Empty Nose Syndrome - My Theory & How to Fix it

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.
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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. **

[@secretjoe8513]

As someone who had ENS symptoms and were told they were psychosomatic I just want to thank you for making a KZbin video about it.

[@aussielegends]

Do you still have them?

[@Acconda]

Unfortunately many people are still losing their lives over this condition, even today, scary. I had one ENT in NHS Staffordshire who said this is just. Myth! Unbelievable

[@amsariari5184]

Were their lives lost due to suicide or due to difficult-to-treat ens symptoms?

[@marklewis9061]

@@amsariari5184 They die because of suicide. You won’t actually die from the condition itself. I have ENS

[@jonathangraham6412]

Is there anything that makes it better? Is there a procedure that fixes it ​@@marklewis9061

[@dougferguson2563]

@@marklewis9061 Both, it's a degenerative condition. Some have more aggressive long term problems than others but not reported or documented properly by Ents for obvious reasons.

[@gg21410]

ENS is such an evil condition to live with, it’s completely debilitating and there’s no respite as it’s every breath 😢

[@jonathangraham6412]

Can you get it without surgery ?

[@LuisLopez-om8zr]

@@jonathangraham6412 no

[@jupatj24]

@@jonathangraham6412 no, I don't think that possible based on what's being described on the video.

[@timcepin3386]

What do people who have a total rhinetomy feel when they breathe?

[@lexi6081]

Can't you just breathe through your mouth?

[@colinbarnerj3a]

I was recently diagnosed with ENS by a doctor in Ohio. My symptoms are eyeball pain, cheek pain, forehead pain and throat pain. It’s every breath, even with non surgical irrigation treatments. There is too much air velocity to my sinuses and throat, causing “toothache like” “pins, needles & razor blades” type pain. I do not have the suffocating sensation, and I hope to God I never do. But I am always in excruciating pain and probably will be for the foreseeable future. Excruciating pain hits differently when it’s where you actually exist, in your face. ENS is not only suffocation. It feels like you’re breathing in cement or sandpaper, literally having you feel like you just had a lobotomy. My vision has become blurred due to dryness everywhere in my face. This is something that NEEDS more attention, and is more common than everyone thinks it is. SPREAD AWARENESS. IT SHOULD BE AS KNOWN AND TALKED ABOUT AS CANCER. It doesn’t only ruin your nose. It ruins your LIFE.

[@sheherazadesandooyea2814]

Hello everyone Just had septoplasty a turbinoplasty 2 months back and didn’t had a clue about ens (my fault; I should have enquired before). I learnt about it just after the surgery and freaked out and informed my surgeon about it. He reassured me not being a potential candidate and I trusted him. I breathe much better and do not have the usual symptoms except a reduction in mucus production and slight decrease in smell. One night, I couldn’t sleep for no apparent reason and remembered ens; so in order to increase pressure inside the nose for the brain to detect amount of air inflow, I placed a small piece of kinésie therapy tape over the nose, to have the opposite action of breathing tapes. I slept and dunno whether it was a good idea; maybe worth a try💁🏻‍♂️ Good luck to everybody🙏

[@carlom.2194]

Hi there! I had surgery Mid of 2023 and early 2024, is when I started having ENS symptoms and been just so concerned ever since. I saw your comment couple nights ago and decided to give it a try - - I would say that it works! I am able to sleep without thinking about my breathing beforehand. Glad I saw your comment. Thanks for sharing!

[@jeffinergiraffe]

It is such a relief to find this video and thank you, thank you so much. I had sinus surgery last October and correction to my septum. Ever since, I have had terrible trouble with blockage at the back of my nose that I end up having to swallow as it doesn’t come down my nose. My nose is dry and feels strange and my severe eosinophilic asthma is so much worse. Nose bleeds are daily. My ENT surgeon didn’t listen and just said something has gone wrong and he wants to operate again. He said the turbinate is binding on my septum. I simply cannot face more surgery on my nose. The risks are far more serious than I was led to believe. I had a cold last week. I didn’t blow my nose once - I had to swallow it all and my lungs were suffering. I have had daily headaches between my eyes every day since October 2023. I wish I could go back in time and not have had the surgery. My life is miserable.

[@paulaestes7763]

I had sinus surgery a long time ago and I thought they had learned how to do a better job. I thought I was finally ready to get another one I was so miserable but I got lucky and went to a good ENT who said they had already taken too much but the symptoms I was having were likely due to migraines not "sinus" headaches and allergies. I got allergy tested and I have a ton of environmental allergies mold, dust, yeast so many of the foods you are eating and allergens in your environment might me making you feel worse. I hope this helps! I'm sorry this happened to you and feel free to ask me any questions you might have. I start allergy shots in a few weeks!!!!

[@ChadCilli]

This makes sense to me. I think our nose needs some resistance in order for us to feel the airflow. If there’s no resistance, then you don’t feel any airflow through your nose, and it feels like you’re being suffocated.

[@gg21410]

right! i honestly don’t understand how any doctor could have ever thought removing them would be the right thing to do 🤯 the body doesn’t just make pointless parts it’s all there for a reason

[@nenadcubric2663]

Not in my Case

[@discontinuity7526]

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.

[@VikVeerENTSurgeon]

I very much agree. thank you.

[@CristianSzwarc]

@@VikVeerENTSurgeon I'm risking saying something very stupid but wondering... if the issue seems to be caused by lack of turbulence what about creating an U shaped clip with a blob on each end. Then each end would go in each nostril and the blobs will slowdown the air. May not be ideal but won't hurt to try. Such a thing could be made with some soft plastic on different sizes and even disposable.

[@huay_]

Vik - thank you for highlighting this emotional and devastating condition. There are so many people out there suffering in silence and this needs to change for sure. Question - with your surgery to treat ENS under local anaesthesia, what exactly is involved? Is cartilage used to raise the floor of the nose? After surgery, how do your patients feel? Whats the success rate of achieving “normal” airflow? All the best Vik and we all appreciate what you do.

[@simonalger5512]

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?

[@VikVeerENTSurgeon]

I've done a post.... lets see what happens.

[@jonathangraham6412]

Can you get empty nose without surgery?

[@ChadCilli]

@@jonathangraham6412 maybe if you damaged your turbinates through an injury

[@vivianriver6450]

Thank you for making this video. I've had radiofrequency turbinate reduction recommended to me. I have severe upper airway resistance syndrome which has worsened recently. My ENT has told me he can do some work on my nose including radiofrequency turbinate reduction, but he suspects a confluence of different factors affecting my breathing. He referred me to a new sleep doc to talk about doing a DISE test, but when I asked about doing DISE, I was told that he only uses DISE to recommend the "Inspire" treatment, plus the sleep doc seemed to think that RERA events aren't really that important because breathing does not cease entirely. BiPAP does help to an extent, but I feel like my body has been telling me that I need something else. It just feels like the whole process of looking for answers is just fraught with pitfalls, but I really appreciate how you've put together some helpful information about ENS. It's just maddening to get referred for a DISE and then be told "We only use that for Inspire". Being told that RERA events are less important feels like hearing "But did you die?" I feel like so many physicians are taking a cookie-cutter approach to diagnosis and treatment and while it helps a lot of people, so many of us are falling thru the cracks and being told that we have "anxiety" or whatever.

[@teethree141]

I had severe upper airway resistance syndrome to the point where I couldn't feel the sensation of air through my nose. I also have a deviated septum. I had a maxillary expansion a few months ago and now I can feel the air through my nose. My ENT dr said he could fix my deviated septum but I'm scared of getting ENS. I am getting DISE soon to figure out where my obstruction is coming from when I fall asleep at night. I've gone weeks without sleeping feeling like I'm choking. Hope you find answers soon!

[@Vrga-en3sg]

These days the word "controversial" = Truth coming out. Nothing controversial about non emergency surgeries marketed to patients. Most patients and sadly a great amount of Ent specialists have no clue how complex and essential nasal turbinates are to a normal functioning resperitory system. Turbinates also have a complex network of sensory nerves which also maintain neurologic and physical homeostasis. What is an embarrassment and crime is how these unscientific procedures with no clear consensus are constantly pushed upon patients who have mild nasal complaints. These mild nasal complaints for the most part can be treated naturally targeting the root cause of inflammation/infection. Once something goes wrong, patients are gaslit and suffer irreversible injuries that intolerable 24/7. Breathing is not like a finger or limb that can be amputated and a person can still function and lead a somewhat normal life. Turbinate injury caused by surgery destroys slowly and degenerates other bodily functions. Never let an Ent operate on your nose unless there is trauma or some life threatening cancer or tumor. You will greatly regret it if something goes wrong as there is no proven therapy to have nasal turbinates regain its original functions.

[@healthyisbeautiful8720]

Very well said!

[@mikerichards913]

Another well presented video. Many thanks. Best regards

[@VikVeerENTSurgeon]

So nice of you

[@healthyisbeautiful8720]

Thank you for making this video. I believe responsible and ethic ents will look closely to find ways to do surgery only on necessary cases and utilize techniques that minimize the risk of leaving a patient with ENS. I have it as result of one cosmetic surgery. It is a horrific condition. So preventable! I wasn’t even aware this was possible. My perfectly functioning nose was destroyed

[@VikVeerENTSurgeon]

I'm sorry to hear that. I hope you get it sorted asap.

[@healthyisbeautiful8720]

Thank you for your kind words but you know very well there is nothing to sort out after the destruction of proper nasal function. All I hope is that you guys take this seriously and stop hurting people

[@Acconda]

Really sorry your life got ruined. I have deviated septum and hardly sleep at the moment, I really need it doing, but this ENS scares me a lot. Sometime think better to just to put myself out my misery like Switzerland than risk surgery unless the surgeon is very much aware of this issue and take all measures to avoid it.

