivable

Testimony:

Stéphane shared a video testimony documenting his experience 

and symptoms. Watch this video further down.

Family Impact:

Left behind his parents: Father, Denis Spinhirny (police officer), 

and mother, Jeannine Poncin (secretary)

Aftermath: 

Devastating impact on family; raised awareness of ENS

Legal Action:

Filed a complaint with the medical board in 2012 but did not pursue further legal action

Empty Nose Syndrome and the Cost of Cosmetic Surgery: The Story of John Malamos (1967–2010)

John Malamos, United States 1967-2010. Based on Interview Notes with John’s Brother

John Malamos resided in Illinois, United States and lived a vibrant and fulfilling life until he had two cosmetic surgeries on his nose. Then his life took a very dark turn that ultimately resulted in his early death at the very young age of 43. The first cosmetic surgery John underwent with no notable breathing issues. Unfortunately, the surgery was not performed correctly and John had to undergo surgery again. During this revision, the surgeon chose to also reduce his nasal inferior turbinates without explaining the risks of this procedure to John. This unnecessary reduction set off a cascade of health problems including insomnia, dryness, pain, suffocation, anxiety, and depression.

 
John’s brother Thomas shared his story to offer a critical reminder to be aware of ALL of the operations that your surgeon may perform and to explicitly communicate that you want to avoid unnecessary “add-on” surgeries such as the reduction of the nasal turbinates. John went into the operating room thinking he was just getting a revision of his cosmetic surgery and left the operating room with both a revision to the cosmetic surgery AND a reduction to his inferior turbinates. That reduction had nothing to do with his cosmetic surgery and it is almost certain John would still be alive today had the surgeon not added this operation and caused John to get the dreaded Empty Nose Syndrome (ENS).

Before his surgery, John lived life to the fullest and hardly had any worries in his life. He was a passionate motorcyclist who loved traveling to the western area of the United States with his motorcycle friends. He had a steady girlfriend, a circle of close friends, family living nearby, and a satisfying career as an assistant manager at Costco. John was a beacon of warmth and joy in his community— a man whose presence was felt deeply by those around him.

Colleagues and customers alike from Costco remember him fondly. They still share stories of his kindness and exceptional management skills over ten years later when his brother visits the store to purchase items. John had a rare talent for making everyone around him feel valued and appreciated. The hundreds of co-workers who attended his funeral and commented on his obituary serve as a testament to the positive impact he had on so many lives. Below is just a few of the many comments left from his co-workers online. (1)  

“John was one of a kind. The most compassionate and dear friend and boss. I will always remember our talks about life and how many times John helped me to get through rough times. I will miss him dearly.”

Kristin Harbke, October 10, 2010

"I met John when joining Costco in 2002. He always greeted me with an infectious smile and we never failed to share a laugh together. More than just a co-worker; John was a great friend. It's rare to encounter someone as outgoing and compassionate as John. I remained in touch with him over the years and I was extremely saddened to hear of his passing. My thoughts and prayers are with the Malamos family during this difficult time."

Patrick Hayes, October 28, 2010

"I would not be where I am today without John. Not only did he give me the opportunity to work at Costco, but he gave me a second chance at life and always made me smile even on the worst days. He made it a point to ask me how I was doing and really make me feel good about myself. I sincerely miss you and thank you for all that you have given me."

Jeff Wilkalis, August 7, 2011

"John, it´s been so long since you´ve been gone but it seems like yesterday. We all still miss you so much and remember you by sharing memories of you. Life is not the same since you´ve been gone.I miss the way you´d make time to talk to us and help solve our problems of life. Such a caring person. You will always live in my heart forever. Say hello to Audrey,I know she´d be looking for you with open arms. May you continue to rest on and be happy forever. Love Ruth"

Ruth Reynolds, July 10, 2023

John Malamos 1967–2010: A Life Cut Short by Rhinoplasty and Turbinate Reduction Surgery

After the surgery on his nasal turbinates, John’s fulfilling and happy life took a very dark turn. In his efforts to understand why he felt like he was suffocating and unable to sleep for days at a time, he sought consultations at renowned institutions such as the Cleveland Clinic and Mayo Clinic. After traveling with his father hundreds of miles for these consultations he was finally able to get a diagnosis – Empty Nose Syndrome – but neither clinic had treatments to offer nor referrals to doctors closer to home. His hopes were dashed to learn there would be no relief from his immense suffering and that his quality of life would continue to be very low for the foreseeable future.

John became very anxious and deeply depressed as a result of ENS. This worried his family as John had no known mental health issues prior to the surgery. He ended up getting treatment and spending time in a mental health care hospital but this just left him feeling even more isolated and hopeless as the root cause of his problems were physical in nature and not mental. 

In his darkest moments, John tried multiple times to end his suffering. He initially attempted suicide using carbon monoxide gas from his car’s tailpipe but backed out at the last moment. A subsequent failed attempt included trying to hang himself. He finally ended up stealing a revolver after visiting a family member’s house and shooting himself the next day. This resulted in his very tragic and early death. Notably, his family was able to demonstrate to their church that his death was the result of a physical condition that had tortured him severely. This was important so that his burial and services could be performed according to the Greek Orthodox tradition.

Thomas Malamos now shares his brother’s story in the hope of raising awareness and preventing future tragedies. He wants people to understand the severe and avoidable impact that ENS can have on a person’s life. Thomas does not believe that his brother would have had his nasal turbinates reduced if he had been explained the risks of the surgery and been allowed to play a role in the decision-making process. Like so many other friends and family members who lost loved ones to ENS, Thomas wonders why the surgeon operated on John’s nasal turbinates. Was it to make more money? Was it because they hadn’t been trained on the importance of the nasal turbinates during medical school? Did the surgeon lack the skill and precision needed to operate on the rest of the nose without touching the turbinates? Knowing the answer to this questions could help others avoid the same fate as his brother. 

