Empty nose syndrome

Empty nose syndrome (ENS) is a clinical syndrome in which there is a sensation of suffocation despite a clear airway. This syndrome is often referred to as a form of secondary atrophic rhinitis. ENS is a potential complication of nasal turbinate surgery or procedure. Affected individuals have usually undergone a turbinectomy or turbinoplasty (resection or reduction respectively of structures inside the nose called turbinates), or other surgical procedures that injure the nasal turbinates.

There are a range of symptoms, including feelings of nasal obstruction, loss of airflow sensation, nasal dryness and crusting, and a sensation of being unable to breathe. Sleep may be severely impaired due to one or a combination of these symptoms.

The overall incidence of ENS is unknown due to the small body of epidemiological study and the lack of a dedicated International Classification of Diseases (ICD-10) code, which would allow incidence reporting of the syndrome. Many cases of ENS may be unrecognized, underdiagnosed, and unreported.

ENS usually occurs with unobstructed nasal passages with a history of previous surgical intervention and sensations of suffocation or obstruction following recovery. Early literature attributed ENS to complete turbinate resection, but later research demonstrated the syndrome in patients who had undergone a range of procedures that involved nasal turbinates, including conservative reductions. Even unilateral (one-sided) ENS has been reported.

The existence of ENS as a distinct medical condition is controversial. More ear, nose and throat (ENT) practitioners and plastic surgeons are recognizing the condition. The Haute-Autorité de Santé (HAS) published guidelines in 2022. ENS is not fully understood and practitioner knowledge about altered nasal breathing in turbinate surgeries varies. Understanding why some individuals exhibit ENS symptoms while others do not and incorrectly attributing symptoms to psychological causes such as anxiety are common reasons people with ENS do not receive care. ENS as a distinct condition is subject to debate, including whether it should be considered solely rhinologic or whether it may have neurological or psychosomatic aspects. Growing awareness of the syndrome and an increasing body of research has led to more acceptance by ENT practitioners.