ENT disorder: what is “empty nose syndrome”?

Rest assured, empty nose syndrome is not a new disease or virus that can fall on you during the winter. However, it remains a very disabling disorder for some patients who have undergone surgery (a turbinectomy) for persistent nasal obstruction such as chronic rhinitis. So much so that the High Authority of Health gives new recommendations to surgeons who practice it.

What is empty nose syndrome?

The empty nose syndrome, also called SNV, is the consequence of a lower or middle turbinal gesture, performed during surgery in front of a persistent nasal obstruction (chronic rhinitis, deviated septum and put back in place…). The Federation of Respiratory Insufficiencies, the FFAAIR, defines it as follows:

This type of surgery involves removing part of the turbinates, these rolled-up growths, 3 in number in adults, located in the nasal cavities. Unfortunately, once damaged, if the surgery has been too invasive or aggressive, the turbinates seem to no longer perform their function. Still according to the FFAAIR: “The nose then loses its ability to properly pressurize, warm, filter, humidify and detect the flow of inspired air. The natural respiratory synchronization between the nose, mouth and lungs is then disrupted. The patients of the SNV then live a real ordeal”.

For Dr. Amine Harichane, ENT surgeon contacted by us, this complication linked to endonasal surgery “that we only see in adults, never in children” when we touch the turbinates is however difficult to assess, since it is based on each person’s feelings in the face of a modification. “The turbinectomy is not a frequent surgery, but it occurs for example when we replace a nasal deviation, and when we have to remove a large part of the turbinate which has developed in the unbalanced space of the partitions. Among the people operated on, we can say that 20% experience this syndrome.

What are the symptoms of empty nose syndrome?

Patients affected by this syndrome generally complain of physical side effects, but also psychological ones.

For physical symptoms, those affected observe

• Severe nasal dryness and burning;
• A paradoxical obstruction;
• Headaches ;
• Frontal sinus and facial pain;
• Posterior flows;
• A loss of smell and taste;
• Shortness of breath.

On the psychological side, this syndrome also causes inconvenience, such as fatigue, insomnia with a feeling of nocturnal asphyxia. This ENT pathology also has the particularity of affecting the entire respiratory system.

What treatment can relieve empty nose syndrome?

For the ENT surgeon, due to the psychological nature of the pain and the feelings of each, the treatment of SNV is complex: “Of course, you must first check that you are not missing out on something else that can be treated, through examinations and imaging. But if it is an empty nose syndrome, symptomatic treatment will often have to go hand in hand with psychological treatment, so that the patient learns to accept, to appropriate this new nose.

New recommendations for professionals

Faced with these unpleasant and persistent disorders, however, the Haute Autorité de Santé published on December 15 a series of recommendations to avoid in the future an excessive occurrence of VNS among patients who consult for nasal obstruction. She therefore advises:

• Prohibit wide lower turbinectomies which are the most at risk of occurrence of VNS;
• Always start the management of VS with medical treatment;
• Only use turbinectomy as a last resort if no other treatment works for at least 6 months;
• Of course, inform the patient of the risk before the intervention;

Recommendations well received and expected, it seems, by ENT specialists. For Dr. Harichane, this makes sense: