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Empty Nose Syndrome: causes symptoms and therapies

Empty Nose Syndrome (ENS): causes symptoms and therapies

Empty Nose Syndrome is a rare clinical syndrome that affects nose and nasal cavity in which people have clear nasal passage only in appearance although suffering a range of symptoms. Empty Nose Syndrome (ENS) is common in people who undergone turbinectomy or other surgical procedures that interfere with turbinates, which are essential structures inside the nose.

Contenuti dell’articolo:

  1. Cause
  2. Symtoms
  3. ENS and Turbinectomy
  4. Diagnosis
  5. Therapies
  6. Perspectives



People who undergone nose surgery or nasal cavity surgery can suffer from Empty Nose Syndrome. Similarly, who undergone a turbinectomy can suffer a range of ENS symptoms, although every turbinectomy doesn’t provoke ENS.

Turbinectomy is the removal or reduction of turbinates, structures inside the nose. This operation is made in order to enlarge nasal cavity to ease breathing.
It is necessary in case of small nasal cavity than make breathing difficult and most people noticed an intense improvement of breathing after the operation.
Moreover, turbinectomy allows reducing medication consumption, enhance the quality of life. However some people suffer from ENS symptoms even after surgery.
Since there are no direct causes, and the diagnosis is not so simple, ENS still remain a controversial disturb and is important to study how to nurse it.



People with ENS experience a range of several symptoms, most commonly feelings of nasal obstruction and sensation of being unable to breath
Some ENS symptoms are: feelings of nasal obstruction, headache, reduction of sense of taste and epistaxis (nose bleeding).

Other possible symptoms:

  • feeling of breathing dry or cold air
  • nasal obstruction, even with clear nasal passage
  • epistaxis (nose bleeding)
  • nasal dryness and crusting
  • breathlessness
  • feeling of breathing too much air
  • dizziness
  • lack of mucus
  • being unable to breathe
  • reduction of taste and sense of smell
  • sleep disorders, such as insomnia and daytime sleepiness

People with ENS could also experiment feeling of suffocation which infect sleep-wake cycle, therefore the quality of life. Anxiety and depression could be present before surgery or with ENS.
If these physical and psychological symptoms persist, we recommend to see a doctor.


Empty Nose Syndrome and Turbinectomy

Turbinates are two bone structures inside the nose and separated by the septum, which is a bone and cartilage section in the middle of the nose.
Turbinates help dividing nasal sinus from nasal cavity and are linked to their ends.
Every nose side has a low, medium and high turbinate. They carry out complex and different functions: the fundamental one is transmitting heat in the quickest way when inhaling through nose; for this reason cold air gets warmer. Moreover they calibrate air humidity and are made of a tissue that swells up and narrows in order to regulate airflow into the nasal cavity.
These functions alter both inhalation and expiration: turbinates help controlling the amount of heath and the fluid loss during expiration. In extreme atmospheric conditions environment, turbinates allow our body to hold back heath and liquids and to keep oxygen levels constant.
Having defined the importance of turbinates, their removal (or the removal of their nerve ends) can provoke serious symptoms. In many cases even a partial turbinectomy can cause ENS symptoms.



ENS diagnosis can be difficult. There are not definitive parameters or reliable tests for identifying it.
Is not possible to strongly assert that turbinectomy causes ENS symptoms. Turbinectomy, even partial, is effective in the majority of the cases and provoke few long-term collateral effects, whereas ENS symptoms can occur after weeks, months or ever years since surgery.
Doctors can diagnose only by excluding other types of diseases which occurs with the same symptoms. In case of any suspect, a damp swab can be used and inserted instead of turbinate in order to verify is this operation reliefs the patient.
However the swab can’t be considered as a valid diagnostic method and it can’t replaced a complete and in-depth diagnosis.



Required therapies consider using nasal washes and antibiotic nasal spray.

There are no univocal therapies for ENS and most of the already existing ones aim only at temporarily placate its symptoms.
Topical therapies, such as spray or saline nasal gel, can help to keep the nose moist, but they also remove mucus and peptides inside nose cavities: this collateral effect can cause the increase of bacteria inside the nose and so it become necessary to use nasal irrigation and antibiotic spray.

In addition to irrigations, there are some tricks that can help to placate symptoms:

  • sleeping with a humidifier
  • sleeping with a CPAP machine
  • living in humid and warm rooms
  • eating lots of soups and drinking warm drinks

Living in a humid room can mitigate symptoms because air humidity eases breathing and facilitate body oxygenation.
Although many people can’t, moving to warm and humid places can recover symptoms.
There are some surgical procedure which consider the implantation of tissues and other materials in order to enlarge remaining turbinates inside the nose and its area.
These surgical procedure can help balance air passage but cannot replace turbinates functions. Other types of surgical operations are being studied, with a focus on the use of plasma and platelets injections.
Some estrogens creams and some erectile dysfunction treatments cause nasal mucus inflammation and they can swell up remaining turbinates tissues and placate ENS symptoms.


ENS cases are difficult to diagnose and perspectives changes from case to case. Surgery and treatments can help get reasonable relief and constant symptoms supervision can help improve the quality life of people who are affected. Also mental health plays an important role on recover from stress and anxiety caused by ENS.

At the moment there aren’t therapies for Empty Nose Syndrome and only collaboration with otolaryngology and mental health specialists can increase the possibility of a therapy or the reduction of ENS symptoms.

Source: Medical News Today