Empty nose syndrome: Case report

Malta Medical Journal Volume 25 Issue 03 2013 Introduction Empty Nose Syndrome (ENS) is a term first introduced by Kern and Moore which is used to describe a rare spectrum of various symptoms suffered by patients who had had previous radical turbinate surgery with a CT scan appearance of the paranasal sinuses after gross tissue loss. The most common symptom is socalled ‘‘paradoxical’’ nasal obstruction, reported by the patient despite objectively permeable cavities on clinical examination with no obstacle found on imaging or rhinomanometry and acoustic rhinometry. 1 In most cases, the inferior turbinate (IT) has been resected radically even though middle turbinate (MT) resection has also been implicated. 2 Incidence is unknown, as there have been no specific studies published. The estimated rate of ENS following inferior turbinate resection is 20%, which induces simple dry nose. 1-2 Houser distinguished several subtypes of ENS according to the resected turbinate: inferior, medial, both, or fourthly, a subtype in which turbinate structures paradoxically appear normal. ENS subcategories are based on the type of tissue that is resected; hence “ENS-both” indicates both the IT and MT were at least partially resected. The management is problematic. We report an elderly gentleman of high social standing with long-standing nasal discharge and chronically blocked nose post radical turbinate surgery many years prior to his presentation, and the management options of ENS.