I saw a news report: At the end of August 2016, a 27-year-old woman named Zhang Rui found a hospital in Urumqi through a Baidu search. She underwent a bilateral anterior ethmoid nerve block and nasal septum correction. Following the surgery, she developed psychological disorders and psychotic symptoms. Half a month later, she jumped to her death. Her family believes that the failed surgery caused Zhang Rui to suffer from "Empty Nose Syndrome." How painful is "Empty Nose Syndrome"? It seems that suicide is not an isolated case.
(1) Due to the interview titled "The Empty Nose Syndrome Group
Behind the Bride-to-be's Death in a Fall, Where Breathing Felt Like Being
Stabbed by a Knife," I recently came into contact with some patients and
suspected patients of Empty Nose Syndrome who have not yet been diagnosed. Let
me share my preliminary thoughts.
1.
Rhinitis is not the same as Empty Nose Syndrome; the
two concepts should not be confused.
2.
Academician Han Demin, a domestic expert in the field
of nasal treatment, stated that more than 20% of nasal surgeries result in
Empty Nose Syndrome.
3.
The treatment of Empty Nose Syndrome remains a global
challenge, and there is no cure currently available.
4.
Domestic tertiary hospitals have largely ceased
performing local nasal excisions and similar surgeries. However, private
hospitals, especially those in Putian, continue to perform these surgeries.
Individuals who did not have Empty Nose Syndrome have developed it as a result.
For example, Sun Sulin initially sought treatment for ear itching, but after
surgery, developed Empty Nose Syndrome. Zhang Rui’s family reported that Zhang
Rui was initially only treated for rhinitis, but the doctor irresponsibly
performed nasal surgery. Following heavy bleeding and unbearable pain, she
committed suicide by jumping off a building half a month later.
5.
Empty Nose Syndrome patients appear physically normal,
without missing limbs, but they are in constant pain. "Every second feels
like a knife stabbing into the brain," said Sun Sulin, an Empty Nose Syndrome
patient. She particularly understands Zhang Rui's suicide. "I wanted to
commit suicide every day for more than a year. If it weren't for my family
watching me closely, I would have succeeded long ago." The key issue is
that many people mistake them for being mentally ill. For example, Sun Sulin’s
family initially treated her as a mental patient. Sun Sulin mentioned that
another Empty Nose Syndrome patient left a suicide note before taking their
life, which read, "Don’t think I am mentally ill; this is the greatest
insult to me."
I want to clarify that many people who initially only had mild rhinitis,
which could have been treated with medication, were instead operated on by some
doctors at certain hospitals (I emphasize some, not the entire medical community).
A small number of them (again, a small number) developed Empty Nose Syndrome,
and eventually, some attempted or committed suicide.
Therefore, I must emphasize again that we cannot generalize or make
sweeping statements. These are just my rough thoughts; please feel free to
criticize and correct me.
(2) I am a patient with Empty Nose Syndrome, so I have some personal
opinions on this matter:
Why did the rhinitis patient Zhang Rui commit suicide due to the
unbearable consequences of a failed surgery? I believe we should start with
understanding the nasal conchae.
What are the nasal conchae?
The lower conchae, which are covered with a layer of mucous membrane,
have a layer of mucus on the surface, and some cilia that are invisible to the
naked eye. Most nasal conchae removal surgeries are performed on the lower
nasal conchae.
What is the function of the
inferior turbinate?
Simply put, the inferior turbinate functions as a supercharger,
humidifier, purifier, and air conditioner. It maintains nasal resistance,
regulates airflow, adjusts the temperature and humidity of inhaled air, and
filters and sterilizes it.
What are the consequences
of surgery?
Once too much of the inferior turbinate is removed, the most immediate
sensation is a lack of nasal resistance, difficulty breathing, and a reduced
sense of smell. If the nasal mucosa, mucus, and cilia covering the turbinate
are damaged, the patient may feel that the throat area becomes particularly dry
and the airflow is imperceptible. The lack of effectively filtered air can
cause reflex headaches, and insufficient oxygen can lead to fatigue. The resulting
depression, neurasthenia, and poor sleep quality are just a few of the many
symptoms. With so many side effects, you can imagine how torturous life is for
patients with Empty Nose Syndrome. I have now forgotten what it feels like to
feel refreshed.
Now you should understand why patients with rhinitis might commit
suicide after a failed surgery, right? I don’t know how long I can hold on, but
who would choose death if they could live well?
Reply to everyone's
question about how to treat rhinitis:
1.
The most direct and effective method is to move to a
place with good air quality.
2.
Regularly flush the nasal cavity with physiological
seawater, and avoid drugs containing hormones or other substances that can
irritate the nasal mucosa.
3.
For those who have tried other treatments with no
success and whose quality of life is severely impacted, "inferior
turbinate submucosal resection" may be carefully considered.
4.
If you have a deviated nasal septum and it is severe
enough to cause respiratory arrest at night, then consider septum deviation
correction surgery.
5.
Always choose a reputable public tertiary hospital for
surgery, verify whether the department is outsourced, and ensure the doctor has
a valid practicing license. Keep all medical records in case of a medical
accident.
6. Don’t trust Baidu! Don’t trust the Putian system! Don’t trust all medical advertisements and recommendations from “relatives and friends”! Resist temptation and think critically!
(3) A 27-year-old woman sought treatment for chronic rhinitis before
getting engaged. She underwent surgery on the day of her initial diagnosis and
fell to her death 19 days later. Her family filed a lawsuit against the
hospital and Baidu.
Why did this happen?
Last night, Shandong TV's "Investigation" aired a report
titled "The Mystery of the Bride-to-Be Falling to Her Death After Being
Treated for Rhinitis." Let’s review it together——
The woman in question was Zhang Rui, 27 years old, who lived in Urumqi
and was planning to marry her boyfriend that year. No one expected that a woman
preparing to embrace a new life would suddenly jump from her 14-story home one
night, leaving behind a series of unsolved mysteries.
Half a year has passed since Zhang Rui’s fall, yet there is still a
large mark left in the green belt where she landed. The police investigation
concluded that the cause of death was a fall from a height. Residents of the
community mentioned that Zhang Rui had been behaving strangely prior to her
death, but the reason she fell from the building was not what the residents
guessed. Zhang Rui and her boyfriend had been dating for eight years, and
neither was originally from Urumqi. They started a software company in Urumqi
and worked hard for more than five years, with their lives and relationship
improving steadily. That was until a small check-up before their wedding. Zhang
Rui's rhinitis was not particularly severe, only flaring up when she had a
cold, causing a lot of clear nasal discharge. In August, she searched on Baidu
for treatments for rhinitis in Urumqi.
At the end of August 2016, Zhang Rui searched for the terms
"Urumqi" and "rhinitis" on Baidu and was directed to the
website of Urumqi Edward Hospital. After making an appointment online, she went
to the hospital on the 27th to see a doctor named Hu Jiankui for rhinitis
treatment. On the day of her first visit,
Zhang Rui was diagnosed with allergic rhinitis, hypertrophic rhinitis,
sinusitis, and a deviated nasal septum. He underwent a bilateral anterior
ethmoid nerve block, turbinate ablation, and nasal septum correction. The
surgery cost Zhang Rui more than 4,000 yuan. In the week following the
operation, he spent hundreds of yuan each day on follow-up treatments at the
hospital. On the morning of the seventh day, Zhang Rui experienced heavy nosebleeds.
On the tenth day after the surgery, he returned to Edward Hospital to have the
gauze removed from his nose.
According to Xiao Yang, Zhang Rui's pain persisted continuously from
that day onward. She was unable to work or lead a normal life and experienced
hallucinations, feeling as though someone was trying to harm her. Seventeen
days after the rhinitis surgery, and two days before her fall, Xiao Yang took
Zhang Rui to the psychiatric department. The medical record noted symptoms
including slowed response, confusion, irritability, impatience, difficulty
sleeping, and poor work performance. An investigation revealed that Zhang Rui
had weak emotional control. Zhang Rui's family believed her fall was related to
the rhinitis surgery and subsequently filed a lawsuit against Edward Hospital.
Notably, Zhang Rui's family also included Baidu as a defendant in the lawsuit.
Zhang Rui's family attorney, Hong Li, explained: "When you type
'Urumqi rhinitis' into Baidu, the top three results are all Edward Hospital,
which can give ordinary users the impression that it is the best hospital,
potentially misleading them." After representing Zhang Rui, Hong Li had
the search results notarized. The notarization shows that in September 2016,
searching for "Urumqi rhinitis" on Baidu yielded several results for
Urumqi Edward Hospital, with the last line of the search results indicating
"v" and "advertisement." The Shuimogou District People's
Court of Urumqi accepted the case.
The suicide of an unmarried bride-to-be is indeed tragic and
regrettable. But this raises a crucial question: why did Zhang Rui's family sue
the hospital that performed the rhinitis surgery, and even Baidu? How could a
rhinitis surgery alone lead to a patient's suicide? To address these questions,
we first need to understand a term in otolaryngology: turbinate ablation.
Turbinate ablation involves the removal of part of the turbinate. Can
this procedure make someone so uncomfortable that they might consider suicide?
We found a rights protection group for Empty Nose Syndrome sufferers, many of
whom have undergone turbinate ablation. We spoke with a patient named Sun
Sulin, who, at the end of 2013, spent over 4,000 yuan on partial removal of the
middle and lower turbinates at a hospital in Shanghai due to ear pain. A week
after the operation, Sun Sulin's symptoms closely mirrored those described by
Zhang Rui.
Sun Sulin reported to the media that for over three years, every breath
she took felt like a knife was being driven into her brain and lungs. The air
felt excessively dry and irritating. She explained, "I have to spray
medicine constantly and carry it with me 24 hours a day. Despite this, it's
only a temporary solution. The moisture is minimal, and it doesn't help with
the issue. My nose has no sensation; I can't feel the airflow or breathing.
