Monday, July 7, 2008

More Treatments for empty nose syndrome (ENS), sinusitis, allergic rhinitis and postnasal drip (discussed below!....from one patient to another)

Having Nasal Surgery? Don’t You Become An Empty Nose Victim! includes 38 pages of non-surgical and surgical treatments for empty nose syndrome (ENS). Many treatments for ENS can also effectively treat sinusitis, allergic rhinitis and postnasal drip. I would like to elaborate upon the treatments in this blog, so as to offer additional food for thought, with the belief you can at least experience some improvement. Many of these treatments are important for general nasal health rather than specifically for ENS, and many are particularly beneficial for ENS sufferers who also have allergy or sinusitis issues. Consequently, some might seem more applicable to ENS sufferers without any additional conditions than others. However, as noted in Having Nasal Surgery? many ENS sufferers have allergies because allergies often lead to enlarged turbinates, which doctors resect. My recommendation to you is to ensure that you are doing treatments from Principles 1, 2, 3, which are to thin mucus (e.g., by irrigation), to keep good blood supply to the nose (e.g., by exercise), and to relax (e.g., by a good sleep). The three examples I cited - irrigation, exercise, and good sleep - are perhaps the most critical activities an ENS sufferrer can do to manage his or her symptoms. Then take some additional thoughts from this blog post and incorporate them into your own treatment plan as you see fit. Just take a few of the ideas posted here, not all of them, so that you will actually do it. I hope this post is useful for you, the reader. It is one of the hardest for me to write, as it is not easy to pinpoint all of the interventions for various nasal problems, but I want to leave you with this additional food for thought. Remember, it is only you, no one else, who holds the keys to taking control of your health.

I acknowledge these treatments do not constitute surgical remedies or a cure; my hope in the surgical domain is that while Alloderm placed into the septum offers relief and does not resorb, doctors need to find materials and perfect techniques that might make for a suitable implant in the lateral wall as well. That’s the next step in this surgical area, in my opinion. That’s my hope for doctors as they continue to perfect and refine implant surgeries….

Now, just as it is stated in Having Nasal Surgery?, it should also be stated here that treatments discussed do not constitute medical advice and I strongly recommend you discuss treatment strategies with your doctor prior to attempting any of the ones recommended here.

Before proceeding further, I must review the 3 guiding principles for good nasal health, my 2-step plan, and provide the outline of my non-surgical treatments in Chapter 9 of Having Nasal Surgery?:

Three Guiding Principles for Good Nasal Health:

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

Principle 2: Maintain blood supply to the nose by stimulating remaining turbinate tissue.

Principle 3: Relax.

Below is the 2-step plan as I wrote on pages 115 and 116 of Having Nasal Surgery?
With these 3 principles in mind, I recommend a simple 2-step approach for taking control of your nasal health:

1) Seek to incorporate 1-2 treatments from each of Principles 1, 2 and 3 in your daily routine. That is a total of 3-6 treatments per day. You might write down specifically what you are going to do, which will encourage and remind you to actually do it. You should also prioritize what is most important. An example treatment plan might be doing pulsatile irrigation 2 times per day, drinking eight 8-ounce glasses of water per day, exercising 3 times per week, and sleeping 8 hours per night. In my own experiences, I find exercise, sleep and irrigation to be the three most important treatments for ENS. The treatments need to be well-rounded, which is why I suggest to select some from Principles 1, 2 and 3. Of course you can do as many treatments as you wish, but you should stick to what you know you can do faithfully; otherwise you will lose track and not do it. Remember, you will need to talk with your doctor about these treatments before attempting them. Your doctor must be a key play in helping you diagnose your specific medical problems and he or she might recommend or prescribe medications or other treatments.

2) If you are diagnosed with ENS and these treatments have not improved your breathing difficulties, you should talk with your ENT specialist who can help determine if you are a candidate for implant surgery or make a referral.

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

Natural Remedies

a) Saline irrigation
Preservatives to avoid in saline solution
How to irrigate with the Grossan Hydro Pulse
b) Nasal sprays
c) Nasal gels
d) Nasal oils

Medical remedies

e) Irrigation with antibiotics
Dr. Grossan’s guide for adding antibiotics to irrigation
f) Guaifenesin
g) Zinc lozenges
h) Allergy shots
i) Antihistamines
j) Three vaccines
k) Decongestants
l) Anti-inflammatories

Dietary remedies

m) Plenty of fluids
n) Hot tea with lemon and honey
o) Chicken soup
p) Vitamins (particularly A and D)
q) Dietary considerations
Products to avoid
Foods that promote healthy sinuses

Environmental remedies

r) Environmental considerations
s) Humidifier
t) Good hygiene

Principle 2: Maintain blood supply to the nose by stimulating remaining turbinate tissue

a) Exercise
b) Swimming
c) Warm packs
d) Other methods of increasing blood flow
Inversion technique

Principle 3: Relax.

a) Sleep
b) Reduce stress
Tips to reduce stress

The primary additional tips I would like to suggest center around irrigation, vitamins and supplements, and dietary considerations.
These are all non-surgical, mostly natural remedies that are not intended to cure ENS, but might help you cope better. This is particularly applicable and true for people who suffer from not only ENS, but have concomitant problems of sinusitis, allergies or asthma as well. We need to take care of all conditions we might have, as we are only as strong as our weakest link. Since many ENS sufferers suffer from other conditions as well, I trust these treatments are useful so our entire body can heal. In any case, the important key to remember is that you, no one else, must be ready and willing to take control of your health. I am confident many doctors would agree with that assertion. You must want to get or feel better, and be motivated to do it. No one else will do that for you.

The additional tips are organized as follows:

1) New tip on how to get the most out of pulsatile irrigation.

2) Strategies to further thin mucus, thereby bolstering effectiveness of irrigation: steam inhalation and taking warm showers before and/or after irrigation.

3) Chris’ vitamins and supplements to consider (some of which are cited in Having Nasal Surgery?):
· Quercetin with bromelain
· Multi-vitamin
· Acidophilus
· New Chapter Host Defense

4) The antihistamine spray Astelin

5) Food tips:
Avoid dairy products and allergenic foods. Do substitutes for milk such
as rice, oat, nut, coconut and almond milk.
Avoid sugar.
Choose foods that are organic.
Consider food supplements – try garlic, onion, oregano.
Chew some sugar-free gum for good oral hygiene.
The best hot tea.

6) Before you get medicine again, get your mucus cultured.

7) Try acupressure.

8) Try craniosacral therapy.

1) New tip on how to get the most out of pulsatile irrigation…

I have been irrigating my sinuses with my head centered and leaning forward over the sink for years. This is the method recommended by Dr. Grossan, as it avoids the potential of getting water into the ears via the Eustachian tube. It is the method shown on videos demonstrating how to perform pulsatile irrigation. I believe this method is effective, but I would like to offer a more aggressive method for irrigating, as recommended to me by Dr. Tichenor ( This method might be particularly beneficial for cleaning the nose of an ENS sufferer who has thick, viscous mucus as well as sinusitis and postnasal drip sufferers. This method consists of tilting your head to the side, so that your head is parallel to the ground. Make the sure the stream of the irrigation is only 1” high and the pressure is low. Then irrigate into the lower nostril for about 4 to 5 seconds or 15-20 cc’s, lift your head up and let the water drain out of your sinuses. If you find water gets into your ears, then lower the pressure or perform the irrigation for fewer seconds. After you are done irrigating 3 or 4 times on the one nostril, proceed to irrigate the other side.

I had some difficulties getting the irrigation into my ears when I first began irrigating in this fashion, but have learned how to remedy that. After my nasal irrigation is complete, I put my head under the bath faucet and turn the water on warm (not hot) and put my head under it. This helps to stimulate the autonomic nervous system and thereby drain water that might otherwise get clogged in my sinuses. Once I have done that, then I proceed to do the throat irrigation. (I do not use salt when I irrigate my throat).

I use the Hydro Pulse as my pulsatile irrigator. The Hydro Pulse pulsates at a rate that stimulates the cilia to their natural rhythm. I find the Hydro Pulse to be gentle and soothing on the sinuses. I am also a firm believer in using the Breathe-ease XL solution, which I believe is the best saline solution for nasal irrigation. This solution was very carefully calibrated by Dr. Grossan, and it is based upon a Locke-Ringer's solution, which medical journals have found to be more effective than saline alone. So if you are looking for optimal health, select the Hydro Pulse and Breathe-ease XL.

2) Strategies to further thin mucus, thereby bolstering effectiveness of irrigation: steam inhalation and taking warm showers before and/or after irrigation.

Strategies to help thin mucus should be beneficial to ENS sufferers who have thick, viscous mucus and a diminished mucociliary clearance system. Of course, allergy and sinusitis would also benefit from these strategies. Before you irrigate (or immediately after you irrigate, for that matter), you might wish to try steam inhalation. Steam inhalation will help to thin the mucus, which will enable the irrigation to be more effective.

On a personal note, I add about 5 drops of eucalyptus oil to the water after steaming it in order to provide the steam with the analgesic (pain-relieving) and antibacterial properties of eucalyptus oil. This oil can be purchased at many health food stores or online. However, it should be noted to not add more than the suggested amount of oil and that “Certain people should avoid eucalyptus steam inhalation, such as those with heart conditions, central nervous system disoders, and pregnant women. Infants, children, and elderly people may not be able to respond appropriately to the heat. (Source: Author Cathy Wong at

Another option is to take a shower immediately before or after an irrigation. Have warm water pour down on your sinuses and you might actually feel the drainage occur. The heat and moisture from the water will certainly help to thin mucus.

3) Chris’ vitamins and supplements to consider (some of which are cited in Having Nasal Surgery?):

· Quercetin with bromelain
· Multi-vitamin

· Acidophilus
· New Chapter Host Defense

I take some vitamins and supplements that I believe are helpful for treating my conditions of empty nose syndrome, sinusitis and allergic rhinitis. Perhaps these vitamins and supplements are more applicable to those with sinusitis and allergic rhinitis, but they could be considered by ENS sufferers who have either of these conditions as well. These supplements are generally helpful for healthy sinuses and immune system improvement. My opinion is that vitamins and supplements are useful, but they are not a substitute or as powerful as a healthy diet – what you eat and drink. It is easy to get lost in the vast array of supplements and vitamins that could potentially help us, and perhaps overspend. But many of us, particularly with ENS, are on limited budgets and don’t have endless money. I would thus caution the reader to simplify and focus on those vitamins or supplements that are going to be most helpful for you. A suggested book you might wish to read is Mayo Clinic Book of Alternative Medicine for a comprehensive yet easy-to-understand discussion of vitamins and supplements (and other forms of alternative medicine).

Below are the vitamins that I use and find helpful. I do not wish to go into great detail about the properties of these supplements, but suffice it to say some general statements about them:

a) Quercetin with bromelain.

This is a classic combination that helps to provide you to maintain proper functioning of the body’s histamine response, thereby reducing inflammation. While ENS sufferers often have inflammation, many also suffer from allergies and sinusitis. Quercetin is particularly beneficial for allergies while bromelain is beneficial for sinusitis. Quercetin is an antioxidant that has antihistamine properties, which is why it is recommended for people with allergies, while bromelain, a pineapple-derived enzyme that is anti-inflammatory, is added to enhance the absorption of Quercetin. As noted in Having Nasal Surgery?, studies have in fact shown that bromelain is helpful in improving sinusitis symptoms. These pills help enhance respiratory function and support a healthy immune system.

b) Multi-vitamin

If you eat right, you might not need a multi-vitamin. But as a measure to promote general good health, multi-vitamins are useful. I use a male multiple vitamin each day, which consists of many vitamins, minerals and herbs. When you go to the grocery store or health food store, the selection of vitamins is vast. My logic is, instead of buying all of the vitamins separately, why not simply purchase a basic multi-vitamin that contains all of the other vitamins, minerals and herbs at about 100% of the Daily Value. This need not be expensive and should not consist of too many nutrients, lest it introduces them at a toxic level.

c) acidophilus

The probiotic acidophilus is important for good digestive and, by extension, sinus health, particulary for those who have been on antibiotics. I take Advanced Acidophilus Plus (Solgar) each day. One capsule consists of 250 million microorganisms of lactobacillus acidophilus and 250 million microorganisms of bifidus lactis. These good bacteria help to maintain healthy digestive health – and offer advantages to other areas of our body as well. A major advantage of acidophilus is the suppression of candida, which is an overgrowth of yeast. It is particularly important to take acidophilus if you are on antibiotics, because the antibiotics will kill not only the bad bacteria, but the good bacteria in the gut as well, leaving your digestive system out of whack. I had to be on a strong antibiotic for 8 weeks this year, and you can bet that I was taking these pills throughout the course of treatment. It is important to refrigerate these pills to ensure that the probiotic microorganisms are preserved. It amazes me how every system in our body is intimately connected. The same is true with digestive health and sinusitis. Probiotics are a hot topic in medicine today and it just makes good sense to take these for good health.

d) New Chapter Host Defense.

This product is a great immune system booster for ENS sufferers who also have recurrent sinus infections. New Chapter Host Defense is a combination of organic mushrooms that help to boost immunity. If you suspect low immunity or have recurrent sinus infections, this might be a worthwhile supplement to try. This product was recommended to me by a doctor who gives me acupuncture. This product claims it helps to increase natural killer cell activity by up to 300%. People who have chronic sinusitis often have weakened immune systems, so this product can help improve immunity. It is expensive, about $39.95 for a 30 day supply in various health food stores, but can be purchased at a lower price by a savvy consumer on the Internet.

One last supplement to comment about: I must add that slippery elm bark is a product that can help soothe minor irritated throats. I have not had great success with it, but it might work for you.

4) The antihistamine spray Astelin.

This spray has been very effective for me, as it is reported to be effective for ENS sufferers who have allergic rhinitis or vasomotor rhinitis. I use Astelin on a daily basis and I find that it provides great relief for my allergies. Astelin is unique in that it offers an antihistamine effect for both seasonal allergic rhinitis and vasomotor rhinitis. It helps those who are troubled by seasonal allergens, such as pollen, mold and ragweed, and environmental irritants, such as car fumes and perfumes. I should note that it is reported to cause drowsiness and has a bitter aftertaste, but I would counter that with the effects of it are solid and proven effective for me.

5) Food tips:
Avoid dairy products and allergenic foods. Do substitutes for milk such as

rice, oat, nut, coconut and almond milk.
Avoid sugar and processed foods, particularly if you have Candida.
Select organic foods.

Consider food condiments – try garlic, onion, or oil of oregano.
The best hot teas: throat coat and breathe easy.

Having Nasal Surgery? Don’t You Become An Empty Nose Victim! provides discourse on the above topics, but I must acknowledge there is so much information available on what foods are best to eat that I do not wish to discuss these topics in-depth. I would prefer to hit the highlights and simply acknowledge modifications I have made in my own life, with the hope that it might help you as well. The discussion here is focused on helping those people who want good general health; it is not geared toward solely an ENS sufferer with no other conditions, but more toward patients with sinusitis or allergy problems.

a) Avoid dairy products and allergenic foods. People who have chronic postnasal drip would do well to heed this advice. It is a well-known fact that cow’s milk is highly allergenic. There are plenty of substitutes for cow’s milk that are available including rice milk, coconut milk, nut milk, almond milk, and oat milk. I appreciate what Dr. Ralph Metson and Steven Mardon wrote in the Harvard Medical School Guide to Healing Your Sinuses about food allergies: “The tip-off that such an allergy may be present is when postnasal drip is the primary symptom.” It is later written, “Milk and wheat are the two foods that most commonly cause the allergic reaction that leads to excess mucus production and troublesome postnasal drip.” The protein in the milk causes mucus production and, while it has been recommended that dairy might help provide nasal resistance for the ENS nose and increase mucus production (which it does) at certain Internet locations, and there might be some merit to this claim, I would contend that it is better to find ways to thin the mucus to help avoid an infection, particularly if you are prone to sinus infections. The primary way to determine if a food allergy is present is by doing an elimination diet. Common food allergens include milk, wheat, corn, gluten, egg, soy, yeast, and sugar. So I suggest trying to eliminate dairy products for a week and see how you feel or if you notice any changes. The key here with eating is simply to be perceptive to how your body responds to different foods; the effects may be subtle, but nonetheless profound. For example, I have noticed I breathe significantly more comfortably when off the milk; granted, I have implants that do provide resistance, but it is a good feeling to have that mucus thin. I also like the suggestion by Carolee Bateson-Koch in Allergies: Disease in Disguise where she suggests eating 70% raw food and 30% cooked food (which has less nutritional value); and she also suggests eating different foods on a regular basis rather than eating the same food over and over and developing an allergy to it.

Books on the topic of food allergies:
You might wish to read “Allergies: Disease in Disguise” by Carolee Bateson-Koch, D.C., M.D. or;
buy a couple of cookbooks such as “The Whole Foods Allergy Cookbook” by Cybele Pascal (delicious recipes!) or “The Allergy Self-Help Cookbook” by Marjorie Hurt Jones, R.N.

b) Avoid sugar and processed foods, particularly if you have Candida. Many people with ENS have been on repeated courses of antibiotics throughout their past, which leaves them at increased risk of having Candida albicans, which is a yeast overgrowth. Patients are at-risk for candida because antibiotics kill off the good bacteria. Generally a special diet free of sugar foods or those containing yeast as well as antifungal medications are used to combat the Candida. (There are also cleanses out as well). Of significance: sugars help to rapidly multiply the yeast in the body. People who crave such sugars might very well have a yeast infection. Avoid it where you can. Even fruits have sugar in them, and you might do well to substitute vegetables for fruits for a short term while you are attempting to get your candida under control. Some people have found success with antifungal medications, but you will of course need to talk with your doctor about that.

Books on the topic of Candida:
Read “The Yeast Connection: A Medical Breakthrough” by William Crook, M.D. or the Complete Candida Yeast Guidebook, Revised 2nd Edition: Everything You Need to know about Prevention, Treatment & Diet by Jeanne Marie Martin and Zoltan P. Md Rona

c) Select organic foods to enhance overall health. There is plenty written about eating raw, organic foods, especially the nutritional value in them, which is in stark contrast to the packaged and processed foods in the grocery market, where the goal of the manufacturer is often to make the most profit without regard for the health of the food. Fact is the more natural the foods you eat, the better off you will be. Period. Organic foods are generally high in nutrients, free of pesticides, antibiotics, growth hormones, nor have they been genetically modified. They are pure. Organic foods might cost more, but the improved health is worth it in my opinion.

d) Consider food condiments – try garlic, onion, or oil of oregano.

Food condiments such as garlic, onion, oregano can all add some life to the food – and they are generally very good for you. Garlic is both anti-bacterial and anti-fungal, and thus can helps fight off a yeast overgrowth (Candida albicans). Onion is a rich source of quercetin (remember quercetin?), which has antihistamine properties. It also has antibacterial and anticholesterol properties to it. Oregano is an herb with antibacterial and antioxidant properties. These are just three food condiments that can provide you with good health.

e) Chew some sugar-free gum for good oral hygiene. As noted in Having Nasal Surgery?, good oral hygiene is important for ENS and sinus sufferers given the close proximity between the mouth and sinuses. In September 2007 (shortly after my book was released), the American Dental Association said that sugar-free gum might help prevent cavities, reduce plaque and strengthen teeth. Specifically, it found that chewing gum for 20 minutes after meals three times a day increases the saliva production, which in turn helps to neutralize plaque acid and strengthen teeth. It is important for ENS sufferers to have good oral hygiene, as the mouth is in close proximity to the sinuses, so chewing gum should be important for us as well. Our bodies are like a large interdependent system and every organ is somehow connected to every other organ, so we need to take care of the whole system lest any part dysfunctions and we become enslaved to the weakest link. Granted, I am not aware of any studies, but I imagine this increased saliva might also help to thin mucus as well, and thereby provide benefit to the throat and digestive system. In any case, I have been chewing sugar-free gum for a while and my recent dentist visit revealed I have no more cavities and no gingivitis.

f) The best hot teas: Throat Coat and Breathe Easy.

