Empty Nose Syndrome – Causes, Symptoms & Treatment

Empty Nose Syndrome

Empty Nose Syndrome is a postoperative condition in which the turbinates are oversized or removed entirely. As a result, the function of the nasal concha, which is to moisten the inhaled air, can no longer be adequately perceived. Despite an enlarged nasal cavity, nasal breathing is obstructed.

What is Empty Nose Syndrome?

The Empty Nose Syndrome is the so-called empty nose syndrome . It is a pathological condition that arises after the turbinates have been reduced in size or even removed . Despite enlarged nasal cavities, the feeling of a blocked nose arises. The reason for this is the lost ability of the nose to moisten the inhaled air.

The air stays dry. Crusts form in the nose, which can also be the starting point for infections. Humans have three turbinates, which can be divided into upper, middle and inferior turbinates. The nasal passages, which are responsible for various functions, are located between the individual nasal conchae.

The superior nasal meatus is located between the superior and middle turbinates. It contains the olfactory organ and is therefore also referred to as the olfactory canal. The nasal passage located between the middle and inferior turbinates is known as the sinus passage and ends in the paranasal sinuses.

The actual airway is the lower nasal passage, which can be found between the inferior turbinate and the palate. It is responsible for nasal breathing and serves to humidify the air we breathe. In addition, the turbinates contain pressure sensors that signal the state of nasal breathing to the brain.

If the turbinates are reduced in size or even completely removed as part of an operation, the message to the brain, the sense of smell and taste and, as already mentioned, the humidification of the breathing air are impaired. This results in both physical and psychological symptoms.


The cause of Empty Nose Syndrome is always a previous improper turbinate reduction. Such surgical interventions must be performed when there is chronic enlargement of the turbinates. Enlarged turbinates impede the passage of air through the nose.

Reasons for enlargement can be allergic reactions , inhalation of dust, smoke or irritants, hormonal disorders , deviated septum or constant use of nasal drops with a decongestant effect. During the operation, the nasal passage is widened so that nasal breathing can function unhindered again.

However, after these procedures, it was often observed that nasal breathing was still impaired. Due to the empty nasal cavity, turbulent flows occur in the nose and thus flow resistance, which leads to a reduction in air transport through the nose. Because of this, the feeling of stuffy nose arises .

Furthermore, the upper parts of the nose are less ventilated due to the changed aerodynamic processes, which leads to an impairment of the sense of smell . The nasal mucosa contracts and produces much less mucus, so that inhaled pollutants can no longer be removed and can therefore accumulate in the nasal cavities.

The dry air causes crusts to form in the nasal cavity, which become targets for bacteria. A greasy coating can form in the nose, which leads to the so-called stinky nose ( ozaena ). The stinky nose emits an unpleasant, sweetish, putrid odor.

Symptoms, Ailments & Signs

Overall, Empty Nose Syndrome is characterized by a variety of physical and psychological symptoms. There is the subjective feeling of not getting enough air, although objectively this does not correspond to the facts. The inhaled air appears cold and dry.

Furthermore, too little or in some cases too much mucus is produced. The nose can drip constantly, while thick mucus in the back of the nose gets into the pharynx. A crust formation in the nose is typical. The sense of smell is severely limited. Often there is pain and pressure in the paranasal sinuses, whereby a sinus infection cannot be diagnosed.

Impeded nasal breathing often interferes with sleep. Due to the bacterial colonization of the encrustations, a sweet, putrid odor often escapes from the nose and mouth. Symptoms also include headaches or, in some cases, nosebleeds . As a result of these impairments, secondary psychological symptoms such as depression , anxiety , concentration disorders , nervousness , constant tiredness and exhaustion can also develop.


Empty Nose Syndrome is diagnosed based on the symptoms that occur after turbinate reduction surgery.


With Empty Nose Syndrome, breathing through the nose is severely impaired because the nasal conchae have been completely removed or greatly reduced in size. As a rule, the patient can still inhale the same amount of air through the nose as before the surgical procedure.

However, those affected may have the impression that the air volume is too low and that the affected person is not getting enough air. The lack of nasal conchae also creates the feeling that the air is cold and dry. Those affected often complain of a permanent runny nose and crusting around the nose. It can also lead to a sinus infection.

In many cases, the feeling of not getting enough air leads to sleep disorders and headaches . Sudden nosebleeds can also occur. The symptoms severely limit the patient’s everyday life and significantly reduce their quality of life. Depression and anxiety can also occur.

Some patients also complain of nervousness. The treatment itself is carried out with the help of sprays that can relieve symptoms. However, in order to fight the Empty Nose Syndrome permanently, a surgical intervention is necessary. There are no complications.

When should you go to the doctor?

Empty Nose Syndrome definitely requires medical evaluation and treatment. Difficulty breathing, problems with mucus production and a severely restricted sense of smell are typical complaints that need to be examined. If an ENS is detected in the course of this, rapid treatment is required. In most cases, a surgical procedure is performed, which is associated with a hospital stay of several days. After the end of the treatment, close monitoring is necessary, because this is the only way to rule out complications.

If symptoms such as a persistent runny nose, crusting or a sinus infection occur, the nearest hospital should be consulted. Medical advice should also be sought immediately if you experience a sudden nosebleed, severe headache or insomnia. If depression or anxiety occurs, a therapist can be called in after consultation with the general practitioner .

People who suffer from an allergy, who breathe in a lot of dust, smoke or other irritants at work or who have a deviated nasal septum are particularly affected by Empty Nose Syndrome. Hormonal disorders and the regular use of nasal drops can also be triggers. Risk patients with the symptoms mentioned should definitely consult a general practitioner.

Treatment & Therapy

There are two therapeutic options available. Both non-surgical and operative therapy methods are used. The non-surgical treatment methods are aimed at symptomatic therapy. However, only surgical correction of the turbinates promises lasting healing success.

Non- surgical methods include daily nasal rinsing , use of seawater nasal sprays, drinking a lot, use of air and room humidifiers, use of expectorants, staying in areas with a sea climate, avoiding harmful environmental influences, building up a better bacterial flora in the nose with special nose drops such as Symbioflora 1.

Sleep masks with humidifiers are also used. During the surgical treatment, the missing turbinates are replaced by appropriate implants. These implants are constructed from the body’s own bone and cartilage fragments or from artificial materials, among other things. Hydroxyapatite cement, Alloderm or silicone can be used as artificial material.

Outlook & Forecast

Unfortunately, there is little prospect of a cure for the empty nose symptom. The respiratory epithelium destroyed in previous operations cannot be replaced. At the moment it is only possible to make breathing through the nose easier again by performing another procedure. However, another operation carries the great risk of further irritating the mucous membranes. In addition, many doctors only operate on very serious breathing restrictions with the empty nose symptom because they do not want to cause any further scars.

Those affected can only relieve their symptoms, such as dry mucous membranes, difficulty breathing and, among other things, itching. Here, nourishing salt water nasal sprays can help. But warm nasal douches and ointments also help to moisturize the dry mucous membranes again for a short time. Especially in winter, when the heating air is dry, those affected have to carry out their care routines several times a day. To facilitate breathing through the nose, special inhalations with ointments are useful.

Without therapy for the heavily stressed mucous membranes of the nose, the empty nose symptom can lead to fine cracks. These can be associated with nosebleeds that are only very light at first and later become more severe. Pathogens can now penetrate through the roughened and cracked mucous membrane of the nose, which means that the risks of chronic rhinosinusitis and other diseases of the nasal mucosa are very high.


Before a planned turbinate reduction, it should be checked whether there are other treatment options. But even if the turbinates need to be surgically reduced in size, there are ways to prevent Empty Nose Syndrome. This is done, among other things, by using minimally invasive nasal and paranasal sinus surgery, which is supported by the use of the latest technologies.


The Empty Nose Syndrome is generally not seen as a disease, but as a condition resulting from surgical reduction of the turbinate. Conventional therapy seeks to artificially moisten the nose, which, according to those affected, feels dry. The dryness often leads to breathing problems and other complaints in Empty Nose Syndrome.

In the postoperative aftercare of Empty Nose Syndrome, patients can do a lot for themselves. You should spend as much time as possible by the sea, where the salty aerosol at the water’s edge wets your nose. Daily nasal rinsing or inhalations with salt water are also helpful, especially during the heating season.

There is much to be said against decongestant nasal sprays. A better alternative for Empty Nose Syndrome is natural saltwater nasal sprays. Ointments with depanthenol and special nasal oils can also be used to counteract the dryness that is felt. These agents also moisten the inside of the nose for a longer period of time.

The fact that those affected drink two to three liters of water a day protects the dry-looking nasal mucosa in Empty Nose Syndrome from actually drying out. Humidifiers can be used during the heating period so that the air in the room never falls below the tolerable level. The degree of humidity that does not lead to mold and is perceived as pleasant varies from person to person.

You can do that yourself

In Empty Nose Syndrome, the turbinate is no longer able to properly moisten the air inhaled through the nose, usually as a result of a surgical procedure. The syndrome often occurs after cosmetic surgery, but can also be the result of medically necessary corrections in the nose area.

The best self-help measure is prevention. In the case of cosmetic surgery, the patient should be fully informed about the possible risks and weigh up whether they want to accept long-term damage such as Empty Nose Syndrome. In the case of medically necessary interventions, other forms of therapy can be tried first.

If an operation is unavoidable, the patient should definitely look for an experienced specialist who is able to carry out a minimally invasive procedure using the latest laser or radio frequency surgical techniques. These surgical techniques maintain the functionality of the nasal concha. The medical associations and health insurance companies will help you to find a qualified surgeon.

If empty nose syndrome has already occurred, the patient can take a number of self-help measures to relieve the symptoms. Long-term exposure to dry air must be avoided at all costs. An air humidifier should be installed in work rooms or at least ventilated regularly. At night, it helps to sleep with the window open or to place an air humidifier in the bedroom. Rinsing your nose with salt water and using seawater nasal sprays can also improve symptoms.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.