Empty Nose Syndrome? Turbinectomy is a Four Letter Word.

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            You complain to your doctor that you don’t have enough room to breathe. The doctor looks in your nose with a bright light and a nasal speculum to open the nose wide. Then he looks in your nose with a telescope. Then he says, “Your don’t have enough room to breathe.”  Then he mentions the four letter word, that word that sends chills and fear to your heart.  “You need a turbinectomy.” You faint or at least you should.

            There are various procedures that doctors do to open a narrowed airway. These include Laser Turbinectomy, Somnoplasty, Coblation, Microdebridement, and Turbinectomy. Despite care, sometimes too much nasal turbinate tissue is removed or destroyed.  Then, on taking an X ray the nose looks empty and then you have the Empty Nose Syndrome –ENS.  These symptoms include frequent infections, sensation of not getting enough air, unusual pain syndromes, poor sleep and reduced sense of smell and taste.

Actually the word turbinectomy says removal of the turbinate. Ectomy as in appendectomy, prostatectomy, cholecystectomy means removal.

            First off, you had better learn what the DOCTOR MEANS by turbinectomy. Does he mean a careful submucous resection that spares the surface of the turbinate? Or does he mean taking a long sharp scissors and cutting the whole thing out? Coblation and microdebreeder methods can be done without harming the nasal structure.  Turbinates are the shelves that are on the sides of the nasal chamber. The main turbinate is the inferior or bottom one.  This provides good cilia movement that moves bacteria and pollen and dust out of the nose.  

            Turbinectomy is a four letter word!  It can mean totally different things. Unfortunately the $%#@ insurance companies ONLY list turbinectomy. If you use a different word, you don’t get paid. And if you do a nasal surgery and don’t list turbinectomy you get paid less.

            Believe me, I have been that route. No, they don’t pay for submucous resection but they do for turbinectomy. Or, you can appeal the policy and after months of letter writing and appeals they still say that only turbinectomy is on the list of paid procedures.  Turbinectomy is a four letter, foul word.

            n ENS the turbinates have been removed or severely reduced. Instead of a blockage, the nose is actually excessively wide open. But, like a garden hose, when the hose opening is wide open, the water has very little pressure and comes out only inches. In the hose, when the opening is made smaller, the water will project several feet.

            In ENS, the nose is now wide open, the sensors for air pressure don't get notified that there is air coming in. That much lowered air pressure "feels wrong" and so the patient feels like he isn't getting any air. Unless your doctor understands this, he will be confused.  Persons who have Empty Nose Syndrome or ENS have a devil of a time explaining this problem.  If the doctor has never used a garden hose he doesn’t understand that wide open means less nasal pressure.  Fortunately, however, persons with ENS generally have normal oxygen levels in the blood.

            When your doctor says turbinectomy, recognize that not only is this a four letter word, but it can ruin your life worse than “I want a divorce” or “your fired.”  You can always get another job, you can’t get another turbinate.

Surgery of any kind should be considered only when other treatments have been tried.  In 2010 there are newer nasal sprays and allergy pills that have helped many of my patients where older medications failed. More important, if you are allergic to your five cats, or the oak tree, no matter what surgery is done, you will still be allergic to the cats and the oak.  Sometimes it is best to get desensitized and then you can breathe fine.

            Besides the newer sprays and pills, there is also pulsatile irrigatioin. Your turbinates swell because they need more blood to dilute the infection or pollen particles. This is because your normal nasal cilia that beat to remove these particles are too slow or too inactive. By using pulsatile irrigation at a rate designed to pulse the cilia back to normal, the offending particles/bacteria are removed in a natural manner.  For example, the Hydro Pulse Nasal/Sinus Irrigator is designed to pulse at a rate to restore cilia function.

            For most patients, once you restore the normal cilia function, then you won’t ever have to hear that terrible word turbinectomy.

            Once someone does have ENS, pulsatile irrigation can be used to artificially act as a cilia movement in order to prevent and clear infections.