As discussed in Having Nasal Surgery? hot tea with lemon and honey is an excellent mucus thinner. A few cups of day is recommended for good health, and even more if you notice you might be coming down with or have a sinus infection. I find teas soothing on my throat and great for sinus health. I have tried many teas in my life, but my personal preference is the organic teas made by Traditional Medicinals ( Specifically, my favorite teas are Throat Coat and Breathe Easy. Throat Coat includes a blend of herbs, including licorice root, Echinacea, cinnamon bark. It really does coat my throat. The other tea I enjoy is Breathe Easy, which also includes the herbs licorice root, eucalyptus leaf, peppermint leaf, ginger rhizome, among others. Both of these teas, in my view, are among the best for sinus health. As an aside, I find that deglycyrrhizinated licorice tablets from my health food store helps to take care of any acid reflux I might have, in addition to just slowing down in life. (People who seem to be very busy and get poor sleep are probably at higher risk for acid reflux.)

6) Before you get medicine again, get your mucus cultured.

This is a basic recommendation for those who might have or be at risk for either a bacterial or fungal infection, but I cannot emphasize it enough. (An endoscopy could also show a fungal infection.) It is my understanding that cultures might not be cost-effective and they take more time for the doctor to perform and interpret, and the insurance company might not reimburse that well. On top of that, some patients might be anxious to try medicine if they sense an infection. Consequently, some doctors do not culture before prescribing medicine, instead prescribing medicine based solely on past experiences with patients who had similar problems and/or the patient’s history. Unfortunately, if you go on a medication such as an antibiotic, it would be good to know that you have a true sinus infection. In my 14+ years of suffering from sinus infections, not one doctor did a culture. Can you believe that? Recently, my doctor decided to do a culture, which showed that I had a staph aereus infection, which is a more common but serious type of infection among patients who have chronic sinusitis. I was put on a 60-day course of Levaquin, 500 mg, which is the strongest oral antibiotic. Some patients with chronic sinusitis need to be put on an antibiotic for 3 to 8 weeks, while I have seen it recommended on the Mayo Clinic website for 3 to 12 weeks. Infections can be intermittent for long periods of time, so it naturally follows that a 10 day course of Levaquin might not clear the infection totally, but a longer course might be needed instead. Of course, it is very important to be on probiotics while on antibiotics because antibiotics kill the good bacteria in the gut.

7) Try acupressure.

Acupuncture is discussed in Having Nasal Surgery? but a treatment regime would not be complete without discussing acupressure. Acupressure is an ancient practice that where you can use your fingers to stimulate key points on your skin that will in turn promote the body’s self-healing processes. Getting that increased blood flow to the nose is important to ensure improvement of nasal sensations. And there are key points for people with nasal problems, such as placing some pressure underneath your cheek to relieve nasal congestion or in the web between your thumb and pointer finger. I enjoy doing acupressure for about 10 minutes each day and it does seem to put me in a deeper state of relaxation while promoting healing. Give it a shot. You won’t need to spend any money doing it.

Book on acupressure:
A very comprehensive book on acupressure is Acupressure’s Potent Points: A guide to self-care for common ailments by Michael Reed Gach.

8) Try craniosacral therapy.

Craniosacral therapy is a light touch therapy that a therapist does on you to improve the functioning of the central nervous system. This technique enhances the craniosacral system, the area in which the brain and spinal cord function. This generally consists of a one hour session that might run in the ballpark of $50-$65 and it usually does not get reimbursed through health insurance; you might be able to get it reimbursed through Flex dollars if your company offers it and your doctor agrees to write you a script for it. Although it is not reimbursed, it’s not voodoo science; it’s based on a medical model, developed by a neurosurgeon, and most of all it works. I believe – and it has been my experience – that this therapy does in fact enhance nervous system functioning. This is a particularly beneficial therapy for people who have incurred head trauma (or nasal trauma) to restore the nervous system health. When I told my doctor who does acupuncture that I believed craniosacral therapy seemed more effective than acupuncture, he was not surprised. I have talked with other ENS sufferers who have also benefited from craniosacral therapy. Give it a shot.

Thanks for reading my additional thoughts and recommendations for non-surgical, primarily natural treatments for ENS, sinusitis, allergic rhinitis, and postnasal drip. These are not cures, as they do not alter the nasal anatomy to reshape the nose back to normal from an overly empty nose, but they might offer symptomatic relief. And they can be of great benefit. I appreciate your interest in treating your nose and hope these ideas are helpful to you, or at least food for thought from one patient to another.

