Empty Nose Syndrome an Overview / Explanation of the condition

Surgery on Turbinates & Nasal Septum and It’s Consequence: Empty Nose Syndrome: Condition Explained

This document explains what Empty Nose Syndrome (ENS) is and presents stories from patients who have developed problems after undergoing turbinate reduction, septoplasty, or sinus surgery. By highlighting their experiences, the document provides insights into the long-term effects and complications of these nasal surgeries!

We can land spacecraft on Mars today and send probes beyond our own solar system, thanks to years of research. We test, fail, and learn from our mistakes, calculate, evaluate, and adjust for a new attempt. Meanwhile, in other areas, we remain in the Middle Ages, a time when lobotomies were performed without questioning the disabilities and personality changes the method caused. We simply refuse to embrace new research and the experiences that patients themselves have. One such area is the treatment of nasal congestion.

Even though we now know that nasal congestion in most cases is caused by factors such as allergies, food intolerances, autoimmune diseases, and increased inflammation in the body due to an inflammatory diet, today's ENT (ear, nose, and throat) doctors still choose to remove the turbinates. This is an organ that evolution has developed in virtually all land-dwelling mammals.

Instead of investigating the root cause of nasal congestion on a systemic level, healthcare chooses to send the patient to surgery. Often, the decision for this surgery is based on a single sequence of X-rays taken at one point in time. It is often claimed that the turbinates in one nostril are too large and need to be removed. The problem with this is that X-rays are not taken at different times of the nasal cycle, during which the turbinates in one nostril swell while those in the other nostril shrink. This occurs in intervals, and most often there is sufficient passage in each nostril when the nasal cycle has shifted sides.

Similarly, it is often claimed during a CT scan of the nose and sinuses that the nasal septum is crooked and needs to be operated on. However, it is not mentioned to the patient that approximately 80% of all people have a more or less crooked nasal septum and that this is normal.

If a patient asks about the risks associated with these surgeries, they are only told that there may be bleeding, infection, and fever associated with the operation. No other consequences of the surgery are mentioned. As a result, the patient goes in believing that it is a minor operation with very limited risks and that the potential consequences are also temporary.

The truth, however, is entirely different. The turbinates and the entire structure of the nose have developed over hundreds of thousands of years to optimize breathing and gas exchange in the lungs. The nose's function in terms of the sense of smell is only one part. Due to their shape and placement, the turbinates create channels of mucosa where the air is humidified, warmed, and prepared before reaching the lungs. The nasal mucosa also produces nitric oxide, which has an antibacterial effect locally in the nose and lungs, and dilates blood vessels in the lungs. When we breathe through the nose, we inhale this gas, which then opens the blood vessels, resulting in better oxygen uptake and more efficient carbon dioxide removal.

Looking further into the function of the nose and turbinates, beyond warming and humidifying air and enriching it with nitric oxide, these organs also play a crucial role in adjusting the resistance in the nose and thus the airflow to the lungs. This is very important because our breathing must always adapt to the body's needs in the given situation. When we exercise, are active, and the sympathetic nervous system is engaged, the blood vessels in the nose constrict, reducing the resistance and allowing more air to reach the lungs. In this state, we want a somewhat more open nose as it increases breathing frequency and the number of breaths per minute to take in more oxygen and expel more carbon dioxide from the body. When we finish our activity and our pulse decreases, the body no longer needs as much oxygen intake and carbon dioxide removal, partly because the muscles are not working as hard and partly because the blood flow to the lungs is less due to a lower pulse. At this point, it is important that the turbinates expand again to some extent to increase the resistance in the nose. When this happens, it leads to fewer breaths per minute, and breathing can then adapt to the body's new situation. As the breathing rate drops, the parasympathetic nervous system, which promotes recovery, healing, and sleep, is activated.

