emptynose

Empty-nose syndrome, often shortened to ENS, is a term used in otolaryngology to describe a set of chronic nasal symptoms that some patients report after extensive reduction or removal of nasal turbinates during surgery. The nasal turbinates are bony structures covered by mucosa that normally humidify, filter, and condition inspired air; their reduction can alter nasal airflow and mucosal function.

Clinical features of ENS typically include a paradoxical sense of nasal obstruction or breathing difficulty despite open nasal passages, along with dryness, crusting, sensation of fullness or “air hunger” in the nose, frequent sniffing or throat clearing, postnasal drainage, headaches, and sometimes a reduced or altered sense of smell. Symptoms can fluctuate and may be persistent for months or years. The condition is controversial, and some clinicians question whether ENS is a distinct syndrome or a consequence of more common chronic rhinosinusitis or post-surgical changes.

Causes are linked to prior turbinate surgery, particularly procedures that remove or aggressively reduce turbinate tissue, such as submucosal resection or turbinectomy, sometimes combined with radiofrequency ablation. The proposed pathophysiology involves loss of mucosal surface area, disruption of mucociliary clearance, altered airflow dynamics, and potential sensory changes in nasal nerves that affect the perception of airflow.

Diagnosis relies on patient history and examination, with endoscopy and imaging used to exclude other conditions. ENS is largely diagnosed on clinical grounds, as imaging can appear normal even when symptoms are present.

Management focuses on symptom relief and quality of life. Approaches include nasal saline irrigation, humidification, topical therapies to manage dryness or inflammation, and, in some centers, reconstructive procedures using grafts or implants to restore turbinate structure. Psychological and behavioral support may also be beneficial for some patients.