3 Effective Ways Empty Nose Sufferers can raise awareness of ENS

Read the blog post entitled 3 goals for ENT specialists:

Read the blog post entitled Press Release: Having Nasal Surgery? Wins Award in National Book Contest

Now, onto my blog post entitled 3 effective ways ENS sufferers can raise awareness of ENS.

Some people with empty nose syndrome (ENS) want to see awareness of ENS increase among the general public and doctors alike. I hope this article provides food for thought on three avenues to make that happen: medical journal articles, medical malpractice lawsuits, and media attention.

ENS is a tragic condition that results from too much turbinate removal during nasal surgery. The turbinates provide numerous functions including heating, humidifying and filtering air, as well as providing airflow resistance to the lungs and directing airflow in the nose in such a way that air strikes all regions of it. When they are removed in attempt to open up the airway, the nose is no longer able to provide these vital functions.

The tragic aspect of ENS is that it is caused by medical error and, on the flip side, that it is fully preventable. Yet the startling fact is that few among the general public seem to know about it and doctors are not overly eager to publicize a problem they created. So ENS sufferers tend to suffer in silence and radical turbinectomies continue to be performed. Consequently, some ENS sufferers not only want publicity, but treatment from a medical community that does not offer many answers. Make no mistake that there has been a significant increase in public awareness of ENS with large thanks to the Internet, as thousands of sites discuss ENS at present, whereas a google search for "empty nose syndrome" in 2003 might have turned up fewer hits than you have fingers. But there is still room for more to learn about it. Many laypeople still have never heard of the condition.

Before ENS sufferers take a real stab at ENS awareness, though, I believe it is important they are feeling somewhat OK - they must take care of themselves first - and are knowledgeable about ENS. The problem is some want more awareness but then leave the ENS scene once they are finding some relief, and consequently do not contribute to ENS awareness.

So let me take a stab at what I believe are three effective avenues to pursue increased awareness of ENS:

1) Medical Journal Articles
2) Medical Malpractice Lawsuits
3) Media Attention

1) Medical Journal Articles

The first method, medical journal articles, is perhaps the most critical and effective method for increasing awareness of ENS among ear, nose, and throat (ENT) specialists. Yet it is perhaps the one area in which ENS sufferers have the least amount of control. We need doctors to publish more articles that are willing to cite the term empty nose syndrome and accurately describe the severity of the condition. While there has been at least 100 years of controversy surrounding total inferior turbinectomies in the medical literature that suggests it causes late-onset atrophic rhinitis or rhinitis sicca, too many doctors continue to ignore the warnings. Many still perform subtotal or partial inferior turbinectomies and many, if not most, perform total middle turbinectomies. Why? Surely money is a reason and so is a reluctance to admit malpractice. But more than that, there are no studies that effectively prove that turbinectomies cause ENS. But this can change.

Doctors can push for a study that shows a clear statistical link between turbinectomies and the devastating symptoms that follow. ENT doctors, for example, could petition a major medical organization such as the American Academy of Otolaryngology or the American Medical Association to perform a long-term follow-up study of groups of patients who have had turbinectomies. We the patients are helpless in this respect, but doctors can demand it.

Yet I would be remiss to suggest we ENS sufferers are totally helpless when it comes to reaching the medical community. My book, Having Nasal Surgery? Don't You Become An Empty Nose Victim! has been read and well-received by top medical professionals. And I'm only a patient. In addition to face-to-face discussions with medical professionals, we the patients can make our voice heard to the American Academy of Otolaryngology by writing a letter, with signatures from doctors, to demand that a position statement with respect to ENS be developed that clearly states what turbinate reductions are likely to lead to ENS and which ones are not, and defining our condition clearly, as well as summarizing what surgical treatment options are available for ENS sufferers, such as Alloderm implants.

2) Medical Malpractice Lawsuits.