[@healthyisbeautiful8720]

@@Acconda I think in cases like yours, where you are suffering a lot, surgery is a reasonable thing to consider. No turbinate reduction, just septoplasty and see if that’s sufficient to help you feel better. See many different ENT and only go for the one who guarantees to be as minimally invasive as possible.

[@cortezhiggins6205]

Do you have a Facebook?

[@Padoinky]

In 2008 I had my deviated septum repaired along w/ turbinate reduction, removal of my tonsils and a uvulectomy and it’s been a tremendous success - I definitely wasn’t the happiest person for about 2wks post-op, but since then, my breathing has improved, my sinusitis and ear infections have abated and my obstructive sleep apnea has been eradicated….

[@morm2173]

Yea I might need that same surgery because sleep apnea has destroyed my life . My inferior turbinates and septum are insane

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!

[@VikVeerENTSurgeon]

It seems to work for me - hence this theory, but this is just my theory. lots of clever people have looked into this so I'm sure there are holes in my idea.

@@VikVeerENTSurgeon Thanks for your reply! No one seems to have understood ENS fully currently. But the simple fact that you are humble about it, sets you apart from most of the doctors I have spoken to over the last years. Unfortunately some still consider themselves infallible "gods in white" (as we like to say in German). So thank you again very much! My going theory is that it's three factors at play. Which can be separate but also multiplicative with each other (hence: factors). Airflow, receptors, nerve damage. There is obviously an issue with airflow and anatomy going to, the air is not reaching where it's supposed to, be it TRPM8 receptors, sinuses, wherever. But there seem to also be patients where this is not a sufficient explanation. They don't benefit as much from the cotton test or implants give only partial improvement. So a lack of TRPM8 receptors, especially in patients with lots of damaged mucosa, might be an additional factor. And lastly, there seem to be patients (House calls them ENS-Type) which present with ENS symptoms without having had much or any turbinate surgery at all. He explains that with damage to the trigeminus, which then stops delivering the receptor signals to the brain. (Scheithauer has this mind-blowing study from 2011 with menthol + fMRI scans). Some of the most severe cases seem to belong to this group. But that's just anecdotal of course. I also found the studies about lowered nasal nitric oxide and 77% comorbidity with hyperventilation very interesting to read. Several patients have reported relief from Enovid VirX Nitric Oxide spray and Buteyko reduced breathing exercises respectively. Both effects are only very temporary though.

[@VikVeerENTSurgeon]

I find those with atrophic rhinitis rather difficult to treat. without it there are still a lot of TRPM8 that seem to work, but once the mucosa dies and becomes more 'skin' like I think the situation becomes very difficult. I've seen people talking about reversing the metaplasia but I'm not sure if these people really improve or if they get just end up with chronically wet skin inside their noses rather than something similar to mucosa. The menthol information is really interesting but again conflicting sometimes like the CFD data. The NO question is not something that I spoke about as I prefer Peter Wormold's thoughts about it (he is a real genius).

@@VikVeerENTSurgeon Oh wow, thanks for pointing out Wormald. I just found his paper on Pubmed about ostium size + nitric oxide. pubmed.ncbi.nlm.nih.gov/12422970/ I have also had my maxillary sinuses windowed (if thats the right term in English), which I suspect would have a similar effect to a widened ostium.

[@felixalb6676]

I see you are german yourself. There's Dr. Bodlaj here. His office is in Lichtenfels. He's one of the very few doctors who treats empty nose syndrome. Perhaps you want to give him a chance (in case you have not yet done so)? Beste Grüße

[@alexdesrosiers7637]

Hello Dr. Veer. You say you don't believe it's a removed receptor that cause ENS. Here is what I can say, based on my extensive readings. First of all, it's the receptors (not one), namely the TRPM8 ones which sense air between 8 and 25 degrees. These are distributed in many parts of the nose, including the turbinate, septum and nasal walls. A study showed that ens patients react very well to menthol inhalation, which activates these receptors. The cotton wool test and implants works in some cases, but not in others. There could be many reasons why it helps, namely that it redirects airflow to working receptors and-or puts more air pressure on the remaining receptors. Thank you for the video, lots of interesting stuff!

[@JessicaCleggMRICS]

Thank you for making this video. I had a septoplasty in 2017, followed by 2 turbinectomy surgeries within 12 months of the septoplasty. I cannot sleep for more than 30 minutes to an hour at a time because my nose blocks up and I “suffocate” myself awake. (Like a drowning sensation) I have to sit up to “regulate” or “unblock” my nose each time. I have seen two ENT’s since who have said there is nothing wrong, my nose is clear and one has said it’s all in my head and it’s just anxiety. I am worried I’m never going to be able to get a good nights sleep again. I very much regret these surgeries and my sleep was much better with a deviated septum.

[@mikekaraoke]

But why did you get 2 done and not just the one, also why didn't you just get them reduced and not removed bits of bone?? Vik also has said he never touches the middle turbinate or the left + right sides as middle will go down naturally after that!

