Reduced concentration, anxiety, and dyspnea are well-known symptoms of Empty Nose Syndrome (ENS). In a healthy, non-operated nose, with the turbinates intact and without damage to the nasal mucosa, there is a plentiful presence of Vagal-C receptors. These receptors, which are nerve endings directly connected to the vagus nerve, are stimulated by the airflow along the nasal lining during inhalation and exhalation. The stimulation of these receptors continuously activates the vagus nerve, resulting in a calming effect on the autonomic nervous system, thereby reducing stress and anxiety. This is why many meditation techniques are based on calm nasal breathing.
In Empty Nose Syndrome, these nerve endings have been destroyed, primarily due to surgery or amputation of the turbinates, and secondarily due to the subsequent dryness that occurs when the nose remains wide open 24/7. Over time, this dryness in the mucosa leads to a degenerative process where metaplasia occurs. This is an adaptive cellular change where the mucosal cells transform to resemble ordinary skin cells. As this process progresses, more and more of the mucosal function and sensation are lost. Consequently, complete Empty Nose Syndrome often develops months to years after the initial surgery, leaving surgeons without accountability.
In Empty Nose Syndrome, hyperventilation is observed in approximately 75-80% of cases, which is often neurologically related but also due to insufficient nasal resistance. Without optimal resistance, the lungs cannot fully expand during inhalation, and the airflow moves too quickly in and out of the lungs for optimal gas exchange. This combination leads to a constant fight-or-flight reaction, which in turn impairs the ability to sleep, concentrate, and relax.
As previously mentioned, stress activation in the limbic system is seen in ENS, partly because the brain can no longer sense airflow in the nose. When study participants with ENS were exposed to menthol, which maximally activates the remaining TRPM8 receptors in the nasal lining, they could again experience a slight sensation of airflow in the nose, leading to a reduction of the stress response in the limbic system.
Let us now review the study:
The study shows that nasal breathing in healthy, non-nasally operated individuals affects brain activity, particularly in areas such as the piriform cortex, amygdala, and hippocampus, which are associated with emotions and memory. This suggests that nasal breathing can enhance cognitive functions and concentration.
Electroencephalography (EEG) during slow breathing shows increased activity of delta and theta waves, which are associated with relaxation and awareness, similar to deep meditation.
Slow breathing also affects the autonomic nervous system, with measurable changes in heart rate variability (HRV) and respiratory sinus arrhythmia (RSA), indicating a balanced function between the sympathetic and parasympathetic nervous systems.
The conclusion of the study was that slow breathing and nasal breathing can improve both psychological and physiological well-being, with benefits including improved concentration, reduced anxiety, and increased calmness.
The effects described in the above study are due to nasal breathing stimulating various types of receptors (nerve endings) in the nose, which in turn stimulate the brain and vagus nerve, leading to psychological well-being, harmony, and balance between sympathetic and parasympathetic activation in the autonomic nervous system. When the nasal mucosa is amputated or damaged, the calming effect on the nervous system ceases, leaving individuals with ENS trapped in sympathetic activation. This stress activation is further exacerbated by hyperventilation observed in 75-80% of ENS cases, which is not mentally induced but has physiological causes resulting from the surgery. These causes are a combination of receptor damage/loss and the nose being physiologically too open for calm and deep breathing that fully expands the lungs.
Additionally, it should be noted that individuals with ENS have had a large portion of their nasal mucosa removed and destroyed. This mucosa normally produces the majority of the nitric oxide (NO) combined in the nose and sinuses. Studies have shown that individuals with ENS have significantly lower levels of exhaled NO. Since NO is a gas that dilates blood vessels, this affects the entire body, including the brain, which now receives less blood, resulting in reduced cognitive function.
In the following study: Nasal Nitric Oxide in Relation to Psychiatric Status of Patients with Empty Nose Syndrome https://doi.org/10.1016/j.niox.2019.07.005, it was found that:
Results: "We included 19 patients with Empty Nose Syndrome (ENS) and 12 patients with chronic rhinitis (CHR). Nasal nitric oxide (nNO) levels were significantly lower in ENS patients compared to CHR patients."
"Nitric oxide (NO) affects important neurotransmitters involved in neuropsychiatric disorders, and NO is proposed to play a 'dual role' in these conditions. Levels of L-arginine and NO metabolites decrease in patients with severe depression. A national survey showed that depression is linked to lower fractional levels of exhaled nitric oxide."
"Our results indicated that NO levels in the sinonasal area may be related to changes in depression and anxiety status in patients with Empty Nose Syndrome (ENS)."
Individuals with reduced nasal resistance may experience symptoms such as fatigue, dizziness, and reduced exercise tolerance due to decreased blood circulation and gas exchange.
Removing or destroying someone’s turbinates and nasal structure and claiming it has no negative effects is a crime that leads to immense suffering for the affected individual, suffering that has resulted in many cases of self-destruction. Surgeons who perform such procedures without informing patients about the potential consequences must be held accountable.