Empty Nose Syndrome (ENS)

Empty Nose Syndrome (ENS), also known as the “Syndrome of the Empty Nose”, occurs frequently after surgical procedures of the nose and is characterized by several symptoms such as respiratory impairment, a dry nose, and related inflammatory processes. Reduction of nasal conchae, which are an internal structure of the nose, or surgery of the nasal septum are associated with the highest risk for this condition – the extensive removal of tissue from the nose may lead to ENS.

Affected patients are suffering from the sensation of a widened, or, as the name of the condition says, an “empty” nose. The vast excision of nasal tissue leads to altered airflow patterns when breathing. Moreover, the mucosa often suffers inevitable damage. As a result, the patient loses numerous functions of a healthy nose.

Pressure sensors engaged in measuring airflow patterns in the nose and passing on related information to the brain whether or not sufficient breathing air is available are not functioning properly any more. Affected patients often complain about shortness of breath (paradoxical airway obstruction), which may be noticed during strenuous activity as well as during the sleeping period.

Mucous cells are also working incorrectly. This malfunction manifests either as a dry nose, in which painful scabs may often form, or in case of excessive mucous production as a constantly running nose. Due to the anatomic vicinity to the throat and the middle ear the condition may affect these structures as well and lead to chronic inflammation with associated pain.

Further uncomfortable symptoms prevail such as headache, nosebleed, and an altered sensation in taste and smell. An improvement of these symptoms through swollen mucosa acquired in a cold may be an indication for the presence of ENS.

Therapy of ENS

The therapy of ENS may be carried out either as a conservative (meaning without surgery) or as a surgical treatment.

Conservative treatment aims at an optimal care of the remaining nasal mucosa. This type of therapy includes a change of lifestyle habits and nutrition, as well as continuous salt inhalation and application of certain drugs. Through these means infections and exposure to detrimental irritants may be prevented. Furthermore, it is important that the nose is constantly kept moist. This is achieved by the application of special nasal sprays and oil or air moistener. In certain difficult cases it may be necessary to wear an oxygen mask over night in order to prevent shortage of breath.

However, many patients suffering from ENS wish for a definitive solution that does not affect their daily life routines and therefore decide to undergo surgical treatment of their condition by means of implantation of artificial nasal conchae. Through this treatment it is possible to ensure a relatively structurally healthy internal nose environment and to achieve a healthy breathing pattern. However, this treatment requires a surgical procedure under general anesthesia that is associated with additional risks. Furthermore, as with all artificial implants, there is a certain risk of rejection.

Treatment of ENS with Stem Cells and Autologous Fat

As with other tissue defects of the human body, it is possible to treat the condition with stem cells from the patient’s own (autologous) fat tissue or simply by means of autologous fat. In contrast to the surgical treatment involving implantation of artificial nasal conchae under general anesthesia, this procedure is done in local anesthesia in an outpatient setting.

For regeneration of nasal mucosa and other damaged internal structures of the nose the injection of Mesenchymal Stem Cells (MSC) as well as Stromal Vascular Fraction (VSC) isolated from the patient’s own fat tissue recommends itself. Additional volume in the nasal conchae and the regeneration of the mucosa can lead to a long-lasting improvement in the symptoms.

In lipofilling (autologous fat transfer) the missing volume in the nasal conchae is replaced by fat harvested from the patient’s own body. Before implantation the fat can optionally be enriched with the patient’s own stem cells. This procedure is called Cell-Assisted Lipotransfer (CAL).