Additionally, it has been aggravating my lungs and stomach. I constantly feel
nauseous and have a cold stomach. My lungs are always coughing, and I
frequently catch colds and have fevers. My immunity is compromised, allowing
cold air and bacteria to go directly to my lungs. After the partial removal of
the middle and lower turbinates, I suffered from stomach pain, headaches,
shortness of breath, overall weakness, and lost my ability to work, requiring
me to stay in bed for long periods. My husband had to resign from his job to
take care of my diet and daily needs. I believe Zhang Rui committed suicide by
jumping from a building because he could not endure the pain following his
surgery."
Could partial removal of the middle and inferior turbinates lead to
symptoms associated with Empty Nose Syndrome? What is the nature of this
surgery in clinical practice? The reporter attempted to contact otolaryngology
departments from hospitals in Beijing, Shandong, and other locations for
clarification, but several experts declined the interview requests due to the
lack of a clear national stance.
The Xinjiang Yunxiang Judicial Appraisal Institute conducted a forensic
clinical assessment based on Zhang Rui's medical records from Edward Hospital
and the mental health clinic records provided by her family. The assessment
found that Edward Hospital committed medical errors in Zhang Rui's diagnosis
and treatment, including insufficient clinical basis, violations of treatment
principles and standards, failure to provide informed consent, and neglect of
necessary precautions. The report stated: "In this case, the medical team
should have adopted a step-by-step treatment approach. Instead, the patient
underwent surgery with an expanded scope of operation. Therefore, the medical
team committed errors that violated treatment principles and norms." The report
also estimated that the hospital's medical faults contributed 25% to Zhang
Rui's death. Edward Hospital's attorney responded by stating that they could
not comment before the court trial.
Whether turbinate ablation causes suffering severe enough to be considered
worse than death is a medical question that needs to be addressed by the
authoritative medical community. Determining whether the surgery on Zhang Rui
was appropriate and whether the hospital's treatment adhered to regulations are
legal matters to be resolved by the court. This case bears similarities to the
Wei Zexi incident, which attracted significant attention last year.
Last spring, Wei Zexi's name was frequently in the headlines, raising
widespread concern about issues like outsourcing of public hospital departments
and search engine bidding rankings. In Zhang Rui's family's lawsuit, Baidu was
named as a secondary defendant, alleging that Zhang Rui was misled by Edward
Hospital's paid search rankings for rhinitis on Baidu.
The reporter observed that Baidu's search engine now clearly marks
commercial promotions and provides risk warnings. Zhang Rui used the search
engine in August of last year, after these changes were implemented. Will Baidu
still be held responsible?
Zhu Wei, a professor at China University of Political Science and Law,
argues that internet users should be aware of advertisements in search results
when using search engines like Baidu. He views this as common knowledge. If
Baidu has reviewed the qualifications of those paying for search services and
clearly marked these as advertisements, then under the Advertising Law, it
should not be held responsible. Advertisements in search results should not
exceed 30%, and if a website engages in false advertising, search engines like
Baidu are obligated to verify and remove such links. Zhu Wei believes that even
if hospitals engage in false advertising on their official websites, search
engines like Baidu might not necessarily be held accountable.
The subpoena obtained by Zhang Rui's family indicates that the court
will open the case on April 24, two weeks from now. However, the reporter has
learned that the court might need to postpone the case due to the defendant’s
objection to jurisdiction. The responsibilities of the hospital and Baidu in
this case will ultimately be determined by the court. A year has passed since
Wei Zexi’s death. We have seen that the country has taken a series of measures,
and we hope that medical and internet advertising practices will become
increasingly standardized, ensuring effective protection of patients' rights.
I had a nasal septum correction surgery at Shenzhen Peace Hospital in
2012. Before the surgery, the doctor described my symptoms as very severe,
warning that without the surgery, a large number of nasal polyps would grow,
making them difficult to treat later and potentially causing fungal sinusitis
and other issues. In reality, I had suffered from rhinitis (primarily
hypertrophy of the inferior turbinate) for many years. Aside from nasal
blockage, I had never experienced other symptoms. The main goal of the nasal
septum surgery was to alleviate facial pain and improve my quality of life.
When the doctor explained the surgical plan, he mentioned that removing
part of the inferior turbinate would make the nasal mucosa unnecessary. The
contact information and mobile phone number provided by the doctor who
performed my surgery turned out to be false, and I was unable to reach him a
month after the surgery. I received local anesthesia, and the doctor’s attitude
was very casual and indifferent. During the operation, the doctor removed
one-third of my right inferior turbinate. I also asked the doctor why he
removed the right inferior turbinate when my nasal septum was deviated to the
left. The doctor replied that it was "common practice."
After the surgery, the packing in my nasal cavity was removed within two
days. However, there was significant bleeding after the packing was removed,
and it had to be replaced. I contacted the surgeon at the time, but his
response was very dismissive and impatient. He said it was normal and handed me
a tissue to manage the bleeding.