When the turbinates are clipped away or significantly reduced, or the nasal passages are excessively opened via septum surgery, this function is lost, and the individual is left with consistently low resistance, leading to over-breathing when the body should relax and recover. This has catastrophic consequences for people's health, sleep, and quality of life, with many individuals becoming completely debilitated after these types of operations. Significantly reduced nasal resistance leads to over-breathing during rest and periods of lower activity, resulting in excessive expulsion of carbon dioxide from the body. Since the body always needs a certain amount of carbon dioxide in the blood for oxygen molecules to leave the blood and reach the body's organs and muscles, this leads to mild hypoxia, meaning a lack of oxygen in the organs. Such oxygen deficiency can be difficult to measure because oxygen is present in the blood but does not reach the organs. The reduction of carbon dioxide levels in the blood also leads to an increased pH level (respiratory alkalosis), making the blood more basic. This affects the body's acid-base balance and can cause symptoms such as dizziness, numbness, and muscle cramps. Additionally, an increased pH level causes the blood vessels to constrict, further impairing oxygen transport in the body, which can manifest as cold extremities.

It should also be noted that there are cases where individuals, after having their noses excessively opened, suffer from nighttime hypoventilation, where carbon dioxide is not expelled from the body adequately, leading to carbon dioxide poisoning.

In summary, when the nose lacks natural resistance, breathing becomes rapid. Exhalation and inhalation occur too quickly, and the number of breaths per minute increases significantly. The air does not stay in the lungs long enough for proper gas exchange, usually resulting in hyperventilation with a buildup of carbon dioxide. Resistance in the nose is also crucial for the lungs to fill completely; without this resistance, the lungs do not fully inflate during inhalation, and lung capacity is not fully utilized, negatively affecting gas exchange.

The nasal mucosa is also rich in sensory nerve fibers that play an extremely important role in monitoring the conditions within the nose. These receptors detect airflow, temperature, and other factors, sending signals to the brain to adjust the nose’s function according to the prevailing conditions. The nasal mucosa is abundant in vagal C fibers that are directly connected to the vagus nerve, which is why calm and deep nasal breathing leads to relaxation and activation of the parasympathetic nervous system. The nose contains several important types of receptors, and one key type among them are the thermoreceptors known as TRPM8. These receptors are responsible for the sensation of breathing. When you step outside on an autumn day and feel the fresh, invigorating air, it is these receptors that inform your brain that you are breathing.

When the turbinates are clipped or destroyed through procedures like radiofrequency ablation, this function is lost. When a sufficiently large area of the nasal mucosa is damaged, this signaling to the brain is almost entirely absent, and the individual experiences air hunger and a feeling of breathlessness despite an open nasal passage. Most people know how uncomfortable it is to have a stuffy nose, and the reason for this discomfort is that the receptors in the nose cannot be stimulated when congested. The brain becomes stressed, and the individual experiences significant breathing difficulties. If one's nasal organs are not operated on, the turbinates eventually reduce in swelling, allowing normal breathing to resume. However, when these organs are destroyed, breathing will always feel strained, and the individual will experience constant air hunger. This condition leads to rapid breathing where the natural pause between inhalation and exhalation is often reduced or completely disappears.

Problems that can arise when the nasal mucosa or structure of the nose is damaged?

Here are some common known issues!

 

• Feeling of shortness of breath or air hunger leading to over-breathing. Regardless of how much or in what way you breathe, you cannot feel satisfied with your breathing. (Cause: A combination of injury and loss of receptors/nerves in the nose, and a nose that is excessively open without natural resistance/altered airflow patterns in the nose). Affected individuals describe it as continuously suffocating. This leads to significant tension in daily life, and almost everyone who is injured experiences extensive problems with sleeping, relaxing, and concentrating. Sleep disturbances and disrupted breathing lead to difficulties in managing the day, and individuals often lose the ability to work and function

 

• Shallow chest breathing: Unnaturally low or absent resistance in the nose leads to shallow chest breathing where the lungs do not fully expand meaning that the lung capacity is not fully utilized. Not all of the lung's alveoli are exposed to gas exchange. This leads to disturbances in oxygen uptake and carbon dioxide excretion..
  
