Empty Nose Syndrome (ENS): Does enlarging turbinates help?

@kay874-Hi. I am so sorry that you are experiencing this.

•What was your entire surgery? And what for?
•There are very few ENTs who help with this kind of iatrogenic(caused by a doctor) effect.
•What type of enlargement procedure did this ENT recommended to you? It sounds like he is recommending enlarging the other turbinates that have not been touched?
Absolutely not. But you would have to have one of the experienced ENS friendly doctors tell you this.
•I would consult with one of the few ENTs across the country who recognize this and have a research department dedicated to this. There are only about 3.
• The pain you are experiencing is for many reasons. Some people have been helped with a low dose amitriptiline.
•Humidification, Anything that can bring moisture to the area. But if your IT’s were completely removed it sounds like you would just be trying to moisturize the floor of your nose.
•Some people have put cotton in the nose to alter the airflow, like the turbinates would have done.
•The reason why you felt this 4 month after surgery was because that’s how long it takes, typically for the overall healing, swelling process to go down. After this has subsided the residual effects are left.
•The pain into the face and neck is neuropathic like pain.
The cranial nerves innervate the nasal cavity and turbinates. The trigeminal nerve is one of the most powerful nerves in the body. These nerves all run through the turbinates. They all work together and need communication.
The nose is an entire organ system that communicates with every cranial nerve. The nasal cavity and turbinates are governed by the sympathetic nervous system. Turbinate removal is a disruption to an entire organ system. When this communication is removed, the nerves have no where to regenerate and everything your body had been genetically programmed to do has been thrown off. You also now how airflow disruption and air hitting nerves and tissues in a way it did not before which can cause dryness and pain. The very word turbinate means turbulence. These bones/tissue provided you with a genetically programmed airflow. You can look up; https://en.m.wikipedia.org/wiki/Bernoulli's_principle to better understand.
Every person has turbinates in their body for a reason. They have so many different functions. Humidification, Airflow, and protectant of germs, particulars and pathogens. When these are removed, dysfunction occurs.
•Enlarged turbinates are not all of the sudden an issue for the body. There are many reasons that this occurs and it is not an anatomical reason that needs to be cut out. Lifestyle, diet, vitamin deficiency, UV exposure, Hormones. I had this conversation w/ a University ENT. He even said they know very little about inflammation and are just now as in 2021, starting to take note that nasal inflammatory issues have a big systemic component to them. So if the body is trying to send you a message through your own unique system, how does cutting out that system ever help anyone? It doesn’t. Most of these surgeries are placebo affect and or just don’t work because they are done for all the wrong/incorrect reasons.
•Some ENTs have eventually stopped performing these types of surgeries, due to being part of so many lawsuits.
•There are now ENTs who give talks at National conferences warning other ENTs about the dangers of these surgeries. As well as now retired ENTs speaking out against their own communities.
•These side effects are not “rare” as they like to say. They are only rare, due to being under reported or never reported because the patient is left seeking other opinions.
The average ENT sees one patient a week for this, but will not tell them the reason for what they are experiencing, therefore more not reported.
•I list all of these things, to add the real life conversations I have had with ENTs as well as to warn others, to never ever ever have anyone touch their nasal/sinus cavity.
Everything is there for a reason and simple daily changes can improve symptoms.
•The physiology of the nose and the natural function should never be messed with.

Hai, thank you so much, this is so helpful. ill need to try Amitriptiline as well, what's the low dose please? i was also not very comfortable with the second surgery, ill still need to get more information on this, i can not risk again.

For me before the surgery, my main problem was severe head ache and pain in my right nostril and upper sinuses, when the scan was done i was told i had a Concha bullosa and a surgery was recommended. it was my first time hearing that and i was so desperate for a solution, i thought the recommended surgery was appropriate for my condition, and when the surgery was done i thought the concha bullosa was removed little did i know that the turbinates were the ones that were removed completely.

your response is helpful, please go through my response and don't hesitate to share more options that can be of help to me, so grateful