It wasn’t until I went to a tertiary hospital and received hemostatic
drugs that the situation improved. After being discharged, my nasal cavity felt
constantly dry, and I experienced over-ventilation. My throat was always filled
with dust. When winter arrived, my throat felt extremely cold, and I kept
retching. No matter what I did, it didn’t get better. Initially, I thought it
was just part of the recovery process, so I didn’t pay much attention. I
continued using saline to rinse my nose, but two years later, not only did my
nasal symptoms not improve, but my lung discomfort worsened gradually. I began
to experience difficulty breathing and suffocation, even feeling labored when
climbing stairs. My eyes were always filled with stars, and every breath felt
like a knife in my lungs, as if they were burned by fire. I could hardly
concentrate on my work, and my work efficiency was consistently low.
It wasn’t until 2015, when I learned about the term "empty nose
syndrome," that I discovered the truth. It turned out that the doctor had
removed one-third of the front end of my inferior turbinate, causing
significant damage to my nasal mucosa. There were large scars left in my nasal
cavity after the removal of the inferior turbinate. My nasal cavity lost its
ability to filter small dust particles from the air, and the discomfort and
pain in my lungs were due to inhaling excessive dust. I wanted to sue Shenzhen
Heping Hospital, which turned out to be a "black hospital," but by
the time I went there, it had been shut down. Specific link: http://sz.house.qq.com/a/20131222/002313.htm
Here are a few things I want to say to all netizens:
1.
Do not trust any non-Grade 3A hospital for surgery,
and be cautious with Armed Police Hospitals or PLA Hospitals.
2.
Empty nose syndrome is real, but the medical community
has not yet clearly defined the condition. Although doctors abroad have
researched it, the effectiveness of current treatments is uncertain.
3.
Although empty nose syndrome is very distressing, you
should not reject nasal surgery altogether. When considering nasal surgery, it
is best to discuss with the doctor whether they recognize empty nose syndrome.
If they do, they will try their best to protect the nasal tissues during the
operation to avoid this condition.
4.
Nasal diseases can lead to many mental problems, but
patients with empty nose syndrome are not "mentally ill." They are
individuals who suffer from a condition that others often do not understand.
Their emotional struggles and impulses are caused by the disease that torments
them, not by any inherent "mental illness."
To those who dismiss empty nose syndrome as a psychological issue without scientific basis: you are truly unworthy of your titles. To put it bluntly, you are not suited to study medicine, a field that requires objectivity and rigor.
5 Causes of Empty Nose Syndrome
The seemingly advanced technologies such as "laser" and
"low-temperature plasma," combined with the promise of a
"one-time cure," have given many patients with nasal diseases a false
sense of hope. However, the reality can be harsh. After a brief period of
symptom relief, many patients end up paying a heavy price: dry nose, nasal
congestion, headaches, increased nasal discharge, and nasal reflux.
Are laser and low-temperature plasma technologies beneficial for
patients with nasal diseases, or are they leading them into a deeper problem?
To unravel this, we must first understand the treatment principles behind these
technologies. Laser therapy employs the photothermal effect of stimulated
radiation light on tissues. The treatment temperature is high (over 150°C), and
it ablates the nasal mucosa by destroying its epithelial layer. Low-temperature
plasma therapy uses high-frequency electromagnetic waves to ablate tissues at
lower temperatures (around 40-70°C). A highly concentrated plasma zone forms
around the electrode through a conductive medium, crushing the organic
molecular chains in the tissue, reducing tissue volume, and causing targeted
ablation. This method is often used to destroy the subepithelial layer of the
nasal mucosa, with the advantage of less heat penetration.
Both treatments focus on the nasal mucosa, which is crucial for the
nasal cavity's physiological function. The mucosal surface not only houses an
important ciliary transport system that clears secretions and dust but also
contains glands that secrete fluids to keep the nasal cavity moist.
Additionally, various receptors in the mucosa respond to whether the nasal
cavity is clear and the temperature is appropriate. Ablating the nasal mucosa
and shrinking the nasal concha with laser and low-temperature plasma treatments
inevitably impacts the function of the nasal mucosa, potentially leading to
counterproductive results. While some believe that low-temperature plasma
affects only the subepithelial layer and not the epithelial layer, thereby
causing less trauma, the reality is that the mucosa's damage cannot be ignored.
Currently, laser and low-temperature plasma technologies are commonly
used to treat inferior turbinate hypertrophy caused by rhinitis. The goal is to
improve nasal ventilation by ablating the inferior turbinate. However, there
are two primary types of inferior turbinate hypertrophy due to rhinitis: bony
hypertrophy, caused by bone hyperplasia of the inferior turbinate, and mucosal
hypertrophy, caused by mucosal hyperplasia. Bony hypertrophy of the inferior
turbinate is unsuitable for treatment with laser and low-temperature plasma,
which explains why many patients experience no improvement or even discomfort
after such treatments. For patients with mucosal hypertrophy, a period of
regular treatment with nasal hormones and other medications is generally
effective, and they should avoid destructive mucosal treatments.
