Empty nose syndrome ( ENS ), one of the forms of secondary atrophic rhinitis, is a rare clinical syndrome in which people who have a clear nasal passage experience various symptoms, most often feeling nasal obstruction , nasal drowsiness and hardening of the skin, and sensation can not breathe. People who experience ENS usually undergo turbinectomy (removal or reduction of turbinates, structures inside the nose) or other surgical procedures that interfere with turbinates; the overall incidence is unknown but seems to occur in a small proportion of those undergoing nasosinal procedures. It appears that health conditions are due to the condition but its existence as a controversial medical condition, cause, diagnosis and management. All aspects have been debated, including whether it should be considered rhinologic, or may have neurological or psychosomatic aspects. By 2015 many ear doctors, nose, and throat do not recognize the condition.
Video Empty nose syndrome
Classification
Four types have been proposed:
- Secondary ENS for inferior caratin resection
- Secondary ENS for middle turbine resection
- Secondary ENS both inferior and middle turbinate
- ENS after the turbine-saving procedure
Maps Empty nose syndrome
Signs and symptoms
No objective physical examination findings are definite to diagnose ENS. Generally, one or more turbinates can be reduced or nonexistent when viewed in medical imaging or through endoscopy without any signs of physical obstruction, the mucosa will be dry and pale, and there may be signs of secondary infection.
ENS symptoms include a breathless sensation, a feeling of nasal obstruction and dryness, and harden, discharge, and foul odor in the nose from infection. Someone with ENS may complain of pain in their nose or face, inability to sleep and exhaustion, and feel annoyed, depressed, or anxious; they may be constantly distracted by the feeling that they are not getting enough air.
Cause
The cause may be changes in the mucous membranes of the nose and nerve endings in the mucosa due to chronic changes to the temperature and humidity of the air flowing in the nose, which is caused by the removal or reduction of the turbinate. Direct damage to the nerve may be caused by surgical intervention; However, by 2015, there is no technology that allows sensory nerve mapping within the nose, making it difficult to determine if this is the cause of ENS. Because the incidence of ENS is rare and researchers can not identify a consistent diagnostic or trigger feature, psychological causes leading to psychosomatic conditions have been proposed.
Diagnosis
There is no consensus criterion for the diagnosis of ENS; it is usually diagnosed with the exclusion of other conditions, with ENS remaining a possible diagnosis if signs and symptoms are present. A "cotton test" has been proposed, in which the wet cotton is held where it should be a konka, to see if it provides relief; while this has not been validated or widely accepted, it may be useful to identify which people are benefiting from the operation.
By 2015, protocols for using rinomanometry to diagnose ENS and measuring the response to surgery are still under development, as well as standardized clinical instruments (well-defined and validated questionnaires) to obtain more useful symptom reporting.
Prevention
Avoiding turbinectomy or using a derivative-saving technique may prevent ENS.
Treatment
Initial treatment is similar to atrophic rhinitis, which keeps the moist nasal mucosa with oil-based salt or lubricating lubricants and treats pain and infection as they arise; adding menthol to a lubricant can help in ENS, as it may use a cold mist humidifer at home. For people with anxiety, depression, or who are obsessed with the feeling that they can not breathe, psychiatric or psychological treatment can help.
In some people, surgery to restore or reduce turbinates may be beneficial.
A 2015 meta-analysis identified 128 surgically treated individuals from eight studies that were useful for ponds, ranging in age from 18 to 64, most of whom had experienced ENS symptoms for years. The most common surgical approach is to make bags under the mucosa and implantation materials - the number and location are based on the surgeon's assessment. In about half the cases, fillers such as dermis nonselular, polyethylene high-density porous medical grade, or silastik are used and about 40% cartilage taken from the person or from the cow used. In some cases hyaluronic acid is injected and in some cases tricalcium phosphate is used. There were no complications caused by surgery, although one person was over-corrected and developed chronic rhinosinusitis and two people were less corrected. Hyaluronic acid was completely absorbed in three people who received it in a year of follow-up, and in six people some of the implants came out, but this did not affect the results because it was fairly fixed. Approximately 21% of people do not experience improvement or marginal but the rest report significant symptoms. Because no studies using placebo or dazzling may have a strong placebo effect or bias in reporting.
Epidemiology and results
Empty nasal syndrome has been observed to affect a small proportion of people who have had surgery to the nose or sinuses, especially those who have undergone turbinectomy (a procedure that removes some bones in the nose). The ENS incident is variable and has not been quantified, but is considered rare.
Untreated, this condition can cause significant physical and emotional distress and long term in some people; some of the early presentations on the condition depict people committing suicide. It is difficult to determine what treatments are safe and effective, and to what extent, partly because the diagnosis itself is unclear.
History
In early 1914, Dr. Albert Mason reported cases of "conditions that resemble rhinitis atrophy" with "dryness of the nose and throat" following a turbinectomy. Mason calls turbinates "the most important organ in the nose" and claims that they are "massacred and discarded with discriminatory distinctions over other parts of the body, with the possible exception of the foreskin."
The term "Empty Nose Syndrome" was first used by Eugene Kern and Monika Stenkvist of the Mayo Clinic in 1994. Kerm and Eric Moore published a case study of 242 people with secondary atrophic rhinitis in 2001 and was the first to link the cause to the previous one. synonymous operations in scientific literature. Whether the condition exists or not and whether surgery is the cause, is debated warmly in Nose 2000, an International Rhinogical Society meeting that occurs every four years, and continues to be debated thereafter at scientific meetings and in the literature; as an example of how the debate got hot, in a 2002 textbook on nasal reconstruction techniques, two surgeons from Utrecht University called turbinectomy a "nasal crime".
Society and culture
In October 2013, the hospital's chief otolaryngology department physician in Wenling was killed by someone who has had ENS symptoms for a year after undergoing septoplasti; the person has been seen many times and nothing is wrong. A year earlier, some rhinologists at a hospital in Shenzhen were stabbed by a patient there. By 2016, according to Spencer Payne, a doctor studying the ENS, many people with symptoms of ENS typically meet with doctors who consider their symptoms to be purely psychological; according to Subinoy Das, another doctor studying ENS, recognition among fox experts is on the rise.
People with ENS have established an online community to support each other and to advocate for recognition, prevention and care for ENS.
References
External links
- American Rhinologic Society Empty nasal syndrome
Source of the article : Wikipedia
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