Empty nose syndrome, a term unfamiliar to many people because of a recent article titled “Empty Nose Syndrome: The real culprit behind the bloodbath that killed a doctor? The article came into the public eye. The article linked “Empty Nose Syndrome” to the Wenling murder case, which was controversial in the academic community. As otolaryngologists, we have to face a large number of nasal patients every day, “Doctor, my nose is not ventilated”, “Doctor, my nose is very stuffy! The various complaints tell a common problem, that is, nasal obstruction. Nasal obstruction is a symptom that can be caused by any lesion that affects the ventilation of the nasal airways. So how to better communicate with patients and help them to understand nasal obstruction correctly? First of all, we have to guide patients to understand the function of our nasal cavity correctly, I usually use a picture like this to illustrate the problem (see the picture below): According to this picture, we can explain to patients very graphically that our nasal cavity is the humidifier, heater, air purifier and resonance box of human body. In addition to its olfactory function, our nose also plays the role of humidifying, warming and dust removal and purification of the breathing air. The first thing to correct is that the nasal cavity is not the empty cavity that some friends imagine. If we look at our nasal cavity carefully, or search the nasal cavity structure schematic on the Internet, we can find that there are many protrusions in the nasal cavity, and careful friends will find that these protrusions are located in the lateral wall of the nasal cavity. The small nasal cavity, seemingly simple, but in fact, there is a great deal to do. Why is there such a complex anatomical structure in the small nasal cavity? What role do these turbinates play? In fact, the role of the nasal turbinates is very simple, through these three turbinates, greatly increase the surface area of the nasal mucosa, increasing the area of contact between the nasal mucosa and the outside world, which is equivalent to heating with a heater, space purifiers thicken the filter layer, humidifiers expand the atomization head, expanding our humidifier, heater and air purifier. In addition to the role of increasing the contact area, there is an important function is to “add blockage”, yes, an important physiological function of the nasal turbinates is to “add blockage”, increase the resistance of the nasal cavity to the air, so that the air breathing into the airway in the nasal cavity for a while longer, the The air is “blocked” in the nasal cavity, so that the air is circulated in the nasal cavity as much as possible, so that our humidifiers, heaters and air purifiers work for a while longer. This brings us to the concept of nasal resistance, which, as the name implies, is the obstruction of the nasal cavity to air. This obstruction has an important physiological significance, facilitating close contact between the airflow and the mucosal surface of the nasal cavity, which is rich in blood supply. Nasal resistance has another physiological significance: the resistance of the respiratory tract to airflow helps the lungs to be in an optimal state of expansion, thus completing gas exchange. Imagine if there is no proper nasal resistance, a large amount of air into our lungs, our lungs how busy ah. Relevant scientific experiments have confirmed that nasal resistance is about 40% of the total resistance of the respiratory tract. Although nasal airflow resistance is higher than oral airflow resistance, most adults (85%) are still used to breathing through the nose. By understanding the above physiological functions, we can have a correct understanding of nasal obstruction first, and the moderate nasal resistance is a normal physiological phenomenon in our body. Some patients may also mention: “My nose is always blocked unilaterally, left and right side patients.” There are many patients who have such complaints, so how can this happen? We need to understand the concept of a “nasal cycle”. In normal people, the volume vessels in the mucosa of the inferior turbinate on both sides are alternately and regularly contracted and expanded, which shows that the size of the turbinates and nasal resistance on both sides are alternately changed accordingly, but the total nasal resistance on the left and right sides remains relatively constant, about 2-7h a cycle called physiologic turbinal cycle or nasal cycle (nasal cycle) The nasal cycle is called the physiologic turbinal cycle or nasal cycle. In other words, the nasal cycle is a change in the state of congestion of the left and right turbinates alternately, which is manifested in the person’s own feeling that one nostril always feels a little worse than the other, precisely because the turbinate on this side is in a state of congestion and the nasal passage is relatively narrow. Therefore, when the nasal turbinates are congested, people will unconsciously turn themselves over and over again in their sleep, which is also the meaning of the physiological turbinate cycle. The physiological significance of the physiological turbinate cycle is to induce repeated turning over during sleep, which helps to release the fatigue of sleep. When the upper respiratory tract infection or allergy, rhinitis, etc., because the turbinates are congested, secrete more, and at the same time the nasal passage is relatively narrower, so it gives people the feeling that nasal congestion and runny nose are always more serious on one side, and sometimes when they wake up, they can find that the original blocked nostrils are well, and the non-blocked ones are blocked again, which is a good example of the nasal cycle. The duration of nasal cycle is 2-7 h. It is caused by the alternating process of congestion and decongestion of nasal mucosa under the control of sympathetic nerve, which is more obvious in adolescence, and its amplitude is most significant after lying down and weakened after standing upright. This is what many patients and friends will have experienced, lying down the nose is not ventilated. Exercise can increase the degree of sympathetic excitation, leading to a decrease in nasal resistance . Changes in body position can lead to changes in venous pressure and sympathetic state , which affects the thickness of the nasal mucosa. When the body is in the lateral position, the resistance of the lower nasal cavity rises due to the pressure on the pressure receptors located on the side of the body and in the skin of the axilla, causing a corresponding neural reflex. Emotional factors can also regulate nasal resistance through the sympathetic nervous system, emotional instability can lead to increased nasal secretions and mucosal congestion, and the same changes when encountering cold air stimulation. Understanding the above physiological functions, we can first have a proper understanding of nasal obstruction, so what kind of nasal obstruction should be treated? I suggest that poor ventilation on the more fixed side often suggests the possibility of nasal septal deviation or neoplastic nasal cavity, combined with purulent secretions and nasal odor. There are very many causes of nasal obstruction, and first of all we must talk about psychological factors, which must be excluded when choosing surgery. Nasal obstruction itself is a sensation, sometimes, or a very emotional one. We all know that when we are nervous and depressed, we feel that we can’t breathe well, and when we are happy, the original nasal obstruction will become less obvious. It is recommended that every patient who feels nasal obstruction should ask themselves 4 questions before consulting a doctor: 1. (You can test the cotton thread in the nostril and observe whether the thread will be blown by the airflow; or use a metal plate with a low surface temperature and place it in front of the nostril to observe the size of the water mist condensation formed by breathing); 2.How much does nasal non-ventilation affect the quality of life; 3.Is there frequent open-mouth breathing; 4.Can I understand that nasal resistance is a normal physiological function? Excluding the psychological factors, we must look at the pathological factors, the most common causes include nasal septal deviation, chronic rhinitis, allergic rhinitis, nasal polyps, etc.. The current flood of television and newspaper advertisements use all kinds of high-tech terms, resulting in many patients receive inappropriate and incorrect treatment, spend some money is a small matter, serious is not cut the inferior turbinate cut, is ventilated, but bring the nose dry, nasal mucosa atrophy, a large number of secretions retained, more painful, serious become atrophic rhinitis. Brief summary: nasal obstruction is a common nasal symptom and one of the normal physiological functions of the human nasal cavity, caused by a variety of objective disease factors, but also subjective psychological role involved. The cause of nasal obstruction should be clearly identified and treated, rather than just “cut”. The surgery of the inferior turbinate alone should be done with caution.