Conservative Treatment of ENS

Conservative management focuses on nasal hygiene and moisturizing nasal mucosa. Ointments, oils, sprays and irrigation are meant to maintain and improve the health of the remaining nasal mucosa in the ENS nose by keeping it moist and free of infection and irritation. These treatments will not cure ENS because they cannot restore the missing or damaged turbinates. However, such treatments can help control some of the symptoms as well as decrease suffering (palliative effects):

  • Daily nasal irrigations of regular saline are always recommended. Many patients prefer to use Ringer’s Lactate solution instead, as they find it’s easier on the mucosa than regular saline, and there are some empirical studies that back up that claim.
  • Saline, Ringer’s Lactate, or hyaluronic acid based – nasal mist sprays, or gels, are always helpful when proper irrigation is not possible.
  • Sesame oil can help in cases of extreme dryness and crusts.
  • Drinking lots of hot soups and beverages. Caffeine is best avoided.
  • Sleeping with a humidifier (cool or warm mist per one’s preference).
  • Sleeping with a CPAP machine that has a built-in humidifier.
  • Acupuncture and shiatsu meant to improve nasal blood supply and nerve function.
  • Dressing warmly and sleeping in a warm environment.
  • Regular physical activity and a healthy life style are most important too.

Other recommendations:

  • Acupuncture and shiatsu meant to improve nasal blood supply and nerve function.
  • Dressing warmly and sleeping in a warm environment.
  • Regular physical activity and a healthy life style are most important too.

Surgical (Implantation) Treatment

Surgical treatment for ENS using implants is appropriate for patients who have experienced large turbinate resections. This treatment can be helpful in improving breathing, but, according to patient reports, may be less helpful in improving nasal dryness. The underlying rational of surgery is to restore the inner nasal geometrical structure of the nasal passages of air (the inferior, middle and superior meatuses). This is commonly achieved through implantation. Surgical treatment involves narrowing back the over enlarged nasal cavity — either by bulking up the partially resected turbinates with implant material or by creating what are called neo or pseudo turbinates. Current implantation materials include: Acellular dermal matrix (ADM), autograft (cartilage), and hydroxyapatite.

Turbinate tissue is unique and there are no potential donor sites in the body to harvest similar tissue from. However, in the nose, Form = Function. It is therefore possible to restore some function by restoring the natural contours and proportions of the nasal passages using implants, and thus – regain some of the nose’s capabilities to adequately pressurize, streamline, heat, humidify, filter and sense the airflow.

By implanting different grafts and material underneath the patients’ submucosa at the right places – the surgeon hopes to create a look alike turbinal structure which will do four things:

  • Restrict the amount of airflow, just enough to allow the nasal mucosa to cope better, while still allowing enough air to pass through for all needs of breathing. This is referred to as normalizing the nasal rates of resistance.
  • Restore close to normal rates of nasal mucosal heat and humidity, as the implant projections trap the heat and moisture in the air returning from the lungs.
  • Normalize the post surgical disrupted airflow patterns of the nose and make sure that the vast majority of airflow is redirected into the middle meatus of the nose.
  • Increase the mucosal surface in the nose that comes in contact with the airflow. This increases airflow sensation, amongst all the other things that are mentioned above that help improve the sensation too.

You can find more information here.

Is there a cure for ENS?

There is currently no cure for Empty Nose Syndrome.

There is hope that with recent advances being made in regenerative medicine that otorhinolaryngologists will explore ways to use stem cells and tissue engineering technology to fully regenerate or reconstruct nasal turbinates, thereby restoring the nose back to normal health.

You can find more information here.

The Future For ENS Sufferers

When will a cure for ENS be available? The answer to this question depends on how quickly researchers devise a method to regenerate nasal turbinates. The technology to produce stem-cell created turbinates already exists, but it is a matter of applying this technology to the condition of Empty Nose Syndrome. And of course, producing the relevant studies.

Hopefully, tissue engineering and regenerative medicine scientists will begin to take a greater interest in functional nasal reconstruction, as the complication rates of functional nasal surgery are amongst the highest rates compared to most other types of elective surgery.

Regenerative Medicine Treatment

Today, the most promising treatment appears to be multiple injections of the combination of Platlet-Rich Plasma (PRP) and Acell MatriStem®, extracellular matrix.

Dr. Subinoy Das, head of U.S. Institute for Advanced Sinus Care & Research in Columbus, Ohio, is the leading doctor using this technique. He also provides updates regularly to the ENS community. The link to his communications is below.

Dr. Das Updates

What is ACell?

MatriStem Products are medical devices appropriate for the topical management of wounds and various surgical procedures. MatriStem is available in particle and sheet forms in various volumes, sizes and configurations.

What is PRP?

Platelet-rich plasma (Abbreviation: PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue.