Dr. Houser on the ENS book

Chris is addressing a tremendously important issue in otolaryngology. Empty nose syndrome is a real entity that requires further investigation. It is fully preventable if the otolaryngology community will embrace it and work to understand it. Furthermore, it is not a hopeless situation; there is hope for improvement and recovery. Although Chris' book is written for the general public, I truly hope my colleagues in ENT will read this book and take it to heart.

-- Steven M. Houser, M.D.
http://www.geocities.com/shouser144/index.html

Dr. Grossan on the ENS book

Chris has done a fine job of presenting empty nose syndrome (ENS). Remarkably this subject is practically unknown by the medical profession. Patients present with I can't breathe through my nose, not getting enough air, I am constantly sick, loss of sense of smell, not sleeping at night. The doctor sees a wide open nose that you can drive a truck through and can't understand the complaints.

But it is like a garden hose - if it is narrow it reaches the far wall, the opening is wide open, the water drips at your feet. The symptoms of ENS are serious and Chris does a fine job explaining what to do.

-- Murray Grossan, M.D.
http://www.ent-consult.com
http://www.grossan.com
http://www.hydromedonline.com/presentingthehydropulse

The ENS book: a closer look

You will notice the photo above is of myself (Chris Martin), my wife Colleen, and our two daughters, Faith, age three, and Abigail, age one.

The purpose of this blog is to raise awareness about a book I am writing on empty nose syndrome (ENS).

This book explores my personal experiences while offering practical treatment ideas. My goal is to have it published by summer 2007. I will provide details about how you can order when the time comes (please stay posted). I am a school psychologist who suffers from ENS, and I believe this condition has not received adequate medical attention from ear, nose and throat doctors or plastic surgeons.

In brief, ENS is an iatrogenic medical condition that is caused when too much turbinate tissue is removed. ENS sufferers experience a variety of symptoms, including the hallmark sign of paradoxical congestion, which means having a sensation of shortness of air despite the nasal cavity being wide open. Other symptoms include difficulty concentrating, weakened ventilation of the lungs, shallow sleep, frequent headaches, a dry nose, sometimes nasal crusting (i.e., dried mucus), thick mucus, sometimes recurrent infections, all of which lead to high rates of anxiety and depression. ENS is clearly a tough problem.

Endorsed by well-known ear, nose and throat specialists familiar with ENS, I strive to offer a genuine message to the reader and hope for the injured patient through:

1. My personal triumph in coping with ENS.
2. A critique of turbinate surgeries for anyone considering nasal surgery.
3. An inside look at the politics of ENS.
4. Best treatments for ENS, many of which also apply to sinusitis, allergic rhinitis and postnasal drip.

As just noted, the treatment ideas are not only applicable to ENS, but also to sinusitis, allergic rhinitis and postnasal drip. Better yet, these treatment ideas come straight from an ENS sufferer. I have received back cover endorsements from Dr. Murray Grossan of Los Angeles, California, and Dr. Wellington Tichenor of New York, NY; along with a foreword from Dr. Steven Houser of Cleveland, Ohio. These are well-known doctors.

+Dr. Grossan is author of the popular book The Sinus Cure and is inventor of the Grossan Hyro Pulse Irrigator, which is an influential product for treating sinuses and allergies.

+Dr. Houser is both a practicing ENT doctor and professor at Case Western Reserve and he published the article, Empty Nose Syndrome Associated with Middle Turbinate Resection, which appeared in the December 2006 edition of Otolaryngology-Head and Neck Journal. He is the primary doctor in the United States who attempts to treat ENS patients through surgical implantation of alloderm.

+Dr. Tichenor is a medical specialist in sinusitis who does not perform surgery, but primarily treats patients who have not responded well to surgery, such as ENS patients. Dr. Tichenor is a leader in both prevention and treatment of ENS. His website, http://www.sinuses.com, has won numerous awards for outstanding content.

Dr. Grossan's back cover endorsement

"...A must-read for anyone with nasal problems so they, too, can understand about ENS and avoid becoming an ENS patient. The up-to-date information can empower the patient to best therapies."

Part of Dr. Houser's foreword

"Chris' story is a compelling one. He tells a very personal tale to help inspire others. He also explores the science behind ENS to really inform others with similar difficulties. His advice to ENS patients is right on. I hope this book will get the attention it deserves. I will certainly recommend it to the ENS patients I treat."

Below are four quotes taken directly from the book:

In spring 2003, a grateful lady traveled 75 miles to personally thank Dr. Murray Grossan of Los Angeles, California, a well-known ear, nose and throat doctor. The reason: her son, then age twelve, was scheduled for a bilateral turbinectomy, a surgery where inner nasal tissue known as turbinates is removed. But she read a 2001 Los Angeles Times article, Sniffing at Empty Nose Idea by Aaron Zitner, in which Dr. Grossan was cited as opposing such procedures because of potential complications such as empty nose syndrome (ENS). Consequently, she cancelled the surgery, visited an allergist, and her son’s nasal problems cleared. He was spared from becoming an ENS patient for life.

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The 1997 partial turbinectomy and septoplasty left me in the following condition:

I was missing 90% of my middle and inferior turbinates, except for 40% of the left inferior turbinate; I had a hole high on my septum; I had a hole in my maxillary sinus; and my ethmoid sinuses were partly removed.

Clearly, far more was removed than stated by the procedures, partial turbinectomy and septoplasty.

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A good question to ask is, “How much of the nasal mucosa, the organ of the nose, can one remove before contributing to ENS symptoms?” We do not know. It appears that we can remove some of the turbinates and the nose works fine. But if too much tissue is removed, results are disastrous. In that sense it appears the more aggressive the turbinectomy, the greater likelihood of ENS.

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Also consider that according to Dr. Grossan, when the concept of ENS was presented at the Triologic meeting about 5 years ago, the response was reported to be a deafening silence. The response at the 2006 annual convention of the American Rhinologic Society was even worse: there was not a single presentation on ENS.

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Table of Contents

Disclaimer...

Table of Contents...

Acknowledgements...

Foreword...

Introduction…

By Wellington S. Tichenor, M.D…

Chapter 1. Empty Nose Syndrome…

a) Brief background of empty nose syndrome…
b) Relationship between sinusitis, allergic rhinitis, asthma and ENS…
c) Mucociliary clearance (MCC)…
d) My own approach to ENS…
e) Plight of the ENS sufferer…
f) Who is this book written for?...
g) Rationale…
h) Four reasons for this book…

Chapter 2. My story: prior to the partial turbinectomy…

a) A deteriorating nasal health…
b) The ‘quick fix’ but a lifetime of regret…
c) Shortly after the partial turbinectomy…
d) I just could not blow my nose…

Chapter 3. My story: the ENS journey…

a) When my sinus problems persisted…
b) An allergy solution…
c) Seeking answers to the stuffy sensation…
d) The unhelpful answer: further surgery…
e) The bittersweet discovery of ENS…
f) Delaying real help while getting little…
g) Temperature extremes and ENS…
h) Battling thick mucus and recurrent infections…
i) Psychological effects of coping with ENS…
j) Why I will not give up…
k) A fortuitous, but never-ending turn of events…
l) Seeking help through Dr. Houser…
m) The office visit…
n) The good surgery…
o) After the surgery…

Chapter 4. What exactly is empty nose syndrome? …

a) The turbinates: how form fits function…
b) Physical symptoms of ENS…
c) Psychological symptoms of ENS…
d) Proposed classification system for ENS: IT, MT, and Both…
e) Empty nose syndrome or atrophic rhinitis?.…

Chapter 5. Commentary on turbinate surgeries…

a) Introductory statement…
b) Submucous resection…
c) Submucous resection with outfracture…
d) Electrocautery…
e) Radiofrequency…
f) Total, subtotal, and partial inferior turbinectomy…
g) Injection corticosteroids…
h) Cryosurgery….
i) Laser surgery…
j) Middle turbinate resection…
k) The multiple surgery experience among ENS patients….
l) My ratings of turbinate surgeries…
m) Future thoughts on turbinate surgeries…

Chapter 6. Politics of empty nose…

a) Some doctors remain stuck on deceiving logic…
b) Logic leads some to believe removing even more turbinate tissue is best…
c) ENTs and plastic surgeons notice positive benefits to some patients…
d) ENS is less likely to be identified because of its iatrogenic origin…
e) Doctors (mistakenly) consider ENS rare…
f) Turbinate surgeries are financially ‘sanctioned’…
g) There is a failure to adequately address ENS…

Chapter 7. ENS: the difficult diagnosis…

a) There is a lack of knowledge on ENS among ENTs and plastic surgeons…
b) There is no objective test to determine ENS…
c) The ENS patient is in denial of his or her symptoms….
d) The suffering experienced by the patient is in relation to how he or she felt before surgery…
e) Severe dryness and atrophy might not occur until years after surgery…

Chapter 8. What ENS is not: postnasal drip

a) Tips for treating postnasal drip…
b) ENS versus PND….
c) What postnasal drip is not: GERD
d) Tips for treating GERD.

Chapter 9. Non-surgical treatments for empty nose syndrome…

1) What to do if you suspect empty nose…
2) Step-by-step approach…

Principle 1: Keep the nose moist while keeping mucus moving…

Natural remedies...
a) Saline irrigation…
b) Nasal sprays…
c) Nasal gels…
d) Nasal oils…

Medical remedies…
e) Irrigation with antibiotics…
f) Guaifenesin…
g) Zinc lozenges…
h) Allergy shots…
i) Antihistamines…
j) Three vaccines…
k) Decongestants…
l) Anti-inflammatories…

Dietary remedies…
m) Drink plenty of fluids…
n) Hot tea with lemon and honey…
o) Chicken soup…
p) Vitamins (particularly A and D)…
q) Dietary considerations…

Environmental remedies…
r) Environmental considerations…
s) Humidifier…
t) Good hygiene

Principle 2: Maintain blood supply to the nose by stimulating residual tissue in the nose…

a) Exercise…
b) Swimming…
c) Warm Packs…
d) Other methods for increasing blood flow…
-Acupuncture…
-Biofeedback…
-Inversion technique…

Principle 3: Relax…

a) Sleep…
b) Reduce stress…

Chapter 10. Surgical treatment options…

Chapter 11. Concluding thoughts…

Appendix A: Glossary…

Appendix B: Websites of interest…

Appendix C: Dr. Houser’s replies to FAQs…

Appendix D: Books of interest…

Appendix E: Index…

About the Author…