Patient Question.
Disease: (Suspected) Empty nose syndrome
Description of the disease: I had a partial excision of the left inferior turbinate at a hospital in my hometown in 2006 for enlargement of the inferior turbinate, and I had good results after the operation. In the afternoon, it is almost impossible to carry out any thinking activities. The left nostril is sometimes blocked and sometimes clear, but whenever the left inferior turbinate is removed and the section of the nasal passage inward is sore and numb, it seems to be worse when it is clear because of the airflow to the brain. I am pretty sure it is caused by the surgery (because there is no discomfort in the right nasal cavity) and it feels related to the airflow hitting the brain, but there are no typical symptoms such as nasal and throat pain of Empty Nose Syndrome. I have visited ENT and neurology departments in several hospitals and have taken rhinosinusitis and sinusitis medications, neurotrophic medications, and saline nasal cleansing to no avail. You are one of the few experts in China on the sequelae of inferior turbinate removal surgery, and I hope I can get your help.
Help wanted: Is my symptom empty nose syndrome? Is there any way to treat or relieve it?
Reply by Wang Xianzhong.
Your own description of your medical history has negated your diagnosis of Emphysematous Rhinitis. Because your inferior turbinate was removed in 2006, it took 2-3 years for your current symptoms to appear. Then the current symptoms cannot be explained by “removal of inferior turbinate”, and the current symptoms can only be explained by other pathological mechanisms. I am not sure how to explain it. I do not rule out the possibility that your current symptoms are related to the left anterior or caudal inferior turbinate, the left middle turbinate, or the compensatory hyperplasia of the left mucosa of the nasal septum. In short, don’t jump to conclusions about yourself, especially don’t put a “empty nose” hat on yourself. That will only make you feel worse.
Patient Question.
Thank you very much for your quick reply! If it is indeed “residual left anterior or caudal inferior turbinate, or left middle turbinate, or left mucosal hyperplasia of the nasal septum” as you said, is there any way to treat it? Why do my symptoms get worse every winter? What percentage of my inferior turbinate has been removed? I also have a symptom that sometimes when I sleep, the remaining inferior turbinate on the left side makes a sound like ice melting.
My condition severely affects my brain’s ability to think and my daily work life is almost impossible. I sincerely beg for your help!
I’d even rather have empty nose now, because it’s at least a known disease!
Wang Xianzhong replies.
I am not a miracle doctor, but the root cause of your problem may have been really hit by my unfortunate words. The reason why you don’t have the symptoms of hyperventilation, nasal dryness, throat dryness, etc., which are common in “empty nasal syndrome”, and your current symptoms only appeared 2-3 years after inferior turbinatectomy is because your inferior turbinate defect is mainly in the middle of the inferior turbinate, and there are residues in the front and back end, plus the lower anterior part of your nasal septum happens to be left-sided. It is because your inferior turbinate defect is mainly in the middle part of the inferior turbinate, with both the anterior and posterior ends remaining, and your lower anterior nasal septum is deviated to the left that you are lucky not to join the ranks of “empty nose” patients. The reason why your current symptoms appear only 2-3 years after surgery and why they worsen every winter is because of the mucosa of the anterior and posterior ends of the left inferior turbinate, the compensatory hyperplasia of the mucosa of the left middle turbinate and the aggravation of congestion in winter. Your current state is a hard slap in the face to the experts who say that inferior turbinate removal can cause atrophic rhinitis. The above is my family’s opinion on the pathological mechanism that has given rise to your problem. Although I can analyze your problem, I cannot solve it. The point is that I do not know what part of the mucosa to remove and how much of the compensatory hyperplasia can be removed to solve your problem and keep you from joining the army of “empty nose” patients. If you cut too much, you will really join the army of “empty nose” patients. If you cut less, it will not solve your problem. This scale, only God knows. I am a general practitioner, so I really don’t know.
Patient Question.