[@yahyaelmi8435]

Try maxillary expansion

[@yahyaelmi8435]

You could also have UARS , do drug induced sleep endoscopy

[@Ozekmobilya]

@user-jq9to2nf6y maybe you're suffering from dryness? Do you have hygrometer in your room? How many times you're sniff water into nose in the day?

[@fabsorbello6620]

So sorry to hear , mine is mild compared and still annoying, Myabe try anti snoring clips in your nose or medical tape across front to alleviate air

[@ghamdi2043]

Thanks for this video

[@astridjones6327]

Please do a video about tracheostomys and the implications of having an alternative airway. Your videos are great thank you so much ❤

[@VikVeerENTSurgeon]

I'll have a think... that will be a hard one...

[@marcusvrcosta]

It's not the best thing to do since the nose have 'special' functions. The tracheostomized patient needs to keep the tracheo clean.

[@LexaTerrestrialx]

Ps it’s awesome you raise the nasal floor for ens patients ! Absolutely incredible & your inquisitive thinking helps

[@marcusvrcosta]

Very interesting the aspect of the airway resistance of cotton test. The same mecanism in the lungs with those smaller cavities.

[@VikVeerENTSurgeon]

I'm not an expert at the lungs. I'll look into this. Thx

[@user-dl3cx5qu4x]

Надо вообше запретить операции по удалению структур внути носа

[@kevinwhite6176]

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. KZbin'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.

[@AlexOzer]

Have you tried nasal breathing strips? Has your ENT considered the possibility of midface deficiency (pretty rare afaik) causing nasal valve collapse?

[@VikVeerENTSurgeon]

I'm personally not a fan of Vivaer but I think its far better than most of the operations out there. If I didn't have celon I would go for this one.

[@yahyaelmi8435]

Do functions septoplasty, ultrasound piezo

[@katcarCarr]

Vivaer procedure done by an expert surgeon made my intern nasal valve collapse worse. Now I am flummoxed how to fix it. I cannot recommend it.

[@AbhiSharma-lg4pb]

@@VikVeerENTSurgeonsir I want inferior turbinate tissue transplant research what I have do for this tell me

[@Matty72UK]

Interesting analysis. Like the Borg reference, Lacutis!😂

[@VikVeerENTSurgeon]

I was wondering who would notice that. My wife keeps telling me to stay professional and stop making jokes, but that one was hard to edit out.

[@DurhamHearingSpecialists]

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!

[@VikVeerENTSurgeon]

Thank you Conor, always nice to see you here.

There is even a video of his doctor saying Michael Jackson probably had ENS! kzbin.info/www/bejne/rKvJZIeEfayGac0

[@gg21410]

It’s very sad as a lot that get ENS from cosmetic surgeries don’t even have breathing problems in the first place, taking a nose from 10/10 functionality to feeling like you’re suffocating from the nose being so open 24/7 in one surgery.

[@LexaTerrestrialx]

Ps it’s awesome you raise the nasal floor for ens patients ! How do you raise the nasal floor??? Absolutely incredible & your inquisitive thinking helps

[@tm5346]

Love you video thank you ! I never had nose problems cobblestones until now it's quite annoying & feels like cuts

[@Jeppyboi83]

what do you think about the Microdebrider Turbinate reduction? is that more likely to cause ENS? is it as good radio-frequency ablation? im trying to figure out with procedure to have done for my blocked sinus. thanks

[@GokuBlack-sn5dr]

Hi Dr, would you say most surgeons who perform radio frequency ablation are able to do so without causing ENS? since it is a less invasive procedure compared to septoplasty/turbinate reduction.

[@rosariodagosto6484]

YOU SHOULDN'T MUCK AROUND WITH HUMAN ORGANS ETC. . BAD MISTAKE 😊

[@VikVeerENTSurgeon]

Agreed

[@jonathangraham6412]

Can you get empty nose without surgery causing it?​@@VikVeerENTSurgeon

[@jacobmorris-ik4lt]

I recently had surgery done on my turbinates end of 2023 and still struggle being able to breathe especially at night which i believe may contribute to the fact that i have developed sleep apnea as no one else in my family has it, its quite frustrating as going into the surgery (although it was delayed twice) i had high hopes that it would fix my air way passage and increase sense of smell and make me feel human again, unfortunately the outcome was barely noticeable and i think they may have only removed tissue when in reality there is a clear blockage further up my nose (that i can clearly feel that is hard like bone) that for some reason every doctor and specialist that i have been referred to says there is no problem that they can see - though it is extremely noticeable when laying down, why they don't look up my nasal passage during then I'm not sure, love your videos Vik - you give me hope

[@mrryan70]

Thank you for making this video. I’m scheduled for a turbinate reduction using radio frequency. I’m terrified of ENS, and have heard that this method can cause nerve damage resulting in ENS. Have you heard of radio frequency causing ENS.

[@healthyisbeautiful8720]

Yes

[@Ghxstfxce777]

How are you feeling now after surgery?

