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
Acupuncture
Biofeedback
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 (www.sinuses.com). 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 http://www.about.com/).

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 (http://www.traditionalmedicinals.com/). 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:
http://emptynosesyndrome.blogspot.com/2008/05/three-goals-for-ent-specialists-on.html

Read the blog post entitled Press Release: Having Nasal Surgery? Wins Award in National Book Contest
http://emptynosesyndrome.blogspot.com/2008/05/press-release-having-nasal-surgery-wins.html

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 www.emptynosesyndrome.org 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.

Thursday, July 3, 2008

Below is pretty much all of the information from my website, http://www.emptynosesyndrome.net/, which I might close down in the near future.

"Too many surgeons today believe they can indiscriminately remove large amounts of turbinate tissue..."

-Wellington S. Tichenor, M.D., Creator of award-winning website http://www.sinuses.com/


*Are you considering nasal or sinus surgery? If so, do you know the range of options, benefits and risks? Are you aware that no professional standard exists regarding what is an appropriate amount of turbinate tissue to remove, which puts nasal surgery candidates at possible risk for empty nose syndrome (ENS)? Have you had a discussion of ENS with your doctor?

*Have you had nasal or sinus surgery, but now find yourself worse off than before? If so, do you know whether you have ENS?

*Are you among the millions of Americans who suffer from at least one of the following: empty nose syndrome, sinusitis, allergic rhinitis, nasal congestion, postnasal drip, asthma or acid reflux? If so, would you like to learn holistic treatments from a sufferer who has been there and, in the process, learn about ENS and potentially prevent yourself from ever becoming an ENS sufferer?

If you answered "yes" to any of the above, then you have come to the right website. The home of a book that attempts to act as a self-help guide on the above issues by raising public awareness on a silent epidemic: ENS.

**WATCH VIDEO TESTIMONIALS BY ENS SUFFERERS AT YOUTUBE**

Go to http://www.youtube.com/ and type in the search phrase "empty nose syndrome"Nine ENS sufferers have created videos as of today (4/14) and five are posted at youtube. These sufferers did a terrific job in creating a video that will go a significant difference in raising ENS awareness. If you are an ENS sufferer,I beg you to please consider making a short video for youtube, which will help our cause.

Also, please consider visiting my friend's Christian-based web blog (who has asked me to keep his name anonymous) at http://emptynosesyndromehope.blogspot.com/. His blog is an encouragement to Christians with ENS and I thank him for his efforts in doing this.


You have made it to the site of a self-help book that I am confident will help you, not make you worse. In fact, this book could change your life. Welcome to emptynosesyndrome.net, a site dedicated to raising awareness on the comprehensive self-help book on empty nose syndrome entitled, Having Nasal Surgery? Don't You Become An Empty Nose Victim! Read on...

My name is Chris Martin and I am a school psychologist from Upstate New York and ENS sufferer of 10 years. I am excited about seeing this book raise awareness of ENS to a new level as I wrote this book in part because I found so few resources for ENS while suffering from this serious problem. Suffer in silence no more! While writing Having Nasal Surgery?, I learned that many of the strategies for treating ENS could actually be very beneficial for a host of nasal and sinus problems. I am not a medical professional, but I am an ENS sufferer and thus have had to "live out" the treatments described in this book. This book is part testimonial and part informational.

How many ENS sufferers are there out there? I estimate 2-4 million Americans suffer from ENS as 500,000 turbinate reductions are performed each year in the U.S., and I back up this claim in Having Nasal Surgery? But the fact is no one truly knows. Another way to look at this question is to ask yourself: If you believe you are the only ENS sufferer in your area, then you need to be honest with yourself and think again: Do you actually believe your doctor did the aggressive turbinate reduction surgery only on you? Consider that, as a result of my book signing on November 10th, 2007, I learned many have ENS in my immediate area in Upstate New York as a result of aggressive turbinate reduction surgeries by a different doctor than the one who did my nasal surgery, as my doctor has since passed away. But you would never know it because ENS is a silent problem.

Abbreviated Reviews/Short Quotes on Having Nasal Surgery?


**Below is a compilation of short quotes of what various people have said about Having Nasal Surgery? Don't You Become An Empty Nose Victim!

Chris Martin's book is excellent and I recommend it to patients.…The important point is that ENS is preventable and this book will go a long way to that prevention. Yes, if you are having ENT surgery read this book.

-Murray Grossan, M.D., Author of The Sinus Cure and inventor of the Grossan HydroPulse Nasal-Sinus Irrigation System

Chris has done an amazing job putting together this book for himself and others considering or having already had nasal surgery.

-Tony Ponte, Alberta, Canada

I have to say that I am impressed. The book is an easy read and Chris does an exceptional job at putting some rather complex concepts into layperson's terms… The story of his journey through the world of ENTs rings all too familiar, and he does a very good job at examining various nasal surgery techniques and ENS medical treatments.

-Anonymous Source

You have written a valuable book for ENS sufferers and the medical community…I know I have said this before, but I am really impressed with your book.

-Margy Olmstead, Indexer for Having Nasal Surgery?

I truly wish that this book had been available prior to my nasal surgeries. I did research, but nothing that would have prepared and informed me like Chris Martin's book. It is very detailed and heartfelt. For those who have already rolled the dice and lost with a nasal surgery, this book offers hope, support and many helpful suggestions.

-ENS Forum Member "RE"

An ENS sufferer himself, Christopher Martin has written a comprehensive and thoroughly 'reader friendly' introduction to what ENS is, what can be done about it, and what to be aware of in various treatment options in "Having Nasal Surgery? Don't You Become An Empty Nose Victim!” Christopher relates his own personal account of coping with ENS, offers an informed and informative evaluation of turbinate surgeries with respect to nasal conditions, provides an 'insider' look at the politics surrounding ENS within the medical community, and identifies the best treatments for ENS, many of which are also efficaciously applicable to sinusitis, allergic rhinitis, postnasal drip, GERD, and asthma. Invaluable reading for medical students, physicians, and non-specialist general readers, "Having Nasal Surgery?" is especially recommended for personal, professional, and community library Health & Medicine reference collections and reading lists.

-Jim Cox, Editor-in-Chief, Midwest Book Review

This slim but potent book is tremendously important and informative not only for those considering nasal surgeries, but for the specialists who perform them.

-Kirkus Discoveries

Martin, now a family man and school psychologist in his late twenties in upstate New York, writes not as a doctor but as a survivor. He presents here a working definition of ENS and a primer on surgical as well as other medical, dietary, and environmental ways to treat its symptoms. He includes a layman’s guide to turbinate functioning and to the science and politics of turbinate surgery. Having learned to manage his condition, he tells a compelling personal story that adds passion and authority to his presentation. Martin grants, as his research shows, that “conservative” turbinate surgery can often alleviate chronic stuffiness, but his presentation implicates the many doctors and plastic surgeons who continue to remove excessive amounts of turbinate.

-Joe Taylor, Foreword Clarion Review

Chris has written a compelling and comprehensive account of his own personal experience with a relatively unknown affliction known as Empty Nose Syndrome (ENS)… Chris's book will make sure that you don't repeat other's mistakes or suffer the potentially devastating effects of nasal surgery.

-Paul, New York

Do yourself, all ENS sufferers out there, and Chris a great favor right now: stop reading this review, and start reading this book! It could save your life.

-Ryan Webb, Ontario, Canada

Anyone who is contemplating sinus surgery should read this book. Also, anyone who has a friend, colleague, or family member who is facing sinus surgery should urge those people to read this book as well… His message is powerful and important…Sinus sufferers who are considering surgery can learn a great deal about their condition and can possibly prevent themselves very serious problems in the future. It is certainly worth the time and money.

-Walter Ballenberger, founder of http://www.postnasaldrip.net/, Monument, CO

Thank you for this most telling account of your journey through the maze of ENS; your efforts in providing comprehensive information about ENS and your personal account of the roads that have led to finding hope is inspiring. It has been a companion when I have felt alone and has been the platform through which I find the strength to advocate strongly for informed consent and knowledge of ENS for any person who is entering into nasal surgery. -Jackie G., New YorkChris Martin has written the ultimate "Bible" for anyone considering nasal surgery in general, and more specifically for those who have breathing problems related to swollen turbinates and are considering turbinate reduction surgery.

-ENS Forum Member T.E.

I have read through the book and have found it really helpful. I think it covers a lot of important information, both technical and emotional.

-S. Kramer, New York

…Very well written and informative.

-Tom

Chris Martin's book is very helpful to anyone considering having nasal surgery, or anyone whom has undergone it and is experiencing troubling symptoms.

-Matt, Indiana

Having Nasal Surgery? is an ideal sourcebook on ENS - informative without being dense, written in a coherent style and filled with first-hand experience on the condition. It's a book that all nasal doctors should have on their shelves and be ready to pass onto patients looking for answers.

-Les Chappell, BookReview.com

His personal disclosures make the book very interesting. I was also very impressed with the amount of references that he cites in each chapter…I cannot imagine a more comprehensive, yet easy-to-understand source of information.

-Paige Lovitt, Reader Views

Could YOU benefit from this book? The following people certainly can:

1) Sufferers of ENS, sinusitis, allergies, nasal congestion, postnasal drip, acid reflux, and/or asthma (pretty much anyone with kleenex in the house) could benefit from the treatment strategies. Having Nasal Surgery? Don't You Become An Empty Nose Victim! includes more than 30 pages of holistic treatment strategies from an ENS sufferer of 10 years.

2) Anyone considering nasal or sinus surgery could be better informed and empowered when discussing surgical options with their doctor. If you are considering one of these surgeries, this unbiased review of medical literature from a patient who has no vested interests could be very beneficial for you.

3) ENT specialists and plastic surgeons, as well as scientists studying regenerative medicine, could benefit by reading the scientific discussions of ENS and patient testimonial.

4) Families and friends could become more knowledgeable and understanding toward ENS sufferers.

Now, here is what is written on the back cover...Have you had nasal surgery, but now find yourself worse off than before? If so, you might be one of millions who suffer from a serious medical condition known as empty nose syndrome, or ENS - a complication of surgery. Symptoms of ENS include shortness of breath (despite a wide open nose), nasal dryness, throat irritation, thick, sticky mucus, shallow sleep, and sometimes chronic sinusitis. Many with ENS are depressed. Some have even committed suicide.

Endorsed by well-known doctors familiar with ENS, Chris offers a genuine message to the reader and hope for the injured patient through:

1) His 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, postnasal drip, GERD, and asthma.

“Chris Martin's book is a must-read for anyone with nasal problems so they, too, can understand ENS and avoid becoming an ENS patient. His up-to-date information can empower the patient to best therapies.”

-Murray Grossan, M.D., Author of The Sinus Cure and inventor of the Grossan Hydro Pulse Nasal-Sinus Irrigation System

“I applaud Chris’ attempt to bring this critically important issue to the public’s attention. If one person can be saved from the devastation this surgery can cause, he will have performed a great service.”

-Wellington S. Tichenor, M.D., Creator of award-winning website http://www.sinuses.com/, and wrote the introduction for this book

Chris is addressing a tremendously important issue in otolaryngology. Empty nose syndrome is a real entity that requires further investigation. 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., ENT specialist, MetroHealth Medical Center and the Cleveland Nasal, Sinus and Sleep Center, assistant professor, Case Western Reserve University, and wrote the foreword for this book

Below are some great links for ENS:

Listen to Dr. Kern's lecture on empty nose syndrome
Empty Nose Syndrome Patient Support Forum
Dr. Houser's rhinology, allergy and sinus pages
Dr. Grossan's non-commercial website
Dr. Grossan's explanation of ENS at Allergy Buyer's Club
Dr. Grossan's commercial website
Dr. Wellington Tichenor's explanation of empty nose syndrome
Testimonials from ENS sufferers
Sinusitis: A Treatment Plan that works for Allergy and Asthma Too
Walt's Postnasal Drip website
ENS means significant nasal problems by Walt Ballenberger
Snortal Portal Blog
Turbinates tutorial
Nose tutorial
Respiratory system tutorial
Obstructed Nose: turbinate surgery options and mention of empty nose syndrome
Grand Rounds Presentation on Atrophic Rhinitis
Need turbinate surgery?
Your nose: the guardian of your lungs
Web MD website
UCSD Nasal Dysfunction Clinic
The Mayo Clinic
Website for researching scientific articles
Cold Tree Press


How to Order

Having Nasal Surgery? Don't You Become An Empty Nose Victim! was released into distribution on August 30, 2007. It is available in english in both the United States and many international countries (through Amazon), such as Canada, United Kingdom, France, Germany, China, and so forth. You will need to check with Amazon for your particular country to see if it is available there. This paperback book is now available for purchase from the following online sites:
Click here to buy from Coldtreepress.com
Click here to buy from Amazon.com
Click here to buy from Barnesandnoble.com (currently the lowest price)
Click here to buy from Booksamillion.com

I encourage you to try to purchase this book for the lowest possible price by clicking on one of the links below:
Compare prices for Having Nasal Surgery? at Alldiscountbooks.net
Compare prices for Having Nasal Surgery? at Bookfinder4you.com

Read below why it will only be sold as a paperback:

I have entertained the possibility of making Having Nasal Surgery? Don't You Become An Empty Nose Victim! an ebook, but with time, thought, and some logical reasons, I have decided a paperback only is best.The reason? An ebook, although I would make 100% of the retail price if I sold it through my website, might appeal more to someone who "wants it fast" and might not read the book as thoroughly, or who might be tempted to distribute it to friends (who also don't read the book carefully). Conversely, a paperback looks more professional than an adobe pdf, it is easier on the eyes, and those who purchase a paperback are more apt to read it and take it seriously. I want people to read my book closely and take it very seriously. That's my mission. I only make 30% (or $3.88) for paperback books sold directly through Cold Tree and 15% (or $1.94) for books sold through other outlets, such as amazon. But my goal in writing this book is not to profit but to generate greater awareness on empty nose syndrome (ENS), and I believe selling a paperback will help me reach that goal much more effectively and quickly than selling it as an ebook.

Articles and News

You can read Chris' articles by clicking on the links below:

"Why You Must Enter Nasal Surgery Informed"http://ezinearticles.com/?id=751407

"Could You Possibly Have, Gulp, Empty Nose Syndrome?"http://ezinearticles.com/?id=751401

"A Nose Destroyed When Turbinates Are Terminated"http://ezinearticles.com/?id=751397

"Why You Must Do Pulsatile Nasal Irrigation Even If You're Healthyhttp://ezinearticles.com/?id=751410

Three Effective Treatment Principles for Sinus Sufferers"http://ezinearticles.com/?Three-Effective-Treatment-Principles-For-Sinus-Sufferers&id=693808http://www.goarticles.com/cgi-bin/showa.cgi?C=587918

Press Release: Empty Nose Syndrome, No Laughing Matter. What it is, and what you can do about it!http://emptynosesyndrome.blogspot.com/2007/08/press-release-empty-nose-syndrome-no.html

On September 27th, the Life & Times of Utica (http://www.lifeandtimesofutica.com/) featured an article regarding Having Nasal Surgery? Don't You Become An Empty Nose Victim!

On October 29th, the Utica Observer-Dispatch (http://www.uticaod.com/) will feature a brief in the Healthy Living section regarding Having Nasal Surgery? Don't You Become An Empty Nose Victim!

Comprehensive Testimonials

Chris Martin's book is excellent and I recommend it to patients. ENS is so little understood or appreciated by the ENT profession. I am attending the national ENT convention and for the first time there is discussion of care to spare the mucosa and prevent ENS, this has come about from patient advocacy. I think patients benefit when they can discuss with the doctor, "will this procedure cause ENS and are there alternatives?"Because of my connection with the Hydro Pulse I probably hear from more persons with ENS than the average doctor so I can appreciate what the patient feels.The important point is that ENS is preventable and this book will go a long way to that prevention. Yes, if you are having ENT surgery read this book.

-Murray Grossan, M.D., Author of The Sinus Cure and inventor of the Grossan HydroPulse Nasal-Sinus Irrigation System. This was stated in a letter posted at http://www.postnasaldrip.net/ on 9/18/2007.

Chris has written a compelling and comprehensive account of his own personal experience with a relatively unknown affliction known as Empty Nose Syndrome (ENS). ENS is basically a surgically ruined nose that does not properly humidify and sense air flow, preventing it from performing its basic functions of smell and controlled, natural breathing. I can attest to the reality of this condition, as I have experienced many of the symptoms outlined in this book, as a result of nasal surgery involving my turbinates. If you are experiencing undefined, or hard to explain nasal dryness and crusting, loss of sense of smell, and uncontrolled breathing through your nose, this is a valuable and singular resource for gaining important insight that may not be provided from your local ENT. The complications and potential side effects of nasal surgery are not completely understood by many in the medical community (otolaryngology included), and as a patient that contends with sinus difficulties or is contemplating surgery, this book will serve as an enlightening introduction into the complexities of the nose. I know that I took for granted this amazingly complex organ and Chris's book will make sure that you don't repeat other's mistakes or suffer the potentially devastating effects of nasal surgery.

-Paul (New York, USA)

Chris has done an amazing job putting together this book for himself and others considering or have had nasal surgery. Please take the time to read this if you’re considering nasal surgery or if you've already had it. I truly believe this book can be a guide to helping those who had nasal surgery gone bad and to those who are considering nasal surgery.

-Tony Ponte (Alberta, Canada)

I have read through the book and have found it really helpful. Chris' story is inspiring...how he has suffered with ENS for so long and manages to still have a positive outlook. I think it covers a lot of important information, both technical and emotional. It is a book that many people could read - sufferers of ENS, friends and family, people thinking about getting surgery. It has helped me to gain a better understanding of what to expect, what turbinates are, their functions in the body, and how to better live with this serious condition. Oh! I wish I was informed like this before the surgery. I would definitely suggest this book to my friends and family so that they have a better understanding of what ENS is and what it entails. There are so many people every year who get butchered by doctors who for one reason or another do not inform their patients properly of the procedure and possible side effects. This is a problem in many areas of medicine. Chris' book is a reminder not to go blindly into surgery but also to live bravely with things one cannot change.

-S. Kramer (New York)

This is a comprehensive book about sinus surgery and empty nose syndrome for the general public. ens is a poorly understood real complication of sinus surgery. this book provides a good explanation of ens and its treatments

-Peggy (Cleveland, Ohio)

Your book is very well written and informative. I almost get sick to my stomach reading some of your experiences with ENTs and trying to get them to understand your symptoms. Great job on the book and you are truly an inspiration! Thank you very much for your excellent book!

-Tom

I have to say that I am impressed. The book is an easy read and Chris does an exceptional job at putting some rather complex concepts into layperson's terms. If you have ever wondered "what the heck is this person talking about?" when reading posts on the ENS forum then this is the book for you. For example, I found the glossary particularly useful as I was never quite sure what "Rhinitis" was or how you spell it. The story of his journey through the world of ENTs rings all too familiar, and he does a very good job at examining various nasal surgery techniques and ENS medical treatments. Chris, I would like nothing more than for your book to sweep the country and for you to appear on Dr. Phil or Oprah spreading the word. For all of you coming to this forum, this is $12.95 (U.S currency for you canadians) well spent.

-Anonymous Source

You have written a valuable book for ENS sufferers and the medical community. In later correspondence, she wrote: I have said this before, but I am really impressed with your book and hope Cold Tree can give it great distribution. As you know audiences for the book will include both lay people who are considering surgery or treatment and the medical community hence the index must be accessible to both. Given these considerations, I will include a peer review to be certain I give this fine, informative book the index it deserves!

-Margy Olmstead, indexer for Having Nasal Surgery?

Chris Martin's book is very helpful to anyone considering having nasal surgery, or anyone whom has undergone it and is experiencing troubling symptoms. The book is easily read by the layperson (me). Furthermore, Chris taps into the personal feelings and struggles that coincide with having an empty nose. Unfortunately, this condition is not understood by many ENTs. I can personally attest to how damaging it is, not only physically, but psychologically too. Especially when this is misdiagnosed and leads to a 2nd or 3rd procedure. Chris provides a fine resource of information to the reader. Finally, he concludes the book with a ray of hope; How progress is being made by a select number of doctors who are willing to take the time to further understand this devastating condition.