  

• Over-breathing: The lack of natural resistance in the nose also results in inhaling and exhaling too quickly, increasing the number of breaths per minute to a level where over-breathing can be observed. There is excessive ventilation relative to the body's needs in the inactive state because there is an incompatibility between ventilation, perfusion, and diffusion in the lungs. Air stays in the lungs for too short a time for sufficient gas exchange to occur.
  
  

• Increased "dead space breathing": The term refers to the space in the respiratory system where no gas exchange occurs. That is, in the nose and trachea. As breathing becomes shallower and more breaths are taken per minute, a larger volume of ventilated air only moves back and forth in the nose and trachea. This air never reaches the alveoli where actual gas exchange occurs, leading to impaired respiratory function.
  
  

• The nose remains excessively open even during rest and physical inactivity when the resistance in the nose would normally increase due to a slight expansion of the nasal turbinates' volume. Normally, this reduces the respiratory rate and triggers activation of the calm parasympathetic nervous system. When the nasal turbinates are absent or when the nose has been excessively opened through surgery, the body cannot regulate resistance and therefore the respiratory rate. Breathing therefore remains rapid and shallow, and the person becomes stuck in the Sympathetic nervous system - the "Fight and flight" system.

 

• Destruction of nasal receptors: When the nasal turbinates and other nasal mucosa are damaged, removed, or burned during surgery, the sensory ability of the mucous membrane is destroyed. When enough tissue in the nose has been damaged or amputated, perception is completely or partially lost. The individual can no longer feel that they are breathing, leading to an irreversible feeling of air hunger and shortness of breath. The respiratory center in the brain no longer receives information that breathing is occurring through the nose because receptors in the mucous membrane that would register airflow are amputated or damaged from the surgery.

When the respiratory center in the brain is deprived of nerve impulses about airflow in the nose, this leads to significant tension. Most people have probably been completely congested in the nose at some point and experienced tension in the body and mind that dissipates the moment nasal spray opens up the nose. This is because the receptors in the mucous membrane can now be stimulated by airflow again, creating a sensation of comfortable breathing and calmness in the body. If enough of the nasal mucosa is amputated or destroyed, eventually a point is reached where so many peripheral nerves are lost that constant air hunger is felt in a similar way to nasal congestion even though the nose is now wide open. This feeling is often combined with discomfort from the nose being wide open.

 

• Increased risk of infection after reduced production of nitric oxide in the nose: ¾ of all nitric oxide (NO) formed collectively in the sinuses in the nose comes from the nasal mucosa itself. NO is a gas that is strongly antibacterial and antiviral. Studies show that breathing through the nose provides more protection against COVID-19 than breathing through the mouth. This is related to the fact that the air is filtered and treated with NO, which kills bacteria and viruses before they can take hold in the mucous membrane and lungs. When the nasal mucosa is destroyed or amputated, the surface where NO can be produced is reduced. When the nasal turbinates are reduced, the nose's ability to filter the air is also reduced. Thus, after a reduction of the nasal turbinates, it will be easier to be infected, both locally in the nose and in the lungs and body.

 

• Reduced blood flow to the lungs after reduction of the nasal turbinates: Inhalation of nasally formed nitric oxide (NO) has a vasodilating effect on the blood vessels in the lungs. This means that it widens the blood vessels. By dilating the blood vessels during nasal breathing, inhaled nitric oxide reduces resistance in the lung vessels, making it easier for blood to flow through the lung vessels. This facilitates oxygen uptake in the lungs and removal of carbon dioxide from the blood, improving gas exchange between the lungs and the blood. Any type of nose operation that damages the mucous membrane or amputates parts of it will therefore lead to reduced production of nasal nitric oxide. This will therefore result in the lung vessels not dilating to the same extent. The result is thus impaired gas exchange in the lungs.