[@sparklingfashion6276]

dont do it

[@marklewis9061]

Radio frequency absolutely causes ens.

[@KhalKhtri]

Dirty secret ENTs won't tell you. All forms of turbinate reduction carries the risk of severe lifelong injuries. No matter how conservative or experienced the surgeon is.

[@msgesus4518]

Can you please do a video on atrophic rhinitus? I had turbinate reduction and my main issue now is dry crusting, being in the office AC I can't breathe after 30mins. Nasal douching only temporarily helps. My ent one year post surgery and after explaining consistently my dryness said I might have this. My dryness has caused a lot of suffering unless I lay down in a warm room for my sinuses to regain moisture. It's a terrible feeling, if theres any change I can make with diet or further surgery I'm really keen to know. Thanks.

[@garlicbread2670]

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.

[@VikVeerENTSurgeon]

I'm not sure about your mum's problem. I don't think I can work it out online. I would look into atrophic rhinitis or even Sjögren's syndrome?

[@sallieharris4940]

I have sjogrerens syndrome, and after covid have exactly the same problem ,I am working with my Dr to resolve this ,so far no luck ,good luck to your mum ,you may have to try 2 or 3 Dr's before someone takes her seriously, took me 15 years to get diagnosed with sjogrens,

[@Scapcz]

Hi, yesterday I have had septoplasty and turbinoplasty, now I am at hospital bed hoping that ENS will not be my case. Too bad that the doctor did not even told me about the possibility. Hope I will be ok

[@forbfisn]

all is good?

[@mrwaverider5537]

How'd it go??

[@sebastiancaycedo6914]

How’s your breathing??

[@Lily-qz3ms]

I got a turbinate reduction and tonsillectomy two weeks ago. I have sinus headaches and I when I breathe it feels like I’m breathing directly from a fan. I am also experiencing fatigue. I hope I don’t have ENS. Im going back to consult my ENT next week.

[@andreherzegovitch7165]

Dr. Vic, at about 10:32 in the video you mention "how to fix" the problem with reduced or excised turbinates. Has this been done? I'm aware of a cartilage implant experimental technique which perhaps deals with adding turbulence to that area of the upper sinuses you illustrated. I have this condition and considering the experimental technique. I am also experiencing the shortness of breath or feeling less lung capacity.

[@GVMedia0]

What do you know about Coblation turbinate reduction and ENS? Any correlation? Possible? Not? about 7 years ago I had a minor turbinate reduction and deviated septum correction and thankfully I was able to breath perfectly for the last few years. About a year ago, I started getting chronic inflammation of the turbinates again and sprays dont seem to work. Azelstine helps open them up between 20% to 50% but not all the time. (i've been using it for 6 months) Well I went to the ENT again and they didnt want to do another turbinate reduction (cutting any) for the threat of ENS (I am surprsed they brought it up but only after I mentioned it on a prior appintment) He offered coblation turb. reducation and said theres no risk of ENS since youre not removing the turbinates. However after doing research I have seen a few people in the comments saying that you can still get it. What do you know about this menthod? I scheduled an appt for 3 months away so I have plenty of time to think it over, research , etc.

[@myeisha5014]

Did you end up doing it?

[@Belugabs]

Great insight, I discovered I have a deviated septum when taking my X-rays for Invisalign, honestly I don’t snore, bleed from my nose or have recurrent allergies/sinusitis but my doctor recommended to see an ENT, he inmediatly told me to have surgery (septoplasty with turbinate reduction with RFrecuency) I have already cancelled two times cause I’m so freaking scared about ens and I honestly think my deviation is not causing major problems in my daily life. What should I do 😢

[@healthyisbeautiful8720]

If you don’t have any problems please don’t do it! Change orthodontist , 80% of people have a deviated septum

[@edwardshell1289]

I was diagnosed with ENS a couple of weeks ago. I had a septoplasty in the mid-80’s. Frustrating. Whenever the air in my nose seems stale, I would use a netipot. There can be anxiety when you’re exerting yourself and you feel congested and like you are suffocating. I resort to mouth breathing. Sometimes I am just hoarse. I also choke because I haven’t figured out how to breathe and eat. On top of things, I have vocal chord dysfunction. My ENT recommended budenoside 0.5mg/2mls with saline in a netipot. It seems to help. When my nose starts whistling or I snore through my nose….I get up and use the budenoside rinse. I went to the ENT thinking maybe I had scar tissue or an infection. I already live with an autoimmune disease so it’s just another issue to understand and adjust to.

[@henntazd680]

hello doctor im from ethiopia i have blocked nose due to concha bollousa my ent recommed me surgury ut im afride to do it

[@maiahoneyagerTV]

Can you please clarify what area is removed too much when you mentioned "removing too much bone, particularly in that mid portion" its prior/around the 12:30 time stamp I had a reduction as a part of a septoplasty. My breathing wasnt really all that bad prior. I just thought it was something simple and normal to fix a ever so slightly hypertrophic turbinate. I was ill informed and want to understand all the information available.

[@BalisticAudio]

I had a septoplasty and turbinate reduction surgery 5 months ago and it successfully improved airflow, however I have a permanent dry mouth and soar throat so far only improved by spending time in extremely humid climates, I really wish my physician warned me before operating, and I really hope my body adjusts somehow in time...my quality of life has diminished and I wouldn't wish it on anybody.

[@mitchplaysriffs]

Check in, how are you?

[@cyrils.1194]

Dear doctor, could it be that acting on the floor of the nose with a palatal expander affect ens ?

[@Vrga-en3sg]

@vikveerEntSurgeon. To date, there is currently no 100% solution to ens not even 70%. It also manifets differently in each case depending on the type of damage done. Please rephrase your title.

[@paulabraden974]

I am wondering if those who have lost the whole structure to injury, cancer etc if they too suffer more from this condition than say some who has lost only part of this structure 🤔 Has anyone tried to temporarily numb the middle section to rule in/out certain aspects of this condition (nerve wise). This condition is both fascinating and heartbreaking at the same time. I can understand that reluctance to have another procedure performed to try to fix the problem.

[@VikVeerENTSurgeon]

I have found that when you remove everything - these people somehow don't get such bad problems as i guess there is nothing impeding air from circulating high up in the nose and sinuses. This however isn't license for me to start trying this on patients - too dangerous in my mind, but it is a good thought. Numbing the area doesn't seem to help as far as i know - not in the patient's ive seen anyway.

[@paulabraden974]

@VikVeerENTSurgeon Thank you for taking time out of your busy schedule to answer some of your follower's questions. It is greatly appreciated. Looking forward to seeing your 'ask me anything' video.

[@algoashutosh]

I've had surgery on my left nostril twice, and now it's very sensitive to air. I always wear a mask so that the warm air feels better to me. Is there a specific treatment for this, or will it be like this for the rest of my life?

[@Ryan-yh8om]

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

[@VikVeerENTSurgeon]

If you are getting pleurisy I would speak to your doctor.

[@goodtimesbeatz6718]

Dr Veer when doing surgery if middle turbinate is blocked airway do you treated it from the bottom or around the turbinate?

[@AstroOnFN]

Doctor I have a deviated septum will you please fix my nose it’s hard to breath! I trust you.

[@talksick508]

Can I find out if I have this? Apologize to anyone who may have it and are really suffering I had surgery deviated septum in 2009 I also took accutane months before this Since then my nose is always dry inside Crusted sometimes bleeds but mainly dry and green looking sometimes inside Still get stuffy when sleeping But through the day it’s not that bad Just very dry I can’t tell if you’re suppose to feel air going in Like I do but don’t feel much when breathing I was told it’s slightly deviated again and really not sure what to do Not sure if I have atrophic rhinitis or this I also have very dry eyes lips and skin Sjorgens was ruled out Also not on any meds And my sleep has been horrible for years They said sleep apnea but I don’t believe I have that

[@11986117]

Please share a video of empty nose syndrome surgery please

[@nodeonecreations]

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 KZbin is from America and there is a lot of methods disparity.

[@VikVeerENTSurgeon]

I don't understand how people do things in America, but actually we all do things slightly differently. I notice that the Americans do otology very differently as well. it must be how our training is very different. sorry no real answer...

[@rd2071]

That is the problem there is no standard consensus on what is deemed standard. Its all up to the Ent which is mind boggling how these surgeries continue to even be legal. Messing with the turbinates structure no matter how conservative is litterally changing a persons unique anatomy and potentially causing irreversible damages.

[@spiiral]

can internal nasal valve collapse mimic the lack of airflow ENS patients feel and induce a dry nose by itself? I've had turbinate surgery in the past but my symptoms only started 6 years after surgery, and coincidentally that's also when my valve started collapsing. I've seen ENT's in my country but it's as if they dont even know what a nasal valve is... I'm really hoping for some kind of answer.

[@biggbossplus9655]

Hai doctor iam 24 and iam from India.I have a nose blockage by a bone from the birth itself and I have running nose and I can't breath through that nose... Doctors advised to do a surgery and make a hole....is it a complicated surgery iam afraid of surgeries kindly reply

[@lexi6081]

Hi, do you know if submucous resection of turbniates is less risk for ENS?

[@FarooqAhmed-bt1cw]

Assalamu Alaikum dear Vik i am ENT consultant doing ENT surgeries from the last 22 years enjoyed it the way you explain it sir what about SMD instead of trimming inferior turbinates

[@georgecarousos6735]

Dr Veer, I'd like to know your theory on why taping my mouth shut to sleep totally opens my nose breathing? My nose is always stuffy, especially when trying to sleep leading to dry mouth, etc. But taping the mouth shut opens the nose dramatically, almost like I've used a nasal decongestant....its wonderful. Cheers

[@gg21410]

Hi Mr Veer, do you do revision surgeries to fix the structure of the nose if it’s been made too small/short along with turbinate damage and ENS?

