Are you suffering from Empty Nose Syndrome?
Anik
et Singh (name changed) had everything going for him — a successful career, fulfiling relationship and steady finances. But despite seeming to have it all, Aniket was depressed. His family started noticing a change in his behaviour and tried to coax him into visiting a psychiatrist. Aniket decided to check with his GP first. As he started recalling his past medical history and medical symptoms, his doctor realised that Aniket wasn't suffering from a psychological disorder. Rather, he had the Empty Nose Syndrome (ENS) — a very unique and rare condition where one loses the sensation that he/she is breathing.
Says stemcell transplant surgeon Dr Pradeep Mahajan, "This happens because the part in the nose called as inferior or middle turbinate that is responsible for this function is excised or disturbed during a nasal surgery. Most of the symptoms in ENS arise because of improper neurosensory receptors, ineffective air conditioning and humidification. Turbinate tissues are recognised sources of certain nerve growth factors, an intrinsic protein that is critical for the natural healing process. When the turbinates are damaged and not functional, the healing process cannot be orchestrated and no nasal message can be carried to the brain."
Adds ENT specialist Dr Sanjay Bhatia, "ENS is a combination of symptoms and causes a sense of nasal obstruction. It was first described by Dr Eugene Kem in 1994."
Symptoms
The most common type is described as ENS-IT. Explains Dr Mahajan, "A patient feels emptiness and very dry in the nose constantly. A person goes into depression in most of the cases. Two other subtypes are also identified based on the symptoms, like in ENS-MT; where there is involvement of the middle turbinate and a patient feels pain while breathing. In the third type, both the turbinates may be involved, with both types of symptoms."
"Watch out for nasal obstruction, crusting and dryness of the nose, which are predominant symptoms. This is inspite of a large roomy nasal cavity after the nasal turbinate resection," says Dr Bhatia.
Diagnosis
According to Dr Mahajan, diagnosis of ENS is based on subjective evaluation.
- A thorough history taking with symptoms evaluation
- History of prior nasal surgeries
- Nasal endoscopy
- Cotton test
- CT-PNS (Plain)
- Modified SNOT 25 questionnaire
- PNIFR evaluation (Peak Nasal Inspiratory Flow Rate)
Treatment
The aim of the treatment should be to restore the inner geometric contours of the nasal passage, to re-establish nasal resistance, to restore normal nasal function including humidification, heat regulation, filtration and airflow sensation. "Once diagnosis is done, conventional medical management involves nasal lavage, use of nasal hydration ointment, directed antibiotherapy, aerosols and local corticosteroids. Until recently, there was no solution for this syndrome; till a few workers tried some treatments using stem cells. The results have been not so consistent. Treatments using platelet rich plasma, platelet rich lipotransfer and Acell have been tried by a few seniors world over, with transient and inconsistent results. A novel and bold approach is to use self-limiting biological scaffolds along with autologous bone marrow concentrate and certain specific growth factors," says Dr Mahajan.
How common is this ailment in India?"As turbinate surgeries are common in routine nasal surgeries and also in malignancies, not many patients have the symptoms," says Dr Bhatia.
ENS is a relatively new entity. In most situations, it goes unnoticed and is under-diagnosed. Recent reports mention a rate of 0.2 per cent of patients who undergo nasal or septal surgery show signs and symptoms of ENS. "In India, though similar prevalence is expected, even the ENT specialists will need to be made aware and educated on this. Protocols for diagnosis as well as composite biological therapy need to be worked upon, developed and standaridised," ends Dr Mahajan.
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