What Is Empty Nose Syndrome?

Medically Reviewed by Brunilda Nazario, MD on May 18, 2023
Written by Shishira Sreenivas
4 min read

If you had nasal surgery to widen airways inside your nose to fix breathing issues but you’re still feeling stuffy or clogged, you might have empty nose syndrome (ENS). 

The term was introduced in 1994 to describe an empty space inside your nasal cavity after surgery. Here’s a look at what ENS looks and feels like, and what to do if you have it. 

It's a rare and complex phenomenon that can happen after you have a partial or complete turbinectomy, or turbinate reduction surgery. It’s a surgical procedure done by ear, nose, and throat doctors (ENT specialists) to remove or shrink your turbinates and help your breathe better. These are small bony structures that help clean and humidify the air you breathe in through your nose before it reaches your lungs. 

But sometimes, due to allergies, infection, or irritation, your turbinates become swollen and congested. That's because mucus builds up and makes it hard to breathe. In most cases, this nasal surgery is successful, meaning it gets rid of breathing issues. However, a small number of people develop complications. This can cause breathing issues, dryness in your nose, headaches, and nosebleeds. 

Experts aren't sure why ENS happens. While research is ongoing, many experts believe removing too much tissue inside your nose during the nasal surgery might be the cause. 

Even though imaging scans might show plenty of space in your nasal cavity to breathe in and out, you might find it difficult to inhale fully when you have ENS. Many report feeling “suffocated,” “hungry” for air, or “emptiness.”

Studies show ENS may stem from certain physical and functional changes in your nose after surgery. Those include:

Change in air pressure inside your nose.  Nasal surgery may cause your body to detect different temperatures or pressure levels on either side of your nose. This may make it difficult to sense that you’re breathing as you should. This could lead to you feeling deprived of air. 

Nasal receptor issues. Typically, the air you breathe in contains small molecules that come in contact with special nerve fibers. These fibers detect changes in pressure, temperature, or smell. Some are located on your turbinates. During or after surgery, if these receptors are damaged or removed, it may affect your ability to sense breathing.

Bacterial infection. While nasal surgery can help get rid of excess mucus buildup in your nose, it can also get rid of healthy bacteria. This can increase your odds of imbalance, or growth, of bad bacteria. That can lead to infection and cause symptoms of ENS.

It’s possible to develop ENS a few weeks, months, or even years after nasal surgery. 

Symptoms can include:

  • Difficulty breathing
  • Stuffy, congested nose
  • Headaches
  • Dizziness
  • Severe dryness inside the nose and throat
  • Nosebleeds
  • Sensation of cold air when you breathe in
  • Low mucus production
  • Postnasal drip
  • Feeling suffocated or drowning 
  • Pain 
  • Inflammation inside the nose
  • Inability to smell normally (anosmia)
  • Problems with sense of taste (ageusia)
  • Fatigue 
  • Difficulty sleeping

 

ENS symptoms can take a huge toll on your quality of life. It also raises your risk for mental health issues, including depression and suicidal thoughts.  

It's also associated with:

  • Anxiety
  • Irritability
  • Distractibility 
  • Trouble focusing and concentrating

These symptoms can also cause you to be less productive at work or school. According to research, 7 in 10 people with ENS report having depression. One study found that people with ENS are more likely to have suicidal thoughts than those who don’t have the condition. More studies are needed to better understand the link between ENS and suicidal thoughts. 

If you or your loved one have thoughts of self-harm, alert your doctor as soon as possible. In case of emergency, call 911 or get medical attention immediately. You can also call or text 988 to reach the National Suicide Prevention Hotline. 

Yes, ENS is a real condition that’s medically recognized. But experts are still in the process of learning more about its cause and how to avoid it. 

Since ENS is rare, it’s not widely understood or often seen by doctors and other health care workers. Plus, the symptoms can be tricky and ENS can be hard to diagnose. That's because imaging scans of your nose usually don't show blockages.

What's more, there’s no formal or standardized test or physical exam to help doctors diagnose ENS.

To diagnose it, your doctor will first rule out other breathing conditions. They may also use an endoscope – a flexible, wire-like tube with a light at the tip. They’ll insert it through your nostrils to take a look at your nasal cavity. 

There’s no cure for ENS. But there are things you can do to manage its symptoms. 

Home remedies can help. They include: 

  • Apply topical moisturizers and use saline sprays. They help reduce dryness and crustiness and keep the area moist. 
  • Drink plenty of fluids.
  • Use a humidifier when you sleep.
  • Use a CPAP machine when you sleep. 

Your doctor may also recommend meds to help enlarge your nasal passages and reduce ENS symptoms. 

In some cases, your doctor might suggest reconstructing your turbinates to help ease your symptoms. To do this, they may add tissue inside your nose to bulk up the empty space. This may help reduce your symptoms.