-Matt (Indiana)

Anyone considering sinus surgery or having sinus problems needs to read this book first!!! ENS is real and you don’t want to get it!

-Jeeves

Chris Martin put a lot of time and energy into writing this book, to raise awareness on this highly debilitating condition that is widely unknown to many, and in some cases even ignored. As someone who is currently suffering ENS symptoms, his personal story really hits close to home and provides me with inspiration, hope and treatment suggestions from a 10-year ENS veteran.

Turbinates are a common source of nasal obstruction and therefore reducing them is a common surgical procedure to reduce congestion. They are also highly complex and their importance is largely misunderstood, even in the medical community. Reducing them too much, or by using a method that damages too much healthy tissue, results in irreversible consequences. This book explains the turbinates, their role in nasal function and also all the different methods used to reduce them. By reading this book, you will be well prepared to understand their importance and the safest surgical options in reducing them. Or you can find out just how important these vital nose organs are, the hard way. You can have your nasal surgery, unaware of any negative consequences as I did, and once you have ENS you will truly understand how important your nose and the turbinates are for your overall well-being. I think you know what to do... just read the book! For those of you that already have ENS, or suspect you might because you still experience difficult breathing among other things after your nasal surgery, this book provides information on the most important ways to treat ENS. If you have recently had surgery, or if you are considering it, buy this book so that you can be well prepared to practice all the treatments mentioned within. Some ENS symptoms have a chance of resolving within a year after surgery, but those chances rely heavily on the actions you take to promote optimal healing.

Even if you don't experience any ENS symptoms, most of the suggestions in the book would be helpful to a healing nose after the trauma of surgery. The amount of references cited in each individual chapter is very impressive and will earn your respect and trust. ENS is real, and it is honestly the worst medical problem I have ever experienced, and unless it resolves within a year, it doesn't go away. This book should be read by anyone considering nasal surgery, those who have already had surgery, and anyone who practices nasal surgery.

ENS is a truly distressing and uncomfortable condition, both physically and mentally that is with you 24 hours a day, 7 days a week. It's impossible to fully understand it until you've had your turbinates amputated and you see the difference, much like having your hand amputated after enjoying full use for your entire life. There is no going back, and at this time there are no doctors in Canada with any significant ENS experience or practice with ENS specific implant surgery which improves symptoms. There are a small few in the United States that acknowledge ENS and even less that have experience in treating it, but Canadian health insurance is very unlikely to cover this treatment outside of the country. I would assume that for most people, traveling to the United States and paying thousands of dollars from your pockets to gain some relief (but in most cases not 100%) to be difficult to manage. Being a young student myself, with little income it certainly doesn't seem very feasible that I will be able to afford proper care anytime soon. My only choice right now is to live with a condition that for many, constantly begs for relief every minute of every day.

We all know the saying, "An ounce of prevention is worth a pound of cure". In consideration of ENS and its symptoms, it might be more appropriate to say that an ounce of prevention is worth a ton of cure. Well this book certainly weighs more than an ounce and it could be the difference between preventing or living with an action that you may regret for the rest of your life. If you have any choice in the matter, you do not want ENS. There has even been documented cases of suicide because of ENS.

Do yourself, all ENS sufferers out there, and Chris a great favor right now: stop reading this review, and start reading this book! It could save your life.

-Ryan Webb (Ontario, Canada)

How would you feel if you went into a surgical procedure to help alleviate a physical problem, only to learn after the surgery is completed that the surgeon created a much more devastating problem than the one you went into surgery to cure, even though the surgeon followed accepted medical practices? In fact you also later find out that over 50% of the people who come down with this artificially created illness meet the definition of clinically depressed, and this is on top of and because of the awful physical anguish which was the result of the initial surgery. And the icing on the cake is that the problems caused in surgery cannot be reversed. The above scenario sounds almost unreal, but this is what happens to victims of ENS, or Empty Nose Syndrome.

Anyone who is contemplating sinus surgery should read this book. Also, anyone who has a friend, colleague, or family member who is facing sinus surgery should urge those people to read this book as well. Christopher Martin has written an important book about ENS.

In layman's terms what happens is this: during sinus surgery all or a portion of the turbinates in the nose are extracted. It has been fairly common practice in the past for turbinates to be cut out because they sometimes can block nasal passages. Not much was known about the functions of the turbinates, and it was felt that extracting them wouldn't cause much harm. In fact the term ENS did not even appear until 1994 when Dr. Kern, formerly of the Mayo Clinic, coined the term when he was treating patients complaining about sinus infections and congestion, which was puzzling because their nasal passages were wide open. In fact they appeared to have an empty nose, and thus the term was coined for this condition. These people felt so miserable that, according to Dr. Kern, two of the patients he was treating committed suicide.