Laser and low-temperature plasma technologies do have their place in
treating nasal diseases, but their indications should be approached with
caution. For patients with severe mucosal hypertrophy of the inferior turbinate
who have not responded to regular drug treatments, these technologies can be
used to ablate the hypertrophic mucosa of the posterior segment of the inferior
turbinate (but not excessively). They can also be used to block the anterior
ethmoid nerve in cases of allergic rhinitis to temporarily reduce nerve
sensitivity and improve symptoms. However, these technologies do not provide a
radical cure. Additionally, they are effective in treating epistaxis, with
bleeding points being closed with the aid of nasal endoscopes. Post-surgery,
patients should rinse their nasal cavity with normal saline and use oily drops
to keep the nasal cavity clean and moist, promoting mucosal recovery.
Patients who have undergone laser or low-temperature plasma treatments
and experience symptoms such as nasal congestion, dry nose, excessive nasal
discharge, or nosebleeds should use normal saline to rinse their nasal cavity
regularly and consider medications that promote mucosal recovery and thin
mucus, such as standard myrtle essential oil (Ginoton), to restore nasal mucosa
function. Ultimately, patients should exercise caution when considering laser
and low-temperature plasma treatments and consult a nasal specialist at a
reputable medical institution before proceeding.
In 2012, I had mild chronic rhinitis. I searched for rhinitis hospitals
on Baidu and clicked on the top result, Shanghai Fuda Hospital (a Putian
hospital). The doctor there performed bilateral middle and lower turbinate
ablation on me in the outpatient clinic. Later, I consulted Dr. Yu Hongmeng of
Shanghai Otorhinolaryngology Hospital. He said that due to this operation, my
nose could not be cured and expressed his concern. Nearly two or three years
later, I began to experience symptoms of empty nose syndrome. Despite numerous
visits to top hospitals in Shanghai and spending over 100,000 yuan on Chinese
medicine, my condition did not improve. A minor rhinitis surgery had led to
empty nose syndrome. It is crucial to approach rhinitis surgery with caution.
We must work together to raise awareness of empty nose syndrome, push for its recognition by national health authorities, include it in disease catalogs and medical textbooks, and encourage national research institutions to study its treatment methods. Ultimately, our goal is to find a cure for empty nose syndrome!
6 Actually, there are surgeries that are not related to rhinitis.
However, I was misled into believing that ear issues were caused by nasal
problems. I experienced discomfort in my ears whenever I heard a noise. Despite
consulting numerous hospitals, they found nothing wrong with my ears.
Eventually, I went to a private hospital where the doctor claimed my ear issues
were related to my nose, and I believed him because I had studied ears but not noses.
The doctor recommended surgery that same day, and the invoice indicated
unilateral ablation. However, during the local anesthesia, I realized both
nasal conchae were ablated. After the surgery, there was edema for a while, and
once the swelling subsided, my nose felt more ventilated. I started using
cotton for a long time to manage it. While my body tolerated it somewhat, I
could only sleep with my head down due to excessive ventilation. Every morning,
my nose felt uncomfortable, and my ear issues remained unresolved.
I later discovered that the hospital had been involved in false advertising and did not have an official hospital grade. I went to another hospital, where the doctor informed me that I didn’t need surgery and that my nasal mucosa was eroded.
7 Following the doctor-killing incident in Wenling, Zhejiang, empty nose
syndrome, previously considered a mysterious condition, began to attract public
attention. Lian Enqing, the perpetrator, was suspected to be suffering from
empty nose syndrome. After a series of unsuccessful attempts to seek medical
help and assert his rights, he attacked the doctor.
Before this incident, empty nose syndrome had been "avoided" by the medical community due to its association with sensitive issues like "over-medicalization." Furthermore, with no definitive treatment available globally, some desperate patients either committed suicide or harmed their doctors. Empty nose syndrome has thus evolved from a medical problem to a societal issue.
Otolaryngology: The Most Affected Area for Medical Injuries
After the Wenling incident, which led to nationwide protests by doctors,
the doctor-killer Lian Enqing was quickly identified as a patient with empty
nose syndrome by his peers.
Long before the Wenling incident, a group of empty nose syndrome
patients had already formed in China. Due to the lack of epidemiological
statistics, the exact number of affected individuals remains unknown.
Wang Xianzhong, a former otolaryngologist at Beijing Tongren Hospital,
has studied empty nose syndrome and conducted exploratory surgical treatments
on some patients. To date, he has diagnosed over 100 patients with empty nose
syndrome, and his patient group includes more than 260 individuals. "The
empty nose syndrome patients we know about are just the tip of the iceberg; we
don’t know the full extent of the group," Wang Xianzhong estimated,
suggesting there may be more than 10,000 cases.
Wang Xianzhong’s diagnosis is primarily based on CT scans showing
significant loss of the inferior turbinate, along with symptoms such as a dry
and cold nasal cavity, hyperventilation, chest tightness, insomnia, and
depression. The most crucial factor is evidence of destructive surgery on the
inferior turbinate.
