Monday, May 26, 2008

Three goals for ENT specialists on empty nose syndrome

When we think about ear, nose and throat (ENT) doctors, what exactly is it that we really want from them? Why do we want more awareness among them? Here is what I think are three goals we want from the ENT profession:

1) To simply understand and become knowledgeable about ENS, so they can diagnose the currently undiagnosed. The doctors can identify the specific symptoms and its relation to the specific turbinate reductions. If we have a problem, just like any other sufferer of a serious condition, we deserve to have our problem correctly identified and offered appropriate treatment options. The difference between us and a cancer patient, is at least they get treated. These previously undiagnosed sufferers should thus be able to get appropriate help. And I don't mean a cure because there isn't one available; I just mean being offered the best options available to relieve the suffering.

2) We want ENTs to develop a position statement and legal mandate in the field about nasal surgeries (and its relation to ENS), and properly inform patients, so that ENTs would not cause ENS to other prospective nasal surgery patients. I personally believe ENTs should be required to mandate allergy treatment and saline irrigation prior to performing a turbinate reduction. This is a selfless reason, because the damage has already been done to us ENS sufferers; however, we know how damaging ENS can be and want to save others. A position paper would state what nasal surgeries are most likely to lead to ENS (e.g., total turbinectomies, partial and subtotal turbinectomies, and laser turbinate reductions) and which ones are least likely to lead to ENS (e.g., submucous resection with outfracture or radiofrequency).

3) To explore, refine and perfect reconstructive surgical options for ENS. Dr. Houser is already doing this and he is doing a terrific job at it. ENTs are surgeons. This is how they can help us. What we want is more ENT doctors to take interest in researching and performing reconstructive surgical options for ENS sufferers and perfecting these surgeries so that the surgeons are using the best and most cutting-edge materials available for implants (e.g., SIS, Alloderm); and through experience, they perfect and refine the size, location, and technique of the implants so that ENS sufferers would get optimal relief. ENT doctors could collaborate with plastic surgeons to perfect the technique and research scientists to use the best materials available.

It is point #3, reconstructive surgical options, that is the focus of a new forum section at

In my own experiences, I have found some relief from treating ENS with implants, as noted in my book. For example, I have much greater nasal airflow resistance, somewhat deeper sleep, and my nose is overall more moist and the mucus somewhat thinner after the implant. I find the implant to serve a sort of "preservation function" for my nose. In Dr. Houser's research article, it was shown that the implants provide improvement ranging from 25% to 90% relief, but his article also noted that the implants do not significantly relieve pain. The implant thus is not a cure, but it has brought partial relief, for which I am thankful.

What I have also learned in treating ENS is that an implant treats ENS, but its effect is more limited on sinusitis, allergies, asthma, gastroesaphogeal reflux, etc. If you have concomitant problems, you need to treat them as well. Our bodies consist of interdependent organs and the whole is greater than the sum of its parts. You are only as strong as the weakest link. You need to treat all issues. And you can often be preventative in treating an issue, such as the more effectively you treat your allergies, the less your symptoms of acid reflux or sinusitis.