[@jeremymarchand46]

Hello, good afternoon, I really need to have a consultation with you. How can I sign up for a consultation? I've seen many antiques with no luck. My breathing is horrible but I have ruled out empty. No syndrome but I do not know if I need another turbanet reduction

[@jonathangraham6412]

How did your Dr rule out empty nose

[@chazlon5061]

Do you have any opinions on Snorex mouth guard?

[@Baldur1005]

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.

[@VikVeerENTSurgeon]

It's true - we don't know enough about this condition. fingers crossed that, what I would call atrophic rhinitis, gets some useful treatment soon.

[@scott-j6u]

Hi Vik, can you get ENS from radiofrequency thermal ablation of the inferior turbinate? Or the mid turbinate?

[@SomethingNick]

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?

What I see a lot of people helping is doing these exercises. Many people feel immediate relief in their nose after practicing for 10min. Its only temporary of course, but if your do it for a few weeks, your breathing should adjust and you should have more permanent effects. kzbin.info/www/bejne/qnzEhniMo8momas

[@nenadcubric2663]

Not all have problems, after removing turbines with a Laser, and some Dr said, my nose function is gone, i said no, now i can Finaly breath Free, after 32 year, for me the priority is Free breathing

[@boxhbbb3530]

I had septoplasty By the NHS and the surgeon mentioned sonething about turbinate and heat, but i dont know what he operated on

[@myeisha5014]

How does your nose feel now after the surgery?

[@ShirleyCooper08]

I had Vivear done and it damaged my turbinates, I still struggled and had surgery but the new ENT told me I had so much scar tissue...he removed some bone from my turbinates but not nearly as much as he wanted....I`m still struggling, wondering if I'm dealing with ENS somewhat...🤔 If Anyone is ever thinking of doing Vivear don't do it !! Especially if they're using them to "pop" the turbinates.... Like in my case..

[@WN-iv8tf]

What do you mean by pop the turbinates? I'm considering doing it because I have hypertrophy on my turbinates that's why I'm asking.

[@jestes7]

What do you mean remove lots of bone? Is that another word for turbinates? Or actual bone in the nose?

[@cullenak4723]

The turbinates are bony structures with soft tissue lining them. When he talks about removing bone he’s talking about removing the bone inside the turbinate which makes them smaller

[@tobyfitzpatrick3914]

I had my turbinates _shaved._ I'm guessing that's completely different to _removal_ of turbinates..?

[@tm5346]

Is eye ,nose connect deficiency such as Crohn's

[@jonathangraham6412]

Is there a procedure that can get rid of this syndrome?

[@pogah1985]

I had a septoplasty and turbinate reduction 4 weeks ago .I feel ok during the day breathing the only symptom I have is lack of sleep .As soon as I get into a deep sleep I’m awake 2 hrs later.My quality of sleep has gone I’m still mouth breathing and snoring but can’t sleep 😢.Is this a sign of empty nose syndrome ?My nose doesn’t seem crusted or dry either so I’m not sure .

[@AbhiSharma-lg4pb]

Wait for 6 months atleast sir you may be healing

[@LexaTerrestrialx]

What is removing the bone of the turbinates ??? Mine were out fractured so crushed

[@LexaTerrestrialx]

Btw.. Theres many patients that get ens after getting anyyyy surgery to their turbinates ! New ones popping up everyday. Not just a total reduction. Any damage to the turbinate can cause this…

[@shred_pow_pow]

As an ENS patient you 100% nailed what I’ve been trying to describe to my care team. Saw a specialist last week that performed the cotton test. I had submucosal resection of turbinates along with septoplasty. The septoplasty didn’t work and left me with a C shaped deformity that pinches the left nostril so that the airflow is totally blocked from my left sinus. Meanwhile the right nostril rockets air directly into the back of my throat. I struggle to sleep and even in a 65% humidified room can’t stop hyperventilating. I have lost the ability to concentrate, read, and meditate. It’s like mildly suffocating all the time, but you also have a constant head buzz from all the shallow hyperventilation. It’s the same feeling as if you were to take 4-5 deep breaths through your nose and get that little head rush. But before completing each breath you already feel immense air hunger and suffocation. It’s worse when the air is dry, if I’m dehydrated, or take any form of decongestant. However, if I grasp the bridge of my nose so that the septum straightens and I feel air in my left sinus again- the shortness of breath immediately ceases. As does the immense pressure I feel on that side. When I had the cotton test it reminded me of what it was like before the surgery. I could feel the slight tug on my nostrils with each breath in and out. The air spinning its way up my sinuses. The cool sensations as moisture evaporated off the walls of my nasal passages. The resistance provided to my diaphragm to slow the exhale and signal the end of a breath. As you said the nose is providing all kinds of sensory feedback to the brain. And it is operating within an extremely tight window of tolerance. In my case it’s a matter of shifting my septum less than 1mm to feel somewhat normal again. Thank you for taking this seriously and being an advocate. I cannot describe how horrible this condition is. I’ve developed sleep apnea, my blood pressure is now stage 2 hypertensive, I have migraines, and this fall I experienced my first cluster headache cycle. Before this surgery I was perfectly fit, was training ultramarathons with a RHR of 37bpm. This condition is debilitating. And I have it mildly compared to others that have had full removal….

