Turbinates, Nasal Congestion & the Dreaded Empty Nose w/ Dr. Jayakar Nayak | ENT Podcast Ep. 89
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- เผยแพร่เมื่อ 12 ก.พ. 2023
- In this episode of BackTable ENT, Dr. Shah and Dr. Agan discuss turbinate hypertrophy, turbinate reduction, and empty nose syndrome with Dr. Jayakar V. Nayak, associate professor of otolaryngology at Stanford University.
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SHOW NOTES
First, Dr. Nayak gives an introduction to nasal obstruction, which may be present in patients presenting with congestion or a “stuffy nose”. Common causes of nasal obstruction include a deviated septum, nasal polyps, large adenoids in children, and turbinate hypertrophy. There are three sets of turbinates, and the inferior turbinates are located in the nose. The function of turbinates is to filter and warm incoming air. The majority of airflow happens in the lowest one third of the nose around inferior turbinates and base of middle turbinates. Turbinate hypertrophy is one of the most common causes of nasal obstruction. Dr. Nayak also notes that the same level of obstruction can affect individual patients differently.
Next, he explains his workup for patients with turbinate hypertrophy. He always asks about specific symptoms the patient is experiencing, being sure to analyze both the right and left nasal cavities. He also inquires about their current nasal regimen (i.e. use of sprays, moisturizers, ointments, gels, etc.), past surgeries, past trauma to the nose, and their breathing goals. Then, he performs an endoscopy on everyone in order to examine the anterior nasal cavity of the native nose before administering decongestant. If he observes turbinate hypertrophy, he will apply topical decongestant and observe if the patient’s symptoms are mitigated. He avoids using decongestant spray because they may irritate patients’ throats.
Dr. Nayak recommends a basic nasal spray regimen in all his patients with turbinate hypertrophy as a first line treatment. Benefits of nasal saline include clearing out mucus and drawing out fluid from tissues to reduce turbinate hypertrophy. Nasal steroid sprays like Flonase work well but other prescription sprays also exist. He notes that tolerance and side effects are usually rare, but possible reasons why medication might have to be changed or discontinued. Combination rinses are also available for patients with additional symptoms, such as allergies. If the conservative medical approach fails, he will move onto turbinate reduction surgery.
Next, he discusses a complication of turbinate reduction, which is empty nose syndrome (ENS). ENS occurs when too much tissue in the nose has been resected, leaving a massively open nasal cavity. Patients experience a wide variety of symptoms, such as difficulty breathing fully, nasal crusting, cold or burning air rushing into the nose, and congestion. Symptoms are assessed using the SNOT 22 score; a score above 11 on a scale of 0-30 indicates a possible ENS diagnosis. Dr. Nayak also explains his in-office blinded cotton test technique to accurately diagnose ENS.
Finally, Dr. Nayak discusses his turbinate reduction technique to reduce the probability of ENS. He only reduces the turbinate size while keeping shape and contour of the bone. He believes that a gradual and conservative reduction is better than a quick and excessive one. He also notes that there needs to be more standardization of turbinate reduction procedures worldwide and data on which techniques are best for preventing ENS as a postoperative complication.
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Perhaps some doctors need to reconsider if the patient even "NEEDS" this surgery. The body has form and function, sometimes compromising form can compromise function.
The patient never needs this surgery unless they had life long chronic issues. The problem is doctors are lazy now and try the one size fits all approach regardless of the patient's individual situation
@@michael47359 If the person has chronic problems, they are not for life because this can be cured in a natural way by re-educating his nasal breathing and swalling !
Also by changing the diet!
Even in case of chronic problems, surgeries will only worsen his condition!
Don't you see the thousands of testimonials? 🤮
Insurance pays $30,000 for the septoplasty and another $30,000 for turbinate reduction. Of course they're going to try to do both.
In the real world, doctors spend not more than a few minutes (not hours!) to decide on the patient's turbinate reduction procedure, oftentimes not telling the patients about it. Those "doctors" tend to use an illusive "turbinate hypetrophy" diagnosis (which is basically normal allergies or nasal cycle) to support their turbinate reduction procedure during the intended cosmetic only procedure (they think: we will reduce the size of the patient's nose (not communicated to the patient, of course), so we have to reduce his/her turbinates". and here we go - a new ENS patient is brought to the world by a 5-10 minute procedure when the patient was under general anesthesia. that is the truth...
100% the truth
So how do you treat nasal cycle induced turbinates
@@yahyaelmi8435 not through turbinate reduction
That is EXACTLY what happened to me. And what is so FRUSTRATING is the ENT doctors know the functions of the turbinates so WHY WOULD THEY EVER CUT THEM.
And then for them to do that without telling the patient of their plan is beyond unforgivable.
If you feel it's necessary fine but communicate it to the patient so they can make an informed decision.
they do it for money.
I was told too much turbinate tissue was removed. The ENT said there is nothing that can be done. My nose is more reactive to pollen/dust. I have asthma now that never had before surgery. I had to have a pneumonia vaccine due to getting lots of respiratory illness. The doctor who did my surgery is not practicing anymore.
Exactly like me i got asthma after my ENS it’s like there was a filter in the nose and it’s no longer there :(
Which type of treatment did you have was it complete turbinate removal or partial
Dangerous procedure. Usually a gluten/dairy allergy.
Which technique did you do ??!
@@ghamdi2043 which technique did you do
Too much focus on volume loss and not enough focus on mucosa damage and nerve damage
And memory, I think there is definitely brain function lost in the resected tissue as well.
@@jamesgizzi3148 Sleep issues go hand in hand with Ens.
I’m well aware
I feel as if my antennas have been severed. And I’m lost
Don't you see that this site is maintained by fake researchers? On all their videos there is the image of smiling doctors with false hopes!
Never get operated on anything, especially not on the nose, they will mutilate you. Your nose is perfect!
I wish this people call ENT live snd see one day what we go thru for the damage the cause to our breathing issue for rest of our life. Word can not describe. You can take out most important part of breathing but once the damage is done they can't fix it.
Turbinates should never be touched unless there is something life threatening like a tumor or cancer. They are the first line of defense as