Empty Nose Syndrome

Empty Nose Syndrome (ENS) is a disease that can occur after surgical removal or reduction of the nasal turbinates or septum correction surgery. The following pages will provide you with extensive information on the development and symptoms of Empty Nose Syndrome, as well as the treatment options at Dr. Robert Bodlaj's ENT practice.

Below Dr. Bodlaj discusses the following topics:

What are the symptoms of Empty Nose Syndrome?

Patients describe the feeling of having a dry, empty nose accompanied by shortness of breath, even though the nose is completely clear and open (see also ‚Dry nose’). The patient has the sensation of too much air flowing in and too little resistance inside the nose. These symptoms often improve when the nasal mucosa swell up due to a common cold.

Some of the typical signs of ENS (Empty Nose Syndrome) are:

  • a feeling of not getting any air, even though the nose is wide open
  • chronic feeling of dryness in the nose and/or throat
  • feeling cold
  • headaches
  • nosebleeds
  • crusting

These physical symptoms are often accompanied by psychological problems such as:

  • depressive disorders
  • feelings of anxiety
  • nervousness and difficulty concentrating
  • sleep disorders, daytime sleepiness, fatigue

Empty Nose Syndrome is therefore a disease that must be taken seriously in physical, psychological and emotional terms, since the nose's functionality is severely limited. The nose's functions allow for both natural nasal breathing and healthy lung function. This in turn influences physical and general well-being.

How does Empty Nose Syndrome develop?

Empty Nose Syndrome is not a disease as such, but rather a postoperative syndrome caused by excessive reduction of the nasal turbinates or improper septum correction surgery.

The nasal turbinates produce nasal mucus and moisture, and thus ensure that inhaled air is warmed and humidified. They also regulate air flow within the nose. They act as a sort of filter, humidifier and heater in the nose. The nasal turbinates therefore play a key role in natural nasal breathing, lung function, and protecting the throat and pharynx from dryness and unfiltered inhaled air. If the turbinates are over-reduced, there is no longer enough nasal mucosa tissue left to humidify the air, and the nose dries out.

The nasal turbinates are also equipped with small pressure sensors that signal to the brain that enough air is passing through the nose. If the turbinates are over-reduced or removed completely, the brain does not receive sufficient information about air flow within the nose. This results in the feeling of not getting enough air, even though the nose is completely open.

What are the treatment options for Empty Nose Syndrome?

The clinical picture of Empty Nose Syndrome has not yet been fully researched, and as yet ENS is being diagnosed and treated by only a few ENT physicians in Germany. Dr. Bodlaj is one of the first ENT experts in Germany to implement a new treatment procedure to restore balance to nasal air flows.

Basically, there are surgical and non-surgical treatment options. The non-surgical forms of treatment are geared toward preservation and care of the remaining nasal mucosa. The nose is kept as moist and free of irritation and infections as possible. The aim of a surgical procedure, on the other hand, is to permanently relieve the symptoms of Empty Nose Syndrome.

Various non-surgical measures can also contribute to maximise the effectiveness of treatment for Empty Nose Syndrome:

  • daily nasal rinses and sea salt inhalation
  • saltwater nasal sprays
  • drinking plenty of fluids, while avoiding drinks containing caffeine
  • taking mucolytic drugs (e.g. GeloMyrtol)
  • use of humidifiers, especially in the bedroom and workspace
  • CPAP sleep mask with humidifier
  • avoiding environmental conditions that dry out the nasal mucosa
  • spending time in areas that have a beneficial effect on the nasal mucosa (e.g. a maritime climate)
  • improving bacterial flora by using Symbioflor1 drops in the nose daily
  • low-fermentation diet
  • a generally healthy, active lifestyle

What are the surgical options?

The goal of any surgical procedure is to bring the air flows in the nose back into balance so as to restore largely natural nasal breathing. The missing nasal turbinates are reconstructed using implants. This is possible with modern implant technology.

Here, too, our practice uses state-of-the-art technical tools. To assist him in making a decision as to where an implant should be placed, Dr. Bodlaj relies on video nasopharyngoscopy as well as data from Rhino-Sys flowmetry and 3D reconstruction with DVT.

Nasal turbinate tissue is unique and irreplaceable. New implant materials like acellular collagen matrix, which are also used in Dr. Robert Bodlaj's ENT praxis, can reduce symptoms. They are placed underneath the nasal mucosa of the septum and/or the lateral wall of the nose, and are meant to restore normal air flows, so that the typical ENS symptoms like dry nose become a thing of the past.

If only a little of the inferior nasal turbinate has been removed, the structure of the turbinate can also be improved by an injection of Cymetra (liquid Alloderm). The advantage of this new "Alloderm implant" is that it is not rejected by the body, and also retains its form and volume in most locations in long-term studies.

Here you can find more information about Empty Nose Syndrome Surgery.

How can Empty Nose Syndrome be prevented?

Even when it is medically necessary to reduce the nasal turbinates or perform a septal correction, Empty Nose Syndrome (ENS) can be prevented. Safe and function-preserving procedures are possible using minimally invasive nasal and sinus surgery, assisted by state-of-the-art technical options like the ones that are available to you at our practice.  
For this reason, Dr. Bodlaj relies on modern laser or radiofrequency techniques for nasal turbinate reduction. A head-mounted microscope, currently available in only few ENT clinics in Germany, is used for corrective plastic surgery on the nasal septum. This ensures a generally pain-free procedure for the patient, and enables the surgeon to carry out an effective yet gentle operation.

With these procedures, the danger of excessive reduction of the nasal turbinates, which can easily occur in traditional procedures involving partial removal using scissors, is eliminated. The nose's functions (warming and humidifying inhaled air) remain unaffected by this kind of function-preserving procedure.

ENS patient information

Do you think you might suffer from ENS and want an expert opinion or to arrange an examination appointment at our practice?

Then please refer to our ENS patient information, which is available for download as PDF file here.

For more information click here for a presentation of the ENS-International Association (ENSIA) and here for their ENS flyer!


Medical Practice Dr.
Robert Bodlaj

Bamberger Strasse 7
96215 Lichtenfels

Fon: +49 9571 5885
Fax: +49 9571 948196
E-Mail: info@schlafmedizin-praxis.de