[@sebastiancaycedo6914]

Nah man, I’m 24 and recovering from surgery and this exactly what I feel, my doctor be telling me not to worry about my septal perforation, (which she doesn’t think it’s a perforation 🤨) in addition to my ears getting progressively more clogged after I sinus rinse, I thought I was going crazy on the weak feeling being an athlete but I happen to have the not enough air symptom! This can’t be real… (They did reduce my turbinates, but had no idea they were 3 separate ones when I asked)

[@arvindramesh2283]

How about stem cell for ENS ?

[@yorocco1]

Agree with some points, disagree with others. ENS can occur from total turbinectomy, resection and cautery. In situations of over-cauterized turbinates there is nerve damage. In fact studies show biopsies of tissue removed from ENS and healthy controls in which receptor nerves are damaged in the former. I, therefore, disagree that the percentage of cases is 13% since the current research does not account for these other types of damage. I think your resistance theory is good, but, I believe that ENS is the result, often, of both tissue loss and nerve damage, causing both laminar flow issues, resistance problems and receptor nerve issues. I had cautery that damaged many nerves and I lost my breathing functions and developed POTS in the years following my surgery. With injections, I slowly regained my ability to humidify and warm inspired air and my suffocation slowly abated as well. Honestly, I think we need more meta analyses done, because there has been a glut of research studies in just the last 5 years.The research has shown nerve damage and distorted laminar flow. In fact those in our community that have gotten implants to improve resistance, still have a number of symptoms. I think this is a step up since we were called “crazy” ten years ago before research validated our complaints. But, I think we have to think of ENS as both a structural and functional issue.

[@nadiag773]

Hello, what are the injections you made please?

[@brian6827]

So my nose won’t fall off? This sounds like what I have!!

[@MikeBroderick33]

Can you get Empty Nose Syndrome congenitally or idiopathically? I have most of the symptoms but have never had nasal surgery.

[@VikVeerENTSurgeon]

atrophic rhinitis is similar and can be caused by things other than surgery

[@MikeBroderick33]

@@VikVeerENTSurgeon Thanks.👍🏻

[@Patricia-vf7nb]

Like is that like i had as a kid they stuck a rod up my nostrils n carterized it bcuz i broke it or got bloody noses alot.. I can't breath out my nose n it runs nonstop...lol

[@morm2173]

Dr Vic I heard that Dr Paul Nassiff came up with a solution. I talk to my rhinologists and ENT about ENS all the time since my inferior turbinate are so large . I heard Vivaer and microdebrider submucosal resection are the best options. Correct me if I'm wrong..

[@KhalKhtri]

The hollywood Dr. You mentioned has a warped understanding of Ens. There is more to it than the misinformation found online solely discussing missing volume. Submucosal resection is also not safe as there have been increased ens patient based reports of being injured from such techniques and other so called conservative turbinate reduction procedures. Overall turbinates should never be touched unless your life depends on it.

[@AbhiSharma-lg4pb]

Please suggest me ens doctor

[@KhalKhtri]

Google it

[@tm5346]

Gezz a small nose ugg oh my it's small lol

[@garymanzano3847]

Hello Vik, wonderfully informative video for this rare condition I have. Thanks for trying to raise awareness and helping those suffering from it. I had a bilateral inferior turbinectomy, uncinectomy, septoplasty, and ethmoidectomy over 20 years ago. It took 8 years for ENS symptoms to arise and started with the inability to catch my breath or take a satisfying inhalation. Since then, I have had 2 bilateral alloderm implants at Metro Health in OHIO performed by Dr. Steven Houser. One to raise lateral wall and another in remaining turbinate. I've had some relief but it is not a cure all procedure, nothing can mimic the function of the turbinate and all that it did. Thanks again. Just felt like sharing. Be well. Here is my nasal surgery Dr. Houser had posted kzbin.info/www/bejne/i3W7mYOlnZeDp8k&ab_channel=ENSInternational

[@ThePassportPapi]

Thank you for this. I just had a septoplasy, nasal valve repair and turbonite reduction. They just took the stilts out and I notice the air I breath is stuffier and dryer now. Colder. It’s not so bad so I probably don’t have ENS, but it definitely feels different. Though I just had my surgery done 5 days ago so I’m sure I will heal to some extent more but now understanding the role of turbenites I’m angry that I let this doctor do the surgery on me. Seems completely unnecessary and just a way to rack up the bill. Nature gave us these things for a reason. Doctors really are just like us with a piece of paper that says they’re smarter but they’re really just as dumb. Straightening a septum or providing support for a collapsed all make sense in order to get symmetry but turbonite surgery is complete BS and I can see why people are changed afterwards from it. I just hope I’m not too altered from having reduced mine

[@madetolaugh3476]

Update?