Martin discusses the basics about how the nose works. He talks about mucous tissue, cilia, and how mucus in the nose is normally disposed of. Of course he discusses the turbinates and the functions they perform, such as directing air flow, providing air flow resistance, warming and humidifying air before it reaches the lungs, etc. He discusses the symptoms of ENS, traces the history of various nasal surgical procedures, even discusses the politics of ENS and why many ENT specialists are not very aware of it or don't consider it seriously. He also talks about various surgery options and gives an opinion about which procedures are the safest and most risky in terms of ENS.

And of course he tells his own story. Here is a young man of only 27 years of age with a young family. He has had to deal with this condition virtually all of his adult life. Here is an excerpt: "While there are times I have felt confident and strong, I will concede there are times when I cried. I cried because of the severity of this problem and the constant management of it. I cried because I want to have more energy for my wife and children, for people other than myself, but I find myself preoccupied with my nose and depleted of such energy. It seemed selfish to be so consumed with my nose, but I could not avoid it. I wish I could say that I never complained, but I cannot. It is ENS with which I have been dealing and ENS is a difficult condition to endure." Martin offers extensive commentary about how he personally deals with his condition and gives suggestions and encouragement for other ENS sufferers.

In the Introduction of the book, Dr. Wellington S. Tichenor, a medical specialist in sinusitis in New York City who often treats patients who have had surgeries that did not work, says the following: "I have been overwhelmed by the devastation that ENS patients experience. As a result of an iatrogenic (caused by medical treatment) origin, the lives of these productive individuals have been profoundly affected. Before their surgery they could go about the lives with varying degrees of difficulty, but after it they were completely disabled." He adds, "Too many surgeons today believe they can indiscriminately remove large amounts of turbinate tissue and, indeed, there remains controversy in the field whether this surgery can be done with minimal complications. I am a strong proponent of conservative turbinate surgery that consists of removing the smallest amount of tissue possible."

If I were to criticize the book I would offer the opinion that Martin is sometimes too technical. I understand why he is doing this, as he wants to fully explain the condition and what to do about it. However, he often sounds like an ENT, which he is not. He clearly explains in his disclaimer at the outset of the book that he is not a medical professional, and I expect he had several ENTs review the book, and they apparently didn't ask him to change what has been published. For all I know everything he says and every medical term he uses are correct, and I would not be surprised if that were the case. It just seems to me that he sounds at times like an ENT, and I would respectfully question his credentials to do so.

What is clear, however, is that he certainly has sufficient credentials to speak about ENS, and his message is powerful and important and clearly overrides the comments in the previous paragraph. I personally have had two sinus surgeries and consider myself lucky and thankful that Empty Nose Syndrome hasn't happened to me.

For a few dollars to buy the book and a couple of hours to read it, sinus sufferers who are considering surgery can learn a great deal about their condition and can possibly prevent themselves very serious problems in the future. It is certainly worth the time and money.

-Walter Ballenberger, founder of http://www.postnasaldrip.net/, a website for sinusitis sufferers such as himself (Monument, CO)

Chris Martin has written the ultimate "Bible" for anyone considering nasal surgery in general, and more specifically for those who have breathing problems related to swollen turbinates and are considering turbinate reduction surgery. This book will also serve as the ultimate guide for how to improve the lives of those who have already had the misfortune of overzealous resections of their turbinates and are now struggling with ENS.

"Having Nasal Surgery?" is the first ever book on ENS. The coping strategies and tips detailed in this book can benefit not only ENS sufferers, but also all those who suffer from chronic nasal problems and discomfort, such as chronic sinusitis, allergic rhinitis, vasomotor rhinitis, and every otherwise healthy individual who simply wants to learn how to better deal with the most common medical problems affecting humanity: the common cold and nasal obstruction. "Having Nasal Surgery?" is addressed to the layman and medical professionals alike. It is written as an easy and well-flowing read, but at the same time is backed and packed with scientific references from the latest medical literature published in leading medical journals. True, Chris Martin is not a doctor himself, but the fact that his book is endorsed by well-known and acclaimed doctors - such as Drs. Grossan, Tichenor and Houser - with a foreword by Dr. Houser himself (a leading authority on ENS) adds greatly to the scientific and medical credibility of this book.

Chris tells of his personal misfortune of suffering from ENS due to an over aggressive surgery he had in his late teens. As a fellow sufferer, I can testify firsthand that his descriptions are honest and accurate. Sadly, ENS is a devastating medical condition which has a very negative impact on the sufferer's well-being and quality of life.

I hope that ENT and facial reconstructive specialists and plastic surgeons will embrace this book just as much as I know their ENS patients will. I hope that through this book they will better understand the depth of suffering from ENS and realize their responsibility to 1) not only avoid destroying the mucosal structures of the nose when they perform nasal and sinus surgeries of all sorts, but also 2) that they will recognize the fact that for many decades now patients have been over "turbinectomized" and as a result there are potentially millions of patients in the world today suffering from ENS symptoms and are misdiagnosed because of overmasking other pre-existing conditions and not enough awareness to ENS.

I hope that one of the accomplishments of this book will be that these doctors begin to more aggressively search for those misdiagnosed ENS patients and that they will maximize their efforts to help improve their symptoms and utilize their knowledge and skills to come up with viable medical solutions (surgical and others) to rebuild or regenerate amputated turbinates.
-ENS Member T.E.