 

• Extensive problems with dryness in the nasal mucosa: When the nasal turbinates are reduced in size, the nose becomes wide open, and the nasal cycle no longer functions as it should. As nature designed it, one side of the nose should be open and take most of the airflow while the other side rests and recovers. The nasal cycle then switches sides at intervals so that there is always an active and a passive side. This also results in less flow in one nostril and a greater flow in the other, allowing a wider range of odors to be perceived.

 

If the nose is opened extremely or if the nasal turbinates are completely removed, the nose remains wide open and this dries out and damages the mucous membrane to the extent that it slowly begins to degenerate. Such degeneration can continue throughout life, which is why many people who have had nasal turbinates or nasal septum surgery etc. experience problems only some years after the surgery. A dry mucous membrane is also much more susceptible to infections with, for example, streptococci or staphylococci, which are devastating to the mucous membrane's health and function, and the infection is not immediately stopped. The bacteria literally eat away at the mucous membrane and destroy its function and nerves.

 

• Even distribution of airflow in the nose ceases. Turbulent flow transitions to laminar flow. Reduced flow velocity in the nose. Decreased activation of receptors that enable the sensation of nasal breathing, reduced production of mucus (resulting in drying of the mucous membrane). Impaired sense of smell.

 

Altered airflow: When the nose is opened up, for example, by reducing the inferior nasal turbinates, the flow pattern changes. In a non-operated normal nose, air is evenly distributed in the channels formed by the three nasal turbinates. If, for example, the inferior turbinate is removed or significantly reduced, the air will now, like water, take the easiest path towards the lungs, which is the lower part of the nose where the nostril is wide open. This means that the perception of airflow in the middle and upper parts of the nose may decrease even if no surgery has been performed there. This also negatively affects the sense of smell as fewer particles reach the upper part of the nose where the olfactory receptors are located.

 

Reduced flow velocity causes air hunger: Nasal receptors sense airflow based on the speed of the air (breathing in harder feels colder in the nose). In a normal nose, air enters the nose and hits the front part of the turbinates, creating a venturi effect. This increases the velocity of the airflow because the turbinates reduce the open diameter for the air to move through. This leads to increased perception of airflow in the nasal mucosa, providing a soothing and calming effect on the nervous system. Breathing feels normal.

 

Higher flow velocity results in more protective secretion: Furthermore, higher flow velocity leads to the mucous membrane producing more secretion to protect itself from drying out. More secretion also means a better immunological defense against local and systemic infection.

Turbulent flow to laminar flow, with impaired warming and humidification: In a normal non-operated nose, the linear airflow in the outermost part of the nose transitions to turbulent flow when the air hits the front part of the turbinates. Turbulent flow is important because it causes the air to rotate, increasing the contact time between the air and the mucous membrane. This results in better warming and humidification of the air, which is important for proper gas exchange in the lungs.

 

Impaired perception of nasal breathing when turbulent flow ceases: When the air rotates in turbulent flow inside the nasal cavity, this leads to an increased perception of airflow, which is important for individuals to feel that they are breathing through their nose.

 

Laminar flow and reduced sense of smell as a result: When the inferior turbinates are amputated or significantly reduced, the airflow will mainly move along the floor of the nose in a laminar flow, resulting in fewer odor particles reaching the upper part of the nose where the sense of smell is located.

 

Conclusion: When the turbinates are clipped or significantly reduced using heat-treated methods, a significant portion of the nasal receptors will be amputated or destroyed by the added heat. This will have catastrophic consequences for the individual's ability to perceive nasal breathing, resulting in constant air hunger and a feeling of suffocation.

 

In the best-case scenario, a few receptors remain in the non-operated mucosa along the lateral wall, in the septal mucosa, or along the floor of the nose. These receptors would to some extent provide nerve signaling to the brain that breathing is occurring through the nose, but unfortunately, these receptors are also indirectly affected by the operation of the turbinates. When the nose has been unnaturally opened, the flow velocity is significantly reduced, rendering these remaining receptors unable to be activated. Additionally, the airflow will now mainly move in the center of the now open nasal cavity, and very little of the airflow will touch the walls where there would have been some possibility of perceiving airflow if the flow velocity had been high enough.

