Empty Nose Syndrome is a complex and confusing problem caused by old operations on the nasal turbinates {when they are removed completely).
I explain why I think this happens and talk through my process of how I figured it out my theory. in the end I explain how I treat ENS and how to prevent it.
I hope you find this video useful.
NEWSLETTER
If you would like more information, news and have access to various devices I give away for free, please sign up to my Newsletter. Click on the link below.
https://cheerful-knitter-8774.ck.page/35648c37b6
SNOREDOCTOR APP
This is my new app that helps people record and analyse their snoring at night. It is completely free (no ads, no paywalls, no personal data is collected). Please use the links below:
Android playstore link – https://play.google.com/store/apps/details?id=com.entandsleep.snoreapp&hl=en_GB&gl=US
Apple App Store
https://apps.apple.com/gb/app/snore-doctor/id1584804963
Camera kit
Canon EOS M6 Mark II – https://amzn.to/2KQjQPF
Canon 50mm F1.8 (nifty fifty) – The lens I use most of the time – https://amzn.to/3eI25yN
Canon Mount Adapter EF-EOS M – https://amzn.to/3j1opDF
Amazon Basics Tripod – https://amzn.to/3cntUuU
Google Pixel 6 Pro – https://amzn.to/3IDMBIB
Audio kit
Yeti Blue Microphone – https://amzn.to/3afEEJ7
Lighting kit
Neewer 2 Pack Dimmable Bi-color 480 LED Video Light and Stand Lighting Kit – https://amzn.to/3onLcu8
Laptop
ASUS ZenBook Pro Duo UX581 – https://amzn.to/2KUsfli
Software
Adobe Creative Suite
Chapters
0:00 introduction
0:10 What is Empty Nose Syndrome?
0:22 What are the nasal turbinates?
0:43 Removing the turbinates (turbinectomy)
0:50 How likely is empty nose syndrome to happen
1:27 This video is not about atrophic rhinitis
2:01 Hot, stuffy, blocked nose
2:06 Cold harsh air in lungs
2:19 Feeling like you can’t breathe
2:26 Cotton wool / Q-Tip test
3:01 Menthol test
3:09 Empty nose syndrome is caused by mid inferior turbinate loss.
3:31 Why I have such a big nose
4:16 Nasopulmonary reflex
4:35 Why is the mid inferior nasal turbinate special?
5:30 How removing the turbinates can affect airflow in the nose
5:54 River water flow analogy
6:11 Central compartment flow in the nose
6:27 Why low resistance means that sinuses do not get fresh air
7:38 Fast central flow and the menthol test
7:50 Turbulence and cotton wool / Q-Tip test for ENS
8:49 Septal Perforation has similar symptoms
9:17 Why the receptor theory is incorrect
9:39 Computational fluid dynamics are inconsistent
10:25 How do you fix empty nose syndrome?
11:31 Why patients do not want surgery for this condition
12:01 How to prevent empty nose syndrome
13:15 Conclusion
** Disclaimer – The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional. **
source
Another well presented video.
Many thanks.
Best regards
Interesting analysis. Like the Borg reference, Lacutis!😂
YOU SHOULDN'T MUCK AROUND WITH HUMAN ORGANS ETC. .
BAD MISTAKE 😊
Can you get Empty Nose Syndrome congenitally or idiopathically?
I have most of the symptoms but have never had nasal surgery.
I'm struggling to decide if being able to nose breathe better is worth the risk of turbinate reduction surgery, a lot of hype at the moment about mouth taping while sleeping and how beneficial nose breathing is but is not fixing my turbinates actually detrimental to my long term health?
I'm really glad you've done this video, because I'm in the process of considering some treatment to widen my nasal valves and possibly do some minor turbinate shrinkage and minor shrinkage of the part of the septum that can swell up (I think it's further back?) The treatment is this brand-name VivAer thing (I'm American, I'm not sure if it's available in other countries), and it's radiofrequency ablation but done externally to tissue (with a bipolar electrode pressed against tissue), instead of the type you have a video of where you shove this steak-thermometer-like needle probe inside some tissue and damage it productively to shrink it. Youtube's algorithm is really interested in showing me videos of people getting turbinate reductions and suffering from getting empty nose syndrome. As far as I can tell, what my ENT wants to do is really just shrink some parts of the turbinates, and REALLY try to expand the nasal valve. When I inhale strongly my nose tries to close up and this treatment is supposed to really focus on widening that just a bit, and since my turbinates especially on one side really seem enlarged, trying to shrink them down a bit at the same time. While I have a mildly deviated septum he suggested not bothering with a septoplasty unless I really want to do it for corrective purposes (you can see it a bit when looking up at my nostrils but not otherwise.)
This makes me feel less afraid to try this VivAer nasal-valve-remodeling procedure, as it's supposed to be quite noninvasive. You don't bleed much if it all, and the recovery is just the damaged tissue scarring up in the shrunken/moved state.
Thanks for video. I think ENS is not one desease that can be classified. It is the spectrum of different symptoms and causes.
What are you saying is one subtype of empty nose syndrome where aerodynamics is prevalent cause. It is when cotton test is working and implants are promising.
The second one is trigemial nerve damage where you end up with non-expressive and non-functional turbinate. Those patients will feel nothing with cotton test or will experience pain or parastesia. Often those patients are having early ENS, but as the neurons regenerate they get better.
Strangely enough those patients had both lateralization AND some radio/crio/laser therapy together. As I expecting damaging nerve in multiple places making it die instead of regenerate.
Hi Vik, when could I expect rib pain to stop from bruised ribs caused by coughing after tonsillectomy. It’s been 3 weeks since the tonsillectomy and 1 week since the rib pain started? Thanks
Very interesting the aspect of the airway resistance of cotton test. The same mecanism in the lungs with those smaller cavities.
It seems nasal surgery is fraught with problems. I wonder how many people undergoing repeat cosmetic rhinoplasty experience this (Michael Jackson I'm sure had alot of airflow problems). Great vid!
Amazing video Dr. Veer! You are doing something truly amazing. Many people suffered a lot and were dismissed by ENT surgeons, and it is dehumanizing. ENT surgeons are not mechanical engineers, they usually don't understand much of fluid dynamics. From an engineering perspective it is obvious that turbulence around the olfactory and sinus areas is critically important. Just because they can cut a piece of the body out and see clear passage does not at all mean that the patient will be okay.
Dear Dr. Veer, thank you very much for your video. Very few doctors take the time to truly try to understand this condition. Thank you so much for the effort you put into researching this and producing this video to share your knowledge with the public, and especially other ENTs.
I am an ENS patient myself and have read most of the published research on this. I find your ideas really interesting, and see them partly contrasting with other research I have read. But your approach of implanting on an awake patient is genius. I had no idea this was possible. Being a patient myself, I know how difficult it is to grasp this disease theoretically. And how trial & error with the cotton test is weirdly the most promising approach to find an implant site.
Best regards from Germany!
Hi Vic, I’ve watched your other videos regarding nasal sprays. My question is can Rinatec be used along side a steroidal spray such as Avamys? Even if you just use it (Rinatec) on an acute as needed basis?
Many thanks!
Hi Vik, thanks for doing a video on this topic. You've discussed ENS occurring due to surgery – but I assume it is also reasonable to assume it can happen through other means. There must be receptors or nerves somewhere along the line that pass the sensation back to the brain to create those sensations of not breathing. Presumably those can get damaged via other means.
I say this because my mum has symptoms that sound very much like empty nose syndrome (that's how I first learnt of it – trying to research the symptoms she described). She developed this following a bad bout of covid. Since we know covid can damage people's sense of taste/smell, it must be able to affect nerves/receptors. Could it also be affecting how they sense air moving through the nose – and when damaged – the sensation that air is not moving through the nose and hence, empty nose syndrome. In this case the cotton wool test wouldn't apply as it the sensors that are damaged rather then the air flow.
(notes – her nose isn't physically blocked – ent checked – just a little dry, no discharge). Her experience of it has been so terrible as she feels as she is suffocating constantly. We haven't been able to get anywhere with the gp/ent treating her. they say it's ok and send her off with some steroid spray.
Could you please do a video on how the NHS does their ENT surgeries and how it often differs from other countries? If it’s even a thing? I’ve just had a septoplasty in Leeds with turbinate reduction using RF. No packing was used or any kind of stent. The results were amazing even on day 1. Is there an NHS standard to these sorts of operations? A lot of content on YouTube is from America and there is a lot of methods disparity.
Please do a video about tracheostomys and the implications of having an alternative airway. Your videos are great thank you so much ❤
Vik, thank you for taking on an emotionally-charged topic like ENS. In general the information you share on your channel is so important for people with breathing issues, and every time I see a new video of yours it feels like Christmas morning.
Do you think you would like to do an AMA (Ask Me Anything) video? Viewers could submit questions in advance, and upvote the ones they like, then you answer the highest-voted ones (or any others you think are interesting). Maybe something you'd consider?