I truly wish that this book had been available prior to my nasal surgeries. I did research, but nothing that would have prepared and informed me like Chris Martin's book. It is very detailed and heartfelt. For those who have already rolled the dice and lost with a nasal surgery, this book offers hope, support and many helpful suggestions. ENS is real! Even with a "conservative" surgery, it is still possible to experience a myriad of debilitating symptoms. Doctors are often dismissive and unhelpful. Hopefully this book will begin to turn that tide.

-ENS Member R.E.

The nose is an organ of the human body that can be afflicted with a number of serious ailments to health. These problems include such conditions as rhinosinusitis, allergic rhinitis, and empty nose syndrome (ENS). It has only been in recent years that physicians have come to understand and treat ENS. But there are still a great many doctors unfamiliar with this syndrome and the treatment options that sufferers have to choose from. An ENS sufferer himself, Christopher Martin has written a comprehensive and thoroughly 'reader friendly' introduction to what ENS is, what can be done about it, and what to be aware of in various treatment options in "Having Nasal Surgery? Don't You Become An Empty Nose Victim!” Christopher relates his own personal account of coping with ENS, offers an informed and informative evaluation of turbinate surgeries with respect to nasal conditions, provides an 'insider' look at the politics surrounding ENS within the medical community, and identifies the best treatments for ENS, many of which are also efficaciously applicable to sinusitis, allergic rhinitis, postnasal drip, GERD, and asthma. Invaluable reading for medical students, physicians, and non-specialist general readers, "Having Nasal Surgery" is especially recommended for personal, professional, and community library Health & Medicine reference collections and reading lists.

-Jim Cox, Editor-in-Chief, Midwest Book Review

School psychologist Martin explores a little-known condition that has lifelong detrimental effects.In direct, instructive language, Martin examines the devastation of Empty Nose Syndrome (ENS), a term coined by a Mayo Clinic physician in 1994. ENS is characterized by a “cluster of symptoms” that occur after too much of the airflow-regulating bony structures in the nasal cavity called turbinates are surgically removed, usually from efforts to assuage sinus pressure, headaches or nasal stuffiness (“turbinate reduction” surgery). The author believes that post-surgery, people with ENS go on to experience a wide array of harrowing symptoms including nasal dryness, sleep disturbances, excessive mucus, nosebleeds, diminished sense of smell and fatigue. Martin became an ENS sufferer after an overly aggressive partial turbinectomy performed in his late teens to improve a chronic nasal inflammatory condition. But before his ENS diagnosis, Martin endured numerous allergy injections, CAT scans, bacterial infections and the possibility of additional surgery. Determined to find answers, the author channeled his disillusionment, anger and psychological distress into increasing awareness about the condition and by positively dedicating (and educating) himself on the possibly devastating side-effects of nasal surgery. His comprehensive research has produced illustrations, tips, charts, glossaries and case studies about ENS, all presented in a straightforward manner, making the information more accessible to average readers with limited medical knowledge or experience. Martin smartly counterbalances the negative experiences (and clinical politics) of ENS with a host of beneficial natural remedies (chicken soup, humidifier, etc.), non-surgical options, as well as a chapter on the author’s own approach after suffering the debilitating effects of ENS. He had enlisted an ear, nose and throat physician to attach two restorative implants inside his nasal cavities, a procedure he advocates as beneficial in improving his own quality of life.This slim but potent book is tremendously important and informative not only for those considering nasal surgeries, but for the specialists who perform them.

-Kirkus Discoveries

In July 1997, shortly before going away to college, Chris Martin underwent surgery to remove turbinate tissue from both sides of his nose. An ENT doctor had recommended the procedure, called a bilateral turbinectomy, to relieve the chronic stuffiness the young man had been experiencing as a result of allergies and sinus infections. In the weeks and months that followed, Martin realized that the surgery had not helped him. The cycle of sinus infections had not only continued, but had intensified. His nose was perpetually dry, his throat sore, his mucous membranes inflamed. Before long, he was also experiencing panic-inducing shortness of breath, disturbed sleep, and intolerance to cold air. He became anxious and concerned. His discomfort led him back to ENT specialists and almost into another surgery, until, by accident in 2003, he discovered a Web site that defined “empty nose syndrome.” He now knew that his problem has a name: ENS. Its cause is summed up by Dr. W.S. Tichenor, a New York City sinusitis specialist: “Too many surgeons today believe they can indiscriminately remove large amounts of turbinate tissue.” Martin and his fellow ENS sufferers are the unhappy victims of these surgeries.
For the past four years, Chris Martin has been learning how to live with ENS. With this book he has fulfilled a major step in his mission to help educate sinus, allergy, and post-nasal drip victims who are considering surgery, as well as ENS sufferers and ENT professionals and plastic surgeons, many of whom have not been exposed to the scant literature about the syndrome. In August 2006, Martin met Dr. Steven Houser, an ENT specialist in Cleveland, Ohio who has been treating ENS sufferers—at times by rebuilding the remains of their turbinate tissue. Dr. Houser has performed two implant surgeries on Martin in order to decrease the nasal airway volume. The lesser amount of air entering the nose results in more resistance to airflow, thus less dryness. A second important effect of Dr. Houser’s implants has been to partially restore the pulmonary functioning that was impaired by the “empty” or too-open nasal passages.
Martin, now a family man and school psychologist in his late twenties in upstate New York, writes not as a doctor but as a survivor. He presents here a working definition of ENS and a primer on surgical as well as other medical, dietary, and environmental ways to treat its symptoms. He includes a layman’s guide to turbinate functioning and to the science and politics of turbinate surgery. Having learned to manage his condition, he tells a compelling personal story that adds passion and authority to his presentation. Martin grants, as his research shows, that “conservative” turbinate surgery can often alleviate chronic stuffiness, but his presentation implicates the many doctors and plastic surgeons who continue to remove excessive amounts of turbinate.

-Joe Taylor, Foreword Clarion Review

The frightening thing about the human body is that it can break down in thousands of ways, and it is impossible to prepare for every contingency. Between the endless variety of specialty doctors, conditions dramatized by hospital television shows and words far larger than an average vocabulary, it's easy to be either terrified by the possibilities or caught off guard when an unheard of condition enters your life. When this happens, the only way to confront the problem is to educate yourself as best you can - and if you have empty nose syndrome (ENS), Christopher Martin's "Having Nasal Surgery? Don't You Become An Empty Nose Victim!" is the ideal resource. One of the first books on the subject, it is ideal for both the typical person considering nasal surgery and doctors who may not know enough about the condition. ENS, as Martin describes it, is a condition resulting from the removal of inner tissue known as turbinates following nasal surgery. This removal leaves the patient unable to breathe properly, with a string of chronic health problems including shortness of breath, nasal dryness, thick mucus and an inability to sleep. The discomfort caused by these symptoms frequently leads to distraction and depression, especially since many doctors don't even know how to treat ENS. Martin, who has lived with ENS since 1997, provides it with a much-needed personal connection. He tells his story in detail, beginning with his flawed surgery and showing specifically how the condition impacted his life and the choices he had to make. Through it all, with the exception of a few wistful "what if" statements, Martin maintains a positive tone and a desire to move forward. The book is not only useful for those looking for a personal story of ENS, but also to anyone who suffers from it and is looking for relief. Martin provides the reader with a comprehensive list of treatments, ranging from practical everyday remedies (even providing recommendations on what brand of nasal spray and gel to use) to recommending a certain type of surgery if necessary. For those who are looking for more in-depth information on ENS, he includes an appendix of medical texts, websites and specialized doctors. "Having Nasal Surgery?" is an ideal sourcebook on ENS - informative without being dense, written in a coherent style and filled with first-hand experience on the condition. It's a book that all nasal doctors should have on their shelves and be ready to pass onto patients looking for answers.

-Les Chappell, BookReview.com

ENS sufferer, Christopher Martin, has written a very comprehensive book about his experience with ENS. ENS, or Empty Nose Syndrome, is defined in this book as, "...a cluster of symptoms in individuals who had a turbinate reduction or excision surgery that resulted in removal of too much turbinate tissue, leaving the nose "empty or wide open and the turbinates unable to function properly." Turbinates, which are located in our nasal cavities, help to warm and humidify air. When a person has turbinate reduction surgery, this can lead to ENS if too much turbinate tissue is removed. This problem is iatrogenic in origin, meaning that it is caused by medical treatment and not something that is genetic in origin. An ENS sufferer is described as having, "...the sensation of not getting enough air despite a wide open nasal cavity, nasal dryness, and thick, sticky mucus." In addition to having their quality of life reduced as a result of this, many people that have ENS also are highly susceptible to depression and future sinus problems. Mr. Martin wrote this book with the hope of making people aware of the complications that can result from turbinate reduction surgery. He offers suggestions for alternative treatments that could be used to avoid having this surgery. People who have sinus, allergy and postnasal drip problems would also benefit from these treatments which include natural, medical, dietary, and environmental remedies. Mr. Martin has been dealing with this issue for ten years. He openly discusses his experiences with a variety of medical doctors and the differing opinions that he was offered. He felt fortunate to finally be able to find the doctors that were able to help him with his problem. These doctors also help contribute to this book. His personal disclosures make the book very interesting. I was also very impressed with the amount of references that he cites in each chapter to help back up his information. People that would benefit from reading "Having Nasal Surgery?" include those close to people with ENS, people considering turbinate reduction surgery, those suffering from ENS, those with sinus and allergy problems, and the doctors involved with this type of treatment. I cannot imagine a more comprehensive, yet easy-to-understand source of information for the people whose lives would be improved by accessing this information. I truly hope that people who are planning to have nasal surgery will find this book before they go through the surgery, and not have to experience what Mr. Martin and numerous other people have had to.

-Paige Lovitt, Reader Views

About the Author

After developing empty nose syndrome (ENS) as a result of surgery in 1997, Chris Martin completed 7 years of college and is a nationally certified school psychologist (NCSP) in Upstate New York.

Despite living with empty nose syndrome for the past 10 years and knowing how tough it can be, Chris still considers himself tremendously blessed because he is married to his beautiful wife Colleen, has two sweet daughters, Faith, age 3, Abigail, age 1, and one son, Luke, who is 6 months old.

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