As part of honoring John’s memory, John’s brother shared photographs and videos from happier times—moments filled with laughter, adventure, and the joy of living life fully. These images serve as a reminder of the person John was before his illness took over, reflecting a life that was bright and full of promise. This is how Thomas would like his brother to be remembered by others. 

(1) https://www.legacy.com/us/obituaries/chicagotribune/name/john-malamos-obituary?id=2754254

John Malamos' PDF file can be viewed here  (takes a while to load)

Yaneiv Oz and Empty Nose Syndrome: A Tragic Consequence of Turbinoplasty

Letter from Toni Carroll, mother to Yaneiv. I think I need you to know Yaneiv before his deterioration began after surgery so you can fully understand how drastic it was. Yaneiv was a people person, loved helping with anything however big or small, fantastic friends still together from pre-school days, hard working, loyal, always the joker & had a love of life like nothing I’ve ever known & football, playing it & watching it was his biggest love, strict diet & work outs twice a day. Yaneiv Oz - PDF file

He always said as a teenager that he felt he didn’t feel much of an air flow through one nostril but not insistent about it. When he was 20 whilst doing his compulsory army service he told me the Dr had referred him to Haddasah Hospital to have a small operation, a Polypectomy (1) in his nose which I tried to talk him out of but not because of ENS which we knew nothing about, just because I always believed when somethings surgically touched something else messes up. Yaneiv was adamant that it was nothing & I didn’t understand how uncomfortable it felt bla bla bla... He had the Polypectomy & Rhinoplasty 🤦🏻‍♀️ I only knew this a couple of months ago when my oldest son told me. 

The day after the operation I went to visit Yaneiv & instantly felt something wasn’t right (gut feeling 🤷🏽‍♀️) But brushed it aside as recuperating. Anyway Yaneiv seemed O.K for a while, held down a job, still working out, football matches, signing up for courses of all types (He loved to study all subjects till he found what finally drew him in).

He had dreams, I think around 2 years after surgery started slight aggressiveness, headaches & insomnia ….. He booked a flight to Australia alone, worked at a company with an Israeli guy he met for a year to save money to travel on before returning home. He lived the dream 🙏 Cambodia, Bali, Thailand & partied in Europe …. I was so proud. He was traveling for just over a year & a half.

But It wasn’t the same Yaneiv that returned 😩

He was still playing football at this point & the gym daily but he couldn’t hold down a job because of constant throat infections, migraines, back & forth to Dr’s more tests, more steroids & referrals to Psychiatric help as they told him over & over it was all in his head. 

Yaneiv still had a bit of fight left in him at this point & moved South thinking the humidity would help staying at his Dads. He went to a Psycologist but only once, he tried acupuncture, voice therapy as he though his voice had changed but I think he felt that way because he had to strain so hard to speak, he was awake all night from suffocation & anxiety which left him groggy & catching an hour here & there when he could. 

Everytime we asked what he felt he only said over & over ‘my throat’ 🤷🏽‍♀️. My daughter had a little boy of 4 in her class at kindergarten that kept clearing his throat (Just like Yaneiv) & she offered him water, he brushed it away & told her it wouldn’t help because it feels like a piece of dry steak constantly stuck at the back of my throat. This little boy who’d had the same operation explained it better than my 26 year old son. 

The depression started kicking in, he stopped replying to his best friends messages, he couldn’t play football anymore because of choking, he became sensitive to dairy products & soooooo very tired. I know he joined the Facebook ENS group 5 days before his death, he had contact with one member who I think she helped him finally to get an appointment with an ENS specialist in Israel.

He hung himself the day of the appointment 

His last wish was that we take the surgeon to court & get justice to stop this. My stepsons Mums a lawyer who said she’d take it on, got all the medical documents together but she didn’t follow it through ☹️..... I wouldn’t be able to do it as Yaneiv said so little, refused for me to talk to the surgeon etc. So anyway if I can help to stop this I will try because I owe it to Yaneiv 

I really hope it’s ok Pia 

My mind is still trying to come to terms with this, so my concentration is appalling 🤦🏻‍♀️

Think it’s fantastic what you’re doing xx Best of luck

(1) A polypectomy is a surgical procedure to remove polyps, which are abnormal tissue growths. It is often performed endoscopically in the nose to alleviate symptoms like nasal obstruction and sinus issues

Yaniv Oz facebook   Instagram

Summary of Yaniv Oz's Case:

Name: Yaniv (Yaneiv) Oz

Gender: Male

Year of Birth: 23/7 - 1992

Year of Death: 16/10 - 2018

Age at Death: 26

Country: Israel

Medical Background:

Yaniv experienced partial airflow obstruction in one nostril as a teenager but managed it well. At 20, during his mandatory military service, he underwent a polypectomy and rhinoplasty at Haddasah Hospital. The surgery involved turbinate reduction, but he was not informed of the potential consequences.

Postoperative Symptoms:

Symptoms began to surface gradually, two years after the surgery, including aggressiveness, headaches, and insomnia. Over time, he developed insomnia, throat and vocal issues, dry nose, and frequent ENT infections. His mental health deteriorated, leading to depression and isolation from friends and activities he once enjoyed, like football.

Treatments:

He consulted multiple doctors, underwent various tests, and was prescribed steroids and psychiatric referrals, but his suffering remained unexplained. He attempted alternative therapies, including acupuncture and voice therapy, without success.

Final Days:

Yaniv joined a Facebook group for Empty Nose Syndrome (ENS) just five days before his death, which he attributed to severe psychological distress. He died by hanging, leaving a farewell letter expressing his wish for his family to pursue legal action against the surgeon to seek justice and prevent similar outcomes for others.