Frankly, I would prefer that it would not have to come to this. Hopefully doctors would adopt sound practices that avoid ENS, and I know many do. Yet still too many continue to perform surgeries that lead to ENS and this practice must be stopped. I must acknowledge that lawsuits are a vehicle behind change, as they could mandate in a shorter amount of time a change in law and practice among doctors. I am aware of several lawsuits throughout the United States and abroad that have taken place in recent years because of ENS, as well as two lawsuits to mind where the ENS sufferer won the case, although neither went to a full trial. I refrained from discussing lawsuits in my book lest some ENS-interested doctors might be overly distracted by it, turned off to ENS and not wish to help. Yet the sad reality is that too many doctors have not changed on their own; change is a slow, gradual process but when the stakes are this high (some will become ENS victims), change could not come quicker.

3) Media Attention.

Frankly, ENS demands more attention and the media can bring our condition to the general public faster than anyone else. Many ENS sufferers, new to wanting to raise awareness about this horrible condition, think of pitching Oprah on ENS. While it is a noble suggestion and Oprah could wield great power for helping these hurting people, and I admit to having tried it myself many times, we probably should be more aggressively pitching our local news stations where we have a better chance of being heard.

Unfortunately, the news media has been slow to pick up our story, because they view it as a minor issue affecting a small populace, although nothing could be further from the truth.

Or, in some instances, the news media caters to the medical community who is paying them large sums of money to run stories that highlight the benefits of nasal surgery. Take Global News Ontario, for instance, a Toronto-based television station that was planning on airing a story about the benefits of nasal surgery, specifically turbinate reduction surgeries using coblation-assisted technology (one of the safest types of nasal surgery). I was contacted by an intern at the station who ran across the website about a month ago and she thought the story on nasal surgeries would benefit from hearing from those who have dealt with the unpleasant aspects of nasal surgery. I let her know how great it would be for the news media to present a balanced story on nasal surgery, which would enhance their credibility among viewers. I also let fellow Canadians know of this opportunity. When I followed up with this intern via a phone call, she informed me there was a "huge" response from ENS sufferers and that "all of a sudden" two stories came up that were demanding her immediate attention, which effective put the story on nasal surgery on the backburner. While that may be true, I surmise she probably had pressure either not to run that story, or to not allow viewers to see our side of the story. She said she would contact me if they decided to run the story. But I haven't heard from her. And I'm not surprised.

Yet I still believe there is hope for media interest. If you are thinking of pitching the media, in addition to making a small video on youtube for empty nose syndrome (a must-do so the media can watch a critical mass of ENS sufferers), which I encourage all ENS sufferers serious about making a difference to do, think about 1) what type of media you hope to pitch, and 2) what message you hope to send. You need to plan carefully, and expect rejection. I have many times. But I have also had some local newspapers run stories on my book, so I have enjoyed some relative success with respect to media awareness on ENS. Here's my suggestion: don't worry too much if the traditional media does not pick you up. Focus on the media most likely to listen. Develop a relationship with someone in the media and know what types of stories that person is working on. Then show that person how the story of ENS ties in nicely with their stories. I would personally suggest to try to secure media attention through 1) high traffic Internet blogs 2) radio stations and 3) newspapers. Keep in mind television stations are often more comfortable airing information that has already been presented in the radio or newspaper, and you have greater control over what is presented in the radio or newspaper than on television. So if the television station picks up the story, great. If not, don't sweat it. It's good to aim large, but to think realistically and small by focusing on the local news, which could ultimately end up becoming a national news story.

When approaching the news media, it is important not to play Mr. Nice Guy. It is important to show them why ENS is newsworthy and important, and how it could attract viewers or readers. Emphasize how terrible and severe ENS can be. Emphasize the large number of sufferers - it is possible that the low millions suffer from ENS in America alone, and thousands could become ENS victims each year. Cite a list of symptoms. Encourage the media to ask the tough questions: why are doctors not required to follow a protocol that mandates certain preventative treatments, such as saline irrigation and allergy treatment, prior to recommending nasal surgery? Why have doctors not developed a position statement on what turbinate surgeries are safe versus which ones might cause harm? Lead them to the answer: Does it have to do with money? Fear of malpractice suits?

If the media were to explore these questions, they could do a ton of good by not only holding the medical profession more accountable, and having many viewers thank them in the process, but any patient who is considering nasal surgery - and that is a sizable percentage of their readership or viewers - can make a more empowered and informed decision about nasal surgery, which will lead to improved outcomes.