Prognosis
There has been very little research conducted on this condition and hardly any long-term follow-ups. For many years this condition was overlooked or mistaken because of secondary problems that usually occur after radical nasal turbinectomies. For instance, the remaining mucosal structures (the septum and the remaining turbinates) often hypertrophy, causing actual physical obstruction on top of the already existing paradoxical obstruction.
The lack of long-term follow-ups of patients with this condition makes it difficult to estimate what percentage of patients, if any, will enjoy a spontaneous recovery or at least a significant enough improvement in their symptoms. But, given that the main cause of the symptoms is the gross loss of normal inner nasal anatomy, it is not likely that this condition can cure itself.
Dr. Eugene Kern, who coined the term "empty nose syndrome", claims that this condition often gets worse over the years through increasing wear and tear of the remaining mucosa in the nasal cavity, because the lack of turbinates leaves the mucosa overexposed to unduly patent currents of unfiltered, and under-conditioned airflow on every inspiring breath. In fact, he maintains that there is an unknown threshold of loss of turbinate tissue from which the nasal mucosa can not recuperate from the daily onslaught of direct airflow. Kern and Moore conducted a large retrospective study of 242 patients which they carefully examined over several years at the Mayo Clinic in Rochester (MN, USA), all of whom had undergone some form of partial or radical turbinectomy, following which they had developed symptoms of atrophic rhinitis. They called this condition "empty nose syndrome" to depict how unnatural these noses looked in CT findings and upon physical examination. They emphasized how negatively this condition had affected their quality of life and sense of well being and the fact that in many of the patients the symptoms seemed to worsen over the years, indicating further damage and wear and tear due to the loss of turbinate protection, as there was no other cause that could explain this. Their findings corroborated early conclusions about turbinectomies that were adopted by ENT communities world-wide after these surgeries first started in the late 19th century and are further more supported by several prominent other studies from the late 20th century following patients that had undergone radical inferior turbinectomies, but some supporters of turbinectomies remain unconvinced as there have been several long-term follow-up studies that claim to have found no major long-term ill effect. So, the controversy remains, although the pendulum has nowadays shifted back amongst most nasal surgeons towards the importance of keeping as much as turbinate tissue possible when performing turbinate reductive procedures.
The patients can replace some of the lost moisture to reduce the risks of mucosal atrophy by coating their nasal lining with protective gels and using saline mist sprays and irrigations, but it seems that unless the turbinates are functionally reconstructed there is little hope to fully recover from this condition.
In recent years there have been several reports of attempts to reconstruct the inferior turbinates of the nose through submucusal implantation of various implant materials, in an attempt to restore normal nasal aerodynamics and physiology. The sample of patients reported on was very small and the follow-up was relatively short, but the results show some promise.
There is hope among patients that with recent advances made in regenerative medicine otolaryngologists will begin to explore ways to use stem cells and tissue engineering technology to fully reconstruct the inferior turbinates of the nose and restore it back to normal.
Read more about this topic: Empty Nose Syndrome