@kay874-Your additional details are helpful. This is what ENTs are notorious for doing and I am sorry you experienced this.
My situation was the same.
-I am not sure how much information you were given.
By the first ENT and the one for second opinion.
-Conchae Bullosa are common findings on CT scans.
A conchae bullosa is a fancy term for air pocket in the bone of your turbinate. These are usually only found in the middle turbinate, so I’m not sure why your inferior turbinates were removed, altered, touched. These typically develop as your nasal cavity develops as a child. They are very common and most people will not know they have them, unless given a CT scan. Which in the ENT world is the only way they can convince you, you have a “problem”. In fact sinus/nasal surgeries only began to sky rocket, when CT/MRI imaging became available. Doctors were finally able to create stories and “findings” for people, convince them they had abnormalities and use to the scans for insurance approval. There is a reason why sinus/nasal surgeries are the highest volume surgeries performed in the US. Until more awareness is brought to this, more people will continue with devastating surgery’s.
What people need to remember is that all of these surgeons are only taught off of baseline text book models of what is “normal”. Each individual body however, is not an exact prototype. We all have different curvatures, bone structures, tissues etc...These ENTs only go off what they deem visually “normal” and what you tell them. So show up to an ENT office with a complaint, they will search for a reason to match your complaint which could have zero correlation what so ever.
Any patient who presents with pain to an ENT especially for headache should always have a Neuro involved first. Many migraine type headaches will show up in the nose forehead and side of head.
TMJ headaches as well refer to the face nose and eye.
10% of patients who ever present to an ENT will actually need/benefit from a surgery.
-There is a lot of controversy in the ENT world about “sinus headaches” and contact point headaches, and how surgery will typically do nothing to help headache that you feel is coming from your sinuses.
QUESTION-were you ever referred to a Neurologist pre surgery to examine these headaches?
QUESTION-was this ENT a new visit for you? Did you have any history of sinus issues? Did this ENT have you even try medical therapy to see if headaches improved? I am going to take a guess, that this ENT was probably late 30’s early 40’s. They are taught how to bill insurance for all kinds of procedures and how to get patients in an O.R. If this ENT worked in a big medical system vs. private practice this happens.
There is a standard protocol in the ENT community that is supposed to involve a minimum of 6 month of conservative medical therapy. If you end up at the wrong ENT who only wants to operate, they will not mention threes options.
QUESTION? Did you have a pre-opp report that explained the surgery. And do you have a post opp report as well?

If you never had breathing issues before, then a conchae bullosa would typically not be the cause of headaches and you say you are breathing fine now.

I would recommend seeing a Neurologist. The one I saw, said she actually attends ENT meetings and speaks to them about the cross over symptoms of headaches and nasal issues. She also stated that she is referred many patients post sinus surgery because in her own words “ENTs know nothing when it comes to nerves”. If you explain to a Neurologist your original symptoms and now your post surgery symptoms they can try to help you.

I am truly so sorry you are now dealing with this. Do know that this is not rare. The ENT community is now becoming more known for this. And more people need to speak up, in order to make others more aware.

Hi @kay874, I'd like to add my welcome. I certainly can't match the amazing info that @nrd1 has given you. But I would like to let you also know about this relevant discussion about empty nose syndrome:
- Facial Pain: Empty Nose Syndrome: https://connect.mayoclinic.org/discussion/facial-pain-empty-nose-syndrome/

Have you considered getting a third opinion from someone who specialized in EDS?

@kay874- to go along with my above reply, I have attached a few links you might find helpul.

•This is description of ENS from a location that offers experimental procedures to help. The contact info is listed along with this description
http://www.usasinus.org/empty-nose-syndrome
•This is a video of an ENT who explains the importance of nasal airflow and the issues with removing turbinates and other structures. This will help you understand some of what you are feeling.
https://m.youtube.com/watch?v=5Gd-FP3F5eQ
• This is an article written by an ENT about pain/chronic pain that he gives his patients whom he sees that show up complaining of pain. It has been shown that the nose (non operated) plays little role in causing headaches, neck and ear pain.
https://docs.google.com/document/d/15f8lACVnlHuOUOXadLnDxbP2OA-8jdfPsG8yczzr3o8/mobilebasic

why would your ent remove all the turbinate for concha bullosa? they usualy remove part of it but its never recommended to remove the whole thing. You werent aware he was gonna do that?