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In otolaryngology, empty nose syndrome (ENS) describes a nose that has been physiologically crippled by excessive surgical removal of turbinates in the nose (mainly the inferior turbinates) in a surgical procedure known as 'turbinectomy' or 'conchotomy'. It is therefore an iatrogenic condition that can and should be avoided. ==Main symptoms== The main physical symptoms are: # Chronic nasal dryness Often leads to chronic mucosal inflammation and pain. Chronic inflammation can cause areas of the mucosa to atrophy and this is why some studies refer to this condition as "secondary atrophic rhinitis".〔Cottle MH. Nasal Atrophy, Atrophic Rhinitis, Ozena: Medical and Surgical Treatment. ''Journal Of The International College Of Surgeons''. Volume 29(4), pages 472-484, 1958.〕〔Passàli D, Lauriello M, Anselmi M, et al. Treatment of the inferior turbinate: long-term results of 382 patients randomly assigned to therapy. Ann Otol Rhinol Laryngol. 1999;108:569-75.〕〔Moore GF, Freeman TJ, Yonkers AJ, Ogren FP. Extended follow-up of total inferior turbinate resection for relief of chronic nasal obstruction. by in Laryngoscope, volume 95, September 1985.〕〔Berenholz L, et al'. Chronic Sinusitis: A sequela of Inferior Turbinectomy. American Journal of Rhinology, July–August 1998, volume 12, number 4.〕〔Wang Y, Liu T, Qu Y, Dong Z, Yang Z. Empty nose syndrome. Zhonghua Er Bi Yan Hou Ke Za Zhi. 2001 Jun;36(3):203-5.〕 At least one large study concluded that it can take 7.1 years, on average, for symptoms of atrophic rhinitis to appear and urges the examining physician to look for early signs and to try to counter them with self-administered daily nasal irrigations and moisturization by the patient.〔Moore EJ & Kern EB. Atrophic rhinitis: A review of 242 cases. ''American Journal of Rhinology'', 15(6), 2001.〕 # Paradoxical obstruction - The feeling that the nose is stuffy, often accompanied by a constant or frequently occurring troubling feeling of suffocation generated by poor airflow feedback from the nasal mucosa, either because of atrophy of the trigeminal nerve endings that are supposed to generate this sensation, their lack of responsiveness because of the mucosa becoming too dry or going through metaplasia, or simply because of the loss of normal nasal aerodynamics following the turbinectomy. Without good and constant airflow sensation of the air flowing through the nose, the nervous feedback to the central nervous system is that of suffocation and or undifferentiated breathing difficulties arise.〔Chhabra N. and Houser SM. The diagnosis and management of empty nose syndrome. Otolaryngologic Clinics of north America. 2009 (April);42(2):311-330,ix.〕〔Scheithauer MO. Surgery of the turbinates and “empty nose” syndrome. GMS Current Topics in Otorhinolaryngology – Head and Neck Surgery 2010. Vol 9:Doc03. (doi: 10.3205/cto000067 )〕 # Neuropathic pain - Chronic inflammation and neurophatic pain in pharynx, eustachian tube, throat, larynx, trachea, in more severe cases - in bronchi and lungs. Chronic hoarse voice and cough can also take place. This is caused by insufficiently processed (moisturised, warmed, cleaned) air passing through the respiratory system. ENS can also serve as an prerequisite for asthma. Other predominant symptoms are lack of a good night's sleep and chronic fatigue.〔Houser SM. Surgical Treatment for Empty Nose Syndrome. Archives of Otolaryngology Head & Neck Surgery\ Vol 133 (No.9) Sep' 2007: 858-863.〕 The chronic nature of the physical symptoms has a significant impact on the patient's quality of life and sense of well-being, causing difficulty concentrating, pre-occupation with symptoms, anxiety, and clinical depression.〔Rice DH, Kern EB, Marple BF, Mabry RL, Friedman WH. The turbinates in nasal and sinus surgery: a consensus statement. Ear Nose Throat J. 2003;82(2):82-84.〕 Also, development of asthma and chronic bronchitis is not uncommon, as the nose is the guardian of the lungs.〔Bionity Life Science Encyclopedia on empty nose syndrome.〕〔Hens G, Hellings PW. The nose: gatekeeper and trigger of bronchial disease, Rhinology 2006 Sep; 44(3):179-87.〕〔Hellings PW, Prokopakis EP. Global airway disease beyond allergy, Curr Allergy Asthma Rep. 2010 Mar;10(2):143-9.〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「empty nose syndrome」の詳細全文を読む スポンサード リンク
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