What is empty nose syndrome?

Most people don’t have perfect noses. Experts estimate that the septum — the bone and cartilage that runs up and down the center of the nose — is off-centered in up to 80 percent of Americans. Some people are born with it off-center, while others develop the condition after an injury later in life.

Most people don’t notice that their nasal septum is off-center. However, in some people, the septum is so far off the nose’s midline that it causes problems when they try to breathe through their nose, and often leads to repeated sinus infections. This condition is called a “deviated septum.” Sometimes a person with a deviated septum will also have enlarged turbinates, which are soft tissues inside the wall of the nose. This can block airflow and further reduce a person’s ability to breathe.

Septoplasty and turbinate reduction are the surgeries used to correct a deviated septum and enlarged turbinates, respectively. Usually these surgeries are routine, and people make full recoveries. They are used to improve breathing problems caused by a deviated septum, such as sleep apnea and abnormal airflow.

However, in some cases, people have reported worsened breathing after their nasal passages are opened up with surgery. Other physical symptoms and even psychological symptoms may present, decreasing a person’s overall quality of life. One such condition is called “empty nose syndrome.” While many doctors are unfamiliar with this condition and don’t understand how best to treat or diagnose it, some doctors have made progress investigating this condition.

What are the symptoms of empty nose syndrome?

The symptoms of empty nose syndrome include:

  • difficulty breathing through the nose
  • a recurring sensation of drowning
  • breathlessness, or a need to gasp for air
  • nasal dryness and crusting
  • headaches
  • nosebleeds
  • low airflow
  • dizziness
  • reduced sense of smell or taste
  • a lack of mucus
  • a thick post-nasal drip back into the throat
  • heart palpitations
  • nasal swelling and pain
  • tiredness, sometimes causing sleep disorders and daytime sleepiness due to low airflow through your breathing passages

Psychological symptoms such as anxiety and depression may be present before surgery or begin at the same time as a person’s empty nose syndrome symptoms. It’s also common for people with empty nose syndrome to have trouble focusing on daily tasks because they are distracted by their condition.

What causes empty nose syndrome?

Doctors aren’t completely sure why empty nose syndrome affects some people who’ve had septoplasty and turbinate reduction but not others. But new research suggests that empty nose syndrome is triggered by the body sensing different levels of pressure and perhaps also temperature in each of the nasal cavities. This may make it difficult for you to feel when you’re breathing.

The nose’s pressure or temperature receptors may be located on the turbinates. Surgery is believed to disrupt these receptors and cause some people to lose their ability to sense their nasal breathing. The sensation is worsened by an increased volume of air flowing through the enlarged nasal cavity. What’s more, surgery can remove some of your nasal mucus, which is important for regulating the beneficial bacteria in your nose. Without it, you may lose good bacteria and gain harmful bacteria. When harmful bacteria colonize your nose, it can worsen the symptoms of empty nose syndrome.

What’s the history of this condition?

Empty nose syndrome is a controversial condition not formally recognized by the medical community. That’s because most septoplasty and turbinate reduction surgeries are considered successful. Many doctors consider it counterintuitive that a surgery used to open up a person’s nasal passages would actually worsen their ability to breathe.

In the early 2000s, ear, nose, and throat (ENT) specialists began addressing this condition as they noticed the pattern in people presenting “empty nose syndrome” symptoms. Some people were so distraught by their inability to breathe properly that they attempted or committed suicide. Since then, a growing group of ENT specialists has started to recognize, study, and treat the condition.

The defining symptom of empty nose syndrome is a nose that feels “stuffy” or “clogged” despite a person’s nasal passages being wide open. Time and increased drying out of the nasal passages appears to worsen this sensation and other empty nose syndrome symptoms.

How is empty nose syndrome diagnosed?

Empty nose syndrome is not officially recognized as a medical condition, and people have only begun studying it. Routine, reliable tests have not yet been developed to diagnose empty nose syndrome.

Some ENT specialists will diagnose it based on a person’s symptoms and by checking turbinate damage on a CT scan. A person’s nasal passage airflow may also be tested. The specialist may find that a person’s nose is too open, causing a low rate of airflow.

But a low airflow rate can be caused by other conditions. A person’s total respiratory health should be evaluated before a doctor arrives at an empty nose syndrome diagnosis.

How is empty nose syndrome treated?

Treatment can have several goals including:

  • moisturizing the nasal passages
  • killing bad bacteria in the nose
  • increasing the size of remaining turbinate tissue in an attempt to increase air pressure in the nose

Some common treatments include:

  • using a humidifier in your home
  • living in a warm, humid climate, particularly one with salty air
  • using antibiotic nasal applications to kill bad bacteria
  • applying hormonal creams to the inside of the nose to increase turbinate tissue size
  • taking sildenafil (Viagra) and other phosphodiesterase inhibitors, which can increase nasal congestion
  • undergoing surgical implantation of bulking materials to increase turbinate size

What is the outlook for empty nose syndrome?

Empty nose syndrome is still not well-understood, but researchers are making progress on better understanding its causes. And this has led them to pursue more effective treatments.

Current treatments are effective at reducing empty nose syndrome symptoms. The key is to find a doctor you trust that will treat the condition. You can find resources and support groups online at the website of the Empty Nose Syndrome International Association.