For many years, these surgeries have been regarded as convenient and
effective means of treating rhinitis. However, the potential side effects of
these procedures have often been underestimated. In a sense, empty nose
syndrome represents a concentrated manifestation of these possible side
effects.
According to media reports, Wang Xianzhong is not entirely certain that
Lian Enqing also suffered from empty nose syndrome. However, he believes that
the 2012 incident in Beijing, where a patient attacked doctors, is related to
empty nose syndrome. On April 13, 2012, a patient named Lv Fuke stabbed
Professor Xing Zhimin of the Department of Otolaryngology at Peking University
People's Hospital, and a doctor at Beijing Aerospace General Hospital on the
same day. Lv Fuke had undergone nasal surgery in Tianjin and sought a
certificate from Xing Zhimin to claim compensation from the hospital. Wang
Xianzhong noted that in the past three years, there have been at least ten
violent incidents in ENT departments, with many perpetrators being patients
with empty nose syndrome. Besides these violent incidents, there are countless
other medical disputes. Wang Xianzhong argues that the rising number of empty
nose syndrome patients has made the ENT department, which is generally a small
department in hospitals, a "severely affected area" for
doctor-patient conflicts.
A Southern Weekend reporter discovered that the medical assault at Shenzhen Pengcheng Hospital on September 4, 2012, which injured four people, also occurred in the ENT department and involved a rhinitis patient. However, since hospitals often handle such cases discreetly, the specifics of these incidents and their connection to empty nose syndrome are largely unknown to the public.
Incomprehensible Pain
According to a Southern Weekend reporter, "empty nose
syndrome" is not yet officially recognized as a disease within the
domestic otolaryngology community. The term "empty nose syndrome"
(ENS) was first introduced by American doctor Kern et al. in 1994 to describe
symptoms resulting from the loss of nasal tissue and normal anatomical
structure. The condition is named "empty nose" because the nasal
cavity becomes excessively spacious due to tissue loss.
Wang Xianzhong began studying empty nose syndrome in 2009. He observed
that some patients who had undergone inferior turbinate surgery, especially
those where the turbinate was excessively removed, experienced a peculiar
symptom: their nasal passages became wider post-surgery, yet they still felt
stuffy. This symptom, known as "paradoxical nasal congestion," is
common in empty nose syndrome patients and is particularly distressing.
This was the case with the doctor who committed violence in Wenling. In
March 2012, Lian Enqing had a "bilateral inferior turbinate submucosal
resection" at the First People's Hospital of Wenling City due to
hypertrophic rhinitis. Despite examinations showing that his nasal cavity was
noticeably open, Lian Enqing continued to experience nasal congestion and
frequently had to use clips or cotton swabs to open his nostrils to breathe. He
also suffered from severe insomnia. Previously gentle, Lian Enqing became
irritable post-surgery, feeling that "the whole world is only the
nose."
Wang Xianzhong attributes the "paradoxical nasal congestion"
in empty nose syndrome patients to inappropriate physical damage to the
inferior turbinate, which disrupts the normal respiratory tissue structure of
the nasal cavity. This disruption leads to deviations from the normal
physiological state of nasal breathing, resulting in a series of respiratory
system disorders and a lack of normal breathing perception.
Yu Hongmeng, an otolaryngologist in Shanghai, notes that the nasal
mucosa contains various receptors that respond to nasal obstruction and
temperature. Thus, treating rhinitis solely through mucosal ablation or
shrinkage can have counterproductive effects.
Not all surgeries that excessively remove the inferior turbinate lead to
empty nose syndrome. Some laryngeal cancer patients do not develop empty nose
syndrome despite their nasal cavities being surgically hollowed out.
Additionally, some empty nose syndrome patients do not require special
treatment one or two years after surgery and recover on their own due to the
body's compensatory mechanisms.
Patients with empty nose syndrome exhibit various "quirks."
Some need to insert cotton in their noses to feel comfortable, others
frequently rinse their nasal cavities, and some use hot water to
"steam" their nostrils. A patient treated by Wang Xianzhong had to
"chase air" for a period—every time he exhaled, he had to chase it forward
to avoid discomfort.
Many patients have expressed a willingness to trade limbs or other
organs for a healthy nose. Fan Qiu (a pseudonym), a Guangzhou patient with
empty nose syndrome, told a Southern Weekend reporter, "It hurts, but we
can’t show it. Unlike those with broken limbs who receive sympathy, we look
normal but are in intense pain. No one believes us; they think I’m
exaggerating."
Psychological pain often surpasses physical pain. The unexplained
"paradoxical nasal congestion" leads many patients to be suspected of
mental issues by doctors and advised to see a psychiatrist. Family members also
struggle to understand the patients' suffering.
Some patients direct their frustration towards doctors. Yu Hongmeng
believes that patients with empty nose syndrome often had certain mental
disorders before surgery, and the surgery exacerbates their emotional
responses. "Without surgery, they feel uncomfortable; with surgery, they
feel worse. If surgery is performed, they desperately blame it for their problems,"
he explains. Therefore, he is cautious about performing surgery on such
patients, even if they persistently request it.
It is noteworthy that some patients who develop empty nose syndrome due
to inappropriate surgery become increasingly fixated on further surgeries,
hoping to use new procedures to treat the condition caused by previous
surgeries. Since 2012, a patient in Zaozhuang, Shandong, has undergone six
surgeries, including inferior turbinate surgery, spending over 100,000 yuan,
yet continues to seek treatment. On December 2, 2013, a patient named Liu,
whose symptoms had improved through his own compensatory mechanisms, insisted
on another operation from Wang Xianzhong due to discomfort in other nasal
areas.
Diseases That Are Avoided
Xianzhong had undergone "low-temperature plasma" surgery, a
popular treatment for chronic rhinitis in recent years. Compared to
conservative treatments and other surgeries, it is very appealing to rhinitis
patients due to its lack of bleeding, low cost, and no need for
hospitalization. After the Wenling incident, some hospitals discontinued this
surgery.
Yu Hongmeng believes that the benefits of low-temperature plasma surgery
for chronic rhinitis have been exaggerated and often abused. In clinical
practice, he found that while many patients experience short-term improvement
in nasal ventilation, they later pay an irreparable price.
An anonymous otolaryngologist told Southern Weekend that the popularity
of surgical treatments for rhinitis has deep-rooted causes. In his view,
smaller hospitals, unable to perform major surgeries, rely on minor surgeries
like low-temperature plasma for income. Revenue targets are set for departments
and doctors, leading to "over-medicalization." With public hospitals implementing
a zero-price difference policy for drugs, surgery has become more important.
A paper published in the Chinese Journal of Otolaryngology in 2001
reported that empty nose syndrome was identified in China as early as 1996. The
authors warned that excessive turbinate resection with ENS is a serious and
challenging iatrogenic complication, urging otolaryngologists to avoid
unnecessary resection or damage to nasal mucosa and structures.
Empty nose syndrome has been included in China’s authoritative medical
textbook, Otorhinolaryngology Head and Neck Surgery, published by the
People's Medical Publishing House, since at least 2005, under the official name
"iatrogenic atrophic rhinitis." The textbook emphasizes that this
condition "should attract attention" due to the lack of specific
treatments.
However, due to significant financial interests and the discipline's
image, empty nose syndrome has not received adequate attention in the industry.
As one otolaryngologist put it, the domestic otolaryngology community tends to
"avoid" the disease, leading to stagnation in academic research on
empty nose syndrome.
Unrecognized Pain and the Challenges of Empty Nose Syndrome
Patients who have undergone inferior turbinate surgery often experience
symptoms similar to those of empty nose syndrome, yet they may be unaware of
this condition. Doctors usually avoid providing a clear diagnosis in medical
records, opting instead for vague descriptions.
Since 2011, Wang Xianzhong has attempted to treat patients with empty
nose syndrome using "filling" surgery, having treated more than 20
cases to date. According to him, two patients were cured, some showed
improvement, and others experienced no effect. The controversial nature of the
treatment has led to disputes with some patients. Despite this, Wang Xianzhong
is not fearful of violent retaliation from patients with empty nose syndrome,
as he ensures they are fully informed about the potential outcomes and risks of
the surgery.
Yu Hongmeng remains pessimistic about the treatment prospects for empty
nose syndrome. Nevertheless, he is favored by many patients because he honestly
communicates the potential risks of inferior turbinate surgery.
Many patients with empty nose syndrome have reported that prior to their
surgery, surgeons focused solely on the benefits and failed to mention possible
side effects. "Regardless of whether there were issues with the surgery,
our right to be informed was not respected," said Yu Jia, a patient from
Wujiang, Jiangsu, in an interview with Southern Weekend. In October 2012, Yu
Jia underwent bilateral turbinate cryotherapy for allergic rhinitis. The
surgery altered the size of his nostrils, and he soon developed symptoms
consistent with empty nose syndrome. Although he was convinced he had the
condition, it was not confirmed by a doctor. Recently, due to persistent pain,
Yu Jia had to quit his job and rest at home.
Southern Weekend reporters attempted to contact several
otolaryngologists for interviews about empty nose syndrome, but most declined.
One doctor stated that, following the Wenling incident, the hospital had
explicitly instructed doctors not to accept interviews with reporters.
Some patients with empty nose syndrome confessed to Southern Weekend
reporters that they harbored intense anger towards doctors and felt urges to
harm them.
Desperate Patients
"Destructive surgeries targeting the inferior turbinate are not
exclusive to China; they are also performed in developed countries in Europe
and America. Why don’t doctors resort to violence in those countries?"
Wang Xianzhong asked during an interview. He attributed the violence in China
to a lack of fairness in the medical system.
"Hospitals are places to treat illnesses, not to resolve
disputes," Wang Xianzhong said. "Courts are the proper venues for
such matters, but patients often distrust the judicial system."