 

• Hypersensitivity to airborne particles: Odors, chemicals, hygiene products, smoke, cooking fumes, etc. Any type of surgery that affects the nasal mucosa can lead to persistent problems with hypersensitivity to odors, smoke, and particles. It is not uncommon to see a reduced ability to smell odors simultaneously with the emergence of hypersensitivity to certain types of particles. When we talk about hypersensitivity here, we are not referring to the individual finding something smells bad. What we are talking about here is pain that occurs in the nose in environments with these particles. Even if the individual has a reduced sense of smell, these substances irritate the mucous membrane, resulting in pain and discomfort. Often, the cause is a dry and degenerated mucous membrane as a result of the surgery. Moreover, the fact that the nose is wide open exacerbates the issue further. In other cases, this hypersensitivity may occur as a result of nasal infection that can arise when the nose becomes dry after surgery.

 

• Hypersensitivity to hot or cold air: When the nose has been excessively and unnaturally opened via surgery, the air is not warmed and humidified before reaching the back of the nose. Here, the cold and dry air irritates the nasopharynx and causes discomfort.

It should also be mentioned that many individuals who have had the wall between the nostril and the maxillary sinus (cheek sinus) removed experience significant problems with cold air. This often leads to nerve pains that can be very distressing.

At the same time, the degenerated and damaged nasal mucosa leads to problems tolerating hot and dry air. Many who have undergone surgery of the sinuses, nasal septum, or turbinates often have to use humidifiers or breathing masks to get through the day. Often, it becomes a constant application of creams and moisturizing ointments to endure the discomfort and prevent further degeneration of the mucous membrane. The problems become especially significant in winter when heaters dry out indoor air. These individuals often have significant difficulties with public transportation, especially in winter when the added heat makes it both warm and dry at the same time. Many are also put in a position where they need to seek specialized care abroad for their problems but cannot fly due to the dry environment in airplanes.

 

• Dizziness When the nose is excessively opened via surgery, this leads to abnormally low resistance in the nose. Breathing now happens too quickly, and the number of breaths per minute increases to a level that is abnormal in relation to perfusion and diffusion in the lungs in the physically inactive state. Due to the lack of normal resistance in the nose, the lungs cannot fully expand, and breathing only occurs in the upper part of the lungs. Over-breathing is a fact!

Over-breathing is also created by the destruction of receptors in the nose due to surgery, causing the individual to experience air hunger. The response from the autonomic nervous system is to increase the breathing rate, and part of this is to reduce the pause between exhaling and inhaling. When the breathing rate increases, breaths become shallower, and the pause between exhaling and inhaling is reduced, leading to dizziness. This is a relatively common condition among those suffering from Empty Nose Syndrome as a result of nasal surgery

·       Insomnia: The majority of individuals who have developed Empty Nose Syndrome also experience significant sleep problems. Most are forced to take sleeping pills and self-medicate to fall asleep at all. Despite this, sleep quality remains poor, and many wake up several times per night with a sensation of air hunger. 

Many also experience mild hyperventilation when waking up with a high pulse. Some also wake up due to pain caused by dryness in the nasal mucosa. Some individuals may stay awake for several days in a row, while others only get about two hours of poor sleep before waking up breathless. Over time, this leads to premature aging and significantly increases the risk of developing other diseases. Sleep problems also result in considerable daytime fatigue and often an inability to function and perform daily tasks.

 

The cause of sleep problems: A surgically over-opened nose lacking natural resistance leads to over-breathing. The lungs do not fully expand, and both inhalation and exhalation occur too quickly. The air does not stay in the lungs long enough for proper gas exchange, and the forced breathing also leads to the individual remaining in a state of stress activation, i.e., dominance of the sympathetic nervous system.

In a non-operated individual, the turbinates should, during rest and low activity, swell to some extent to increase resistance, allowing the breathing rate to decrease. This calms down the system and adapts gas exchange to the current perfusion and diffusion in the lungs, which now occurs to a lesser extent. When the turbinates are clipped or significantly reduced through methods such as radiofrequency treatment, this ability is destroyed, and the nose remains wide open all the time, causing the individual to become stuck in hyperventilation.

Damage to superficial nerves: Some individuals with Empty Nose Syndrome also have an inability to feel airflow in the nasal mucosa. This has several causes, but primarily it is because a sufficient amount of mucosa with receptors has been amputated or destroyed. This lack of sensation in the nose deprives the brain of vital information about breathing, resulting in stress activation.

Breathing functions somewhat like our hunger; we eat, Ghrelin is produced, and we are satisfied for the next few hours. We feel no immediate need to eat again. Similarly, breathing works. When air passes through the nasal mucosa, receptors are stimulated, and the brain receives a signal that we are breathing. We are now satisfied with breathing and can wait a few seconds before taking another breath without feeling air hunger.

When the nose is opened up and the mucosa is destroyed, there comes a point where there are so few remaining receptors in the mucosa that no nerve impulse is sent from the nose to the brain. We no longer feel that we are breathing through the nose, resulting in paradoxical obstruction. After the operation, the nose feels wide open, but a similar feeling arises to that of common nasal congestion: in other words, we feel air hunger and are not satisfied with breathing.

This sensation of air hunger leads to activation of the sympathetic nervous system, and the person becomes stuck in a state of stress. The brain's way of solving the problem is to increase the breathing rate and reduce or eliminate the pause between exhaling and inhaling. Unfortunately, this becomes counterproductive as it further increases sympathetic activation.

So, in summary, not being able to feel airflow in the nose leads to a situation akin to overeating. Some eat and eat but do not receive sufficient secretion of the hormone Ghrelin, which can suppress the desire for more food. Similarly, those who have damage to the superficial nerves in the nasal mucosa will always feel air hunger regardless of how much they breathe. This constant air hunger directly leads to sympathetic activation, which is further exacerbated by the brain increasing the breathing rate to try to alleviate the situation.

Thus, the individual who has destruction of the superficial nerves in the nasal mucosa will take one breath after another but never feel satisfied with breathing. Immediately after exhaling, they will have a strong need to inhale again without the slightest pause. This thus drives hyperventilation. There will always be a sensation of air hunger, regardless of how one breathes, and this is something that cannot be trained away or become accustomed to.

All of this described above is the cause of the stress and sleep problems that we commonly see among those who have undergone nasal surgery.

 

• Increased heart rate sympathetic activation (fight and flight)

When the individual is not satisfied with breathing and has too rapid and shallow breathing and has impaired perception of airflow in the nose, this leads to stress activation in the manner described above. When the individual becomes stuck in dominance of the sympathetic nervous system, the heart rate also rises. Many with conditions such as Empty Nose Syndrome report a resting heart rate around 90-100 beats per minute. Something that obviously puts extra strain on the body over time.

 

• Impaired concentration due to breathing difficulties

Common among operated patients is difficulty concentrating. Many experience cognitive impairment after their nasal surgery, which is often due to a combination of significant sleep problems, hyperventilation, fatigue, and dizziness. There are many studies showing that nasal breathing improves brain function. Therefore, it is not surprising that cognitive impairment occurs when nasal breathing has been disrupted.

 

• Dry throat difficulty speaking

In a healthy non-operated individual, the air in the channels formed between the turbinates is warmed and moistened. The air now flows over a warm and moist mucous membrane and is therefore warmed and moistened. The air is distributed as it should by the turbinates, and turbulent flow prolongs the contact time of the air with the mucous membrane. When the turbinates are clipped or reduced, the nose becomes excessively open, and the natural ability to humidify and warm the air is now destroyed. In cases where the inferior turbinates are reduced, dry and unprocessed air now moves in a laminar flow along the lower part of the nose and then hits the back of the nose and throat unprocessed. Here, irritation often occurs over time where the dry air dries out and causes discomfort. In some cases, this leads to difficulty speaking, and many find themselves coughing and clearing their throat due to irritation.

 

• Nasal nerve pain and headache

When the nasal mucosa becomes dry and damaged, nerve pain in the nose often occurs. A dry mucosa lacks the same protection, and over time, a dry mucosa leads to degeneration. The mucosa loses blood flow and becomes thinner, nerves come closer to the surface of the mucosa, and irritation occurs. Additionally, airflow patterns in the nose may change after nasal surgery, causing some areas to receive more airflow while others receive less or no airflow at all. The areas receiving increased airflow may become sensitive, especially if these areas are also dry and degenerated.

 

Often after nasal surgery, nerve pain is observed radiating in one direction or the other. Some experience nerve pain radiating into the eyes, usually originating from the upper part of the nasal mucosa. Others may experience pain radiating into the face. In some cases, nerve pain also leads to headaches. Nerve pain is typically described as a burning sensation, usually worse during inhalation than exhalation and usually worse in dry environments or environments with odor particles or smoke in the air. Some also worsen with cold air.

 

• Runny nose

Drainage from the eyes in terms of tears exits under the front part of the lower turbinates. Tears flow out and are distributed over the surface of the mucosa, somewhat like pouring a bucket of water against a wall. When the lower turbinates are clipped, tears tend to flow directly out of the nose. In situations when it is cold outside or windy, the eyes produce more tears than usual, and without the lower turbinates, everything flows straight out through the nose, resulting in constant sniffling. Since the nose is wide open after surgery, it is also difficult to draw in tears as there is not enough suction from an open nasal cavity to draw in a thin liquid. Additionally, surgery often destroys the mucosa's ability to reabsorb fluid through the mucosa itself.

• Increased fluid loss

When air is breathed in through the nose, the outermost part of the turbinates is cooled, while the air carries heat and moisture from the mucosa to the lungs. When the air is exhaled through the nose again, warm and humid air from the lungs will meet the now cooled mucosa, causing condensation between a warm airflow and a cold surface. This water is then absorbed by the mucosa again, and the body thus saves fluid. When the turbinates are removed, there is no surface for condensation, so all moisture is exhaled. The nose itself also becomes drier as no condensation occurs. Removing the turbinates thus leads to abnormally large fluid loss, which can be measured using, for example, Masimo pulse oximeter - Pleth variability index.

 

• Decreased productivity

More severe cases of Empty Nose Syndrome severely impair functionality and often result in a total inability to work. Individuals are forced to rely on low incomes from insurance companies or disability agencies. Having nasal surgery and then developing Empty Nose Syndrome is thus an economic burden as well as a mental and physical burden for the individual. Since Ear Nose Throat doctors refuse to accept ENS in many parts of the world as they earn significant amounts of money from performing these surgeries, affected individuals often find themselves in a precarious situation where they cannot work but are forced to work anyway. This often leads to terminations from the employer's side as they do not accept the individual's disability.

 

• Frustration/impatience/irritability

Constant breathing issues, sleep problems, and pain lead to significant tension in daily life, often manifesting as frustration, impatience, and irritability. The refusal of surgeons and society at large to listen to affected patients exacerbates the irritability further.

 

• Depression, resignation and suicide

As of this writing, after a brief investigation from English-speaking Empty Nose Syndrome groups, we have found evidence of around 40 cases of suicide where the individual has left information stating that it was due to their Empty Nose Syndrome.

 

Chronic pain, ongoing breathing problems, and constant sleep issues can eventually break even the strongest individuals. When society refuses to listen to affected individuals and there is no cure for the condition, many become resigned and depressed. The number of unreported suicides is enormous as we have only been able to check a few individuals associated with English-speaking groups.

 

• General disability

Difficulty functioning and performing daily activities. This is due to pain, dryness, sensitivity to odors, particles, warm air, etc. Furthermore, due to constant shortness of breath and hyperventilation and constant sleep problems. Also due to dizziness.

 

• Dry eyes

Dry eyes are commonly reported among those who have Empty Nose Syndrome. The nasal mucosa is in close contact with the mucosa in and around the eyes. If there is chronic inflammation in the nasal mucosa due to dryness, cytokines (inflammatory signaling molecules) also reach the eye's mucosa, causing many to experience dryness here as well.

 

Additionally, many individuals with Empty Nose Syndrome are forced to take sleeping pills, which leads to anticholinergic effects. This is because it blocks acetylcholine from attaching to the muscarinic receptors. The consequence is systemic dryness, decreased secretion production in the intestines, decreased tear production, saliva, etc.

 

Summary: ENS and its systemic effects on the body

Here, a brief introduction has been provided to some commonly occurring symptoms following aggressively performed nasal surgeries. The list above is not exhaustive. Empty Nose Syndrome is a systemic condition that affects the entire individual both physiologically and mentally, often resulting in secondary diseases. The condition also leads to disturbances in the balance between oxygen and carbon dioxide in the body and negative changes in blood pH levels. For example, over-breathing can cause the blood to become more alkaline than it should be, leading to a condition known as Respiratory Alkalosis. This can cause a range of symptoms, including dizziness, tingling in the fingers and toes, muscle cramps, and in severe cases, it can lead to unconsciousness.

When the blood becomes chronically more alkaline, it can also negatively affect organs such as the kidneys. Here's how it happens.

The Role of Kidneys in Acid-Base Balance: The kidneys play a vital role in maintaining the body's acid-base balance by regulating the secretion of hydrogen ions (H+) and bicarbonate (HCO3-). In alkalosis, the kidneys attempt to compensate by reducing the secretion of bicarbonate and increasing the secretion of hydrogen ions.

Metabolic Changes: Prolonged alkalosis can overwhelm the kidneys' ability to compensate, leading to metabolic changes. This can adversely affect kidney function and lead to an imbalance in electrolytes, such as potassium and calcium.

Electrolyte Balance: Chronic alkalosis can cause hypokalemia (low potassium levels) because alkalosis promotes the movement of potassium into cells. Hypokalemia can, in turn, lead to kidney damage and impaired kidney function over time.

Kidney Damage: Persistent changes in pH and electrolyte levels can cause structural damage to the kidneys. This can contribute to the development of kidney diseases or worsen existing kidney problems.

Impact on Bone Health: Prolonged alkalosis can also affect bone health, as the body may mobilize calcium from the bones to compensate for the high pH level. This can lead to osteoporosis, indirectly affecting the kidneys through altered calcium levels in the blood and increased risk of kidney stones.

Surgery of the Nasal Turbinates - Today's Lobotomy

There is ample knowledge today about Empty Nose Syndrome and the effects of excessive nasal surgery. However, ear, nose, and throat doctors refuse to acknowledge this knowledge. They refuse to listen to affected patients and they refuse to inform about the risks. The reason is that the industry has evolved over decades to profit from nasal surgeries. An ear, nose, and throat doctor's primary task is not to investigate the underlying cause of a patient's nasal congestion but their main task is to operate. This is regardless of whether it is necessary or not. It is what they have been trained for, and it is what they and the clinic profit from. Patients are misled into believing that these operations are risk-free. Therefore, authorities must step in and take responsibility. It cannot be acceptable for people to be so devastated that they take their own lives after these operations.

Below, for those who doubt the consequences of removing nasal organs, you can see the results for yourself. Here you can see comments from over 120 patients who have undergone surgery of the sinuses, nasal septum, or nasal turbinates.