This paper was posted before on this forum here, but at that time it was in German. In this post there's a link to the full english version, with illustrations.
Paper: Surgery of the turbinates and “empty nose” syndrome
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010; 9: Doc03.
Published online 2011 April 27. doi: 10.3205/cto000067
Marc Oliver Scheithauer
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ulm, Germany
Full article can be accessed at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199827/
This is an excellent paper on how surgery can cause ENS. It talks in detail about various surgical methods and the negative effects they have.
Titles of the sections:
- Abstract
- Introduction
- Anatomy and physiology of the turbinate
- Diagnostics
- Variants of turbinate pathology
- Therapy of the inferior turbinate
- Treatment of the middle turbinate
- Turbinate surgery during childhood
- “Empty” nose syndrome
- References
The last paragraph of the paper says:
- As the ENS therapy is unsatisfactory for both patient and doctor, minimal invasive surgery on the turbinate which preserves the mucosa remains one of the most important principles for rhinosurgical therapy.
Here's the abstract:
*: Note, not sure about the recommendation for "anterior turbinoplasty". I'm guessing it wouldn't work for nasal congestion in the back (posterior)? I don't know. There are papers even recommending RF Coblation as a "good" method (and the maximum time they tested the patient was 2 months after surgery which is short) while other papers say it doesn't have long lasting effects.
Other papers (like this one) have recommended SMR (sub-mucous resection) with lateral displacement as the most safe and long-lasting method. Although the effect of lateral displacement (outfracture) was found to be temporary in some papers as the turbinates return to their original (medial/middle) positions eventually.
So (as always) read everything with your own judgement and healthy skepticism. This is good information in any case on different methods of surgery and their effects, and there is a lot of information in the ENS section at the bottom (section
.
Paper: Surgery of the turbinates and “empty nose” syndrome
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010; 9: Doc03.
Published online 2011 April 27. doi: 10.3205/cto000067
Marc Oliver Scheithauer
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ulm, Germany
Full article can be accessed at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199827/
This is an excellent paper on how surgery can cause ENS. It talks in detail about various surgical methods and the negative effects they have.
Titles of the sections:
- Abstract
- Introduction
- Anatomy and physiology of the turbinate
- Diagnostics
- Variants of turbinate pathology
- Therapy of the inferior turbinate
- Treatment of the middle turbinate
- Turbinate surgery during childhood
- “Empty” nose syndrome
- References
The last paragraph of the paper says:
- As the ENS therapy is unsatisfactory for both patient and doctor, minimal invasive surgery on the turbinate which preserves the mucosa remains one of the most important principles for rhinosurgical therapy.
Here's the abstract:
Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The desired goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings, whilst simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose, they ensure climatisation, humidification and cleaning of the inhaled air. Thus free nasal breathing means a decent quality of life, as well.
Regarding the multitude of different surgical techniques, we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover, there is a lack of prospective and comparable long-term studies, which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation, and therefore it is the method of choice today. (* See note below)
Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The “empty nose” syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interfere with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in “empty nose” patients are presented.
*: Note, not sure about the recommendation for "anterior turbinoplasty". I'm guessing it wouldn't work for nasal congestion in the back (posterior)? I don't know. There are papers even recommending RF Coblation as a "good" method (and the maximum time they tested the patient was 2 months after surgery which is short) while other papers say it doesn't have long lasting effects.
Other papers (like this one) have recommended SMR (sub-mucous resection) with lateral displacement as the most safe and long-lasting method. Although the effect of lateral displacement (outfracture) was found to be temporary in some papers as the turbinates return to their original (medial/middle) positions eventually.
So (as always) read everything with your own judgement and healthy skepticism. This is good information in any case on different methods of surgery and their effects, and there is a lot of information in the ENS section at the bottom (section
.