Many patients with empty nose syndrome have considered suing hospitals
to seek justice, but most have abandoned the idea, believing that they would
not prevail. Nevertheless, their resentment towards doctors remains strong.
“Almost all ENS patients feel they have been treated unfairly,” Wang noted.
“They feel abandoned by society and their families, which intensifies their
despair and anger.”
Six months after undergoing partial inferior turbinate removal surgery,
Lian Enqing began experiencing discomfort. He embarked on a prolonged quest for
medical treatment and to assert his rights.
Zheng Bijian, assistant to the director of Wenling First People's
Hospital, recounted that at the end of December 2012, Lian Enqing approached
him, complaining that "the surgery was ineffective." The hospital’s
ENT department director reviewed the case and found no issues with the surgery.
About ten days later, Lian Enqing returned to the hospital, requesting another
surgery to alleviate his pain. However, after a departmental consultation, it
was concluded that further surgery was unnecessary. Zheng Bijian admitted that
Lian Enqing appeared extremely distressed during his visit, even kneeling in
desperation.
Dr. Wang Yunjie, who was later killed by Lian Enqing, was not the
surgeon for Lian Enqing’s operation but had been involved in mediating the
medical dispute.
Lian Enqing was convinced he had empty nose syndrome. During his
inferior turbinate surgery, he also had "nasal septum correction
surgery" at Wenling’s First People's Hospital. He believed something had
gone wrong, thinking that the right side should have been operated on, but the
left side was treated instead, according to his sister, Lian Chao.
Zheng Bijian informed Southern Weekend reporters that the hospital had
sought advice from Tang Jianguo, vice chairman of the Zhejiang Provincial
Otolaryngology and Head and Neck Surgery Society, regarding Lian Enqing's case.
The reporter attempted to verify this with Tang, but Tang declined an
interview.
A deputy director of the Wenling Municipal Health Bureau admitted that
Lian Enqing had also contacted the Health Bureau about the controversy
surrounding his nasal surgery.
According to his sister Lian Chao, in early 2013, she accompanied Lian
Enqing to several tertiary hospitals in Hangzhou’s ENT departments, where
doctors found no issues with his nose. By August 2013, they visited a top
hospital in Shanghai, where doctors again found no problems. This led Lian Chao
to suspect mental issues and she admitted her brother to the Shanghai Mental
Health Center. “My brother didn’t want to go, and he attacked me and smashed my
phone,” Lian Chao said.
Medical records show that on October 24, the day before the murder, and
nine days after being removed from the Shanghai Mental Health Center by his
family, Lian Enqing went for his final nose check. He saw Zhang Zhaohui, an
otolaryngologist at Taizhou Municipal Hospital, and used a pseudonym on the
patient registration form, suspecting collusion among doctors.
Southern Weekend reporters later sought an interview with Zhang Zhaohui
about Lian Enqing’s treatment, but Zhang declined, stating that the interview
required hospital approval. The hospital’s vice president also said that
approval from higher authorities was necessary.
The following day, Lian Enqing, a suspected empty nose syndrome patient, went to Wenling First People's Hospital armed with a knife and hammer.
The Broader Implications of Unaddressed Pain
The pain associated with empty nose syndrome is difficult for others to
understand, as evidenced by the doctor-killing incident in Harbin.
Several years ago, I experienced rhinitis due to overwork and late
nights. I sought treatment at the First Affiliated Hospital, where
anti-inflammatory and expectorant drugs initially cured me. However, the
symptoms recurred within half a month and eventually progressed to frontal
sinusitis. I later went to the Second Affiliated Hospital, where the situation
seemed to improve. But as I aged and my health declined, the nightmare began
anew—weather changes, nasal congestion, frequent runny nose, severe throat
infections, coughing, and breathing difficulties. After extensive research, I
discovered that 80%-90% of those who undergo surgery face such sequelae, which
are often incurable. Doctors attribute this to individual resistance.
Reflecting on this experience, my advice is as follows: unless
absolutely necessary, avoid surgery. Rely on your body’s natural resistance
unless it is a life-threatening situation. Diseases fall into three categories:
incurable, self-curable, and treatable. Seek out the right doctor—those who
rely solely on surgery may not offer the best solutions. You must become an
expert in your own health.
I hope to find a business model to address this issue and wonder if it
will succeed.
Additional Point: There are many quack doctors and charlatans today; it’s essential to use your own judgment.
1.
Chinese medicine’s claim of omnipotence: Reflect on whether any disease
is truly incurable.
2.
Medicine’s progress: What were once considered
the best solutions may be replaced by better ones due to adverse events.
Medicine is not infallible; self-care and resistance are crucial.
3. Complexity of organisms: Individual differences
necessitate precision medicine, highlighting our limited understanding of
biological mechanisms. Advances are
still needed.
4. Impact on medical staff: While 60% of medical staff are dedicated and life-saving, they also need to support their families. Tolerance and patience are necessary, and we await improvements in the medical insurance system to address growing needs.
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