Is it possible to treat “compensatory hypertrophy of the mucous membrane and winter congestion” through non-surgical methods? I have been taking medication for rhinitis and sinusitis for a long time, but to no avail. In addition, why are my symptoms of “heavy headache, slow thinking and inability to concentrate” much worse than before the surgery? What’s even stranger is that if I can fall asleep for even a short time in the middle of the day, my symptoms will be much less severe in the afternoon, but on the contrary, if I don’t fall asleep, they will be especially severe, and sometimes I have facial numbness.
Thank you again for your patient answer!
Wang Xianzhong replied.
Try to see if your symptoms can be relieved by running. Since I think your symptoms are caused by compensatory hypertrophy and congestion of the mucosa, you can only reduce the congestion and swelling of the mucosa to relieve it. Running is the only way to reduce mucosal congestion without side effects. The nap can relieve the symptoms may be related to your sleeping position, what position do you use when you sleep?
Patient Question.
Sometimes I sleep on my back, sometimes on my side, sometimes on the table. It seems to have nothing to do with the position, but it has a decisive relationship with whether I can fall asleep.
Wang Xianzhong replied.
Do you snore during nighttime sleep? Do you hold your breath? Are you overweight?
Patient Question.
None of them.
Reply by Wang Xianzhong.
Then I can’t explain why napping can relieve your discomfort at the moment.
Wang Xianzhong replied.
Do you have the symptoms of “heavy headache, slow thinking and inability to concentrate” before the operation?
Patient Question.
I had the impression that I was only dizzy before surgery.
Wang Xianzhong replied.
Your current symptoms may be related to the left middle turbinate. To confirm the diagnosis, you need to come to the clinic to do a swab test. If you only do partial excision of the left middle turbinate, it should be safe. But I can’t be sure that the partial removal of the left middle turbinate will not result in other weird symptoms that I can’t predict.
Patient Question.
Is it possible to slightly trim the left inferior turbinate residue as well? When my left nostril is blocked, I sometimes hear a crunching sound inside when I inhale hard, and I don’t know which part it is. I also had drooling in my sleep after surgery, and I wonder if it is nerve damage. My own feeling is that it would be good to cut off that circle of flesh, and I even considered cutting the nerve to make the nasal cavity unconscious. Also, I don’t think I need surgery for my deviated septum, right?
I have consulted many doctors on this website and I feel that your speculation is the most reliable, I will find time to go to Beijing to see you. Thank you again for your help.
Wang Xianzhong replied.
Your feeling is quite consistent with my speculation. However, as I said: the site of resection I may be able to find, but how much to remove, only God knows, I really don’t know.
I positioned myself as the most common doctor, and I am “more than the way”, so I can get your affirmation: “the most reliable”. Doctors should not be “creative with their ideas and make things worse”. I resigned from Beijing Tongren Hospital, which is called the “national team”, and I am willing to be an ordinary doctor.
Patient Question.
Dr. Wang, I would like to ask you again: Is there any way to check the specific area of mucosal congestion and swelling or to show you the area where I feel discomfort? What do you mean by the cotton pad test?
Wang Xianzhong replied.
The swab test is a method to find the point inside the nasal cavity that may be related to your discomfort. This point is not a haphazard distribution. Everything has a cause and effect. There is a pattern to it. The world has a mechanism to keep it running steadily. Find your “pain points” also need to have the idea to guide, it is possible to find. Very modestly, this kind of thought, only exists in my head. Otherwise, your condition would not have been delayed until now. It’s not that you don’t have the conditions to see a doctor, it’s that the doctor you see doesn’t have the ideas in my head.
Wang Xianzhong replies.
The administrativeization of medicine and scientific research has allowed doctors to live very comfortably without learning anything and falsifying to mix a senior title to sell medicine, so doctors who can cure the disease are not absent, but very scarce. The cure is supposed to be luck, and good luck is hard to find at the moment. Good luck!