Empty Nose Syndrome

Common finding after aggressive turbinate surgery

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Empty nose syndrome is a pathological entity, historically linked to Klebsiella Ozaenae infection. Patients with this condition suffer from nasal obstruction, crusting, foul smell and purulent nasal discharge - which have a substantial negative impact on the patient's quality of life. Current medical thought states that aggressive nasal turbinate surgery (very frequent) is the major factor leading to empty nose syndrome. But the mechanisms involved are more complicated and not yet fully understood - with hypoventilation and superinfection of the secretions (with prolonged bacterial antigen exposure), rising nasal temperature and loss of neural sensibility just some of these.

We present the case of a 43-year-old male patient who suffers from nasal obstruction, purulent rhinorrhea, foul smell (both perceived by himself and the others around him) and partial loss of taste. Symptoms have appeared and aggravated following nasal radiofrequency turbinate reduction 7 years ago. Nasal endoscopy and CT scan showed the absence of inferior nasal turbinates as well as foul-smelling crusts which line the whole nasal passage and also block the drainage pathway of the paranasal sinuses. 

Bacteriological testing identified Pseudomonas spp., Staphylococcus Aureus and Klebsiella Ozaenae. After medical treatment and local hygiene measures, the patient was scheduled for surgery to reconstruct (partially) the inferior nasal turbinates. 

Empty nose syndrome is a difficult-to-treat condition that is best avoided by reducing surgical trauma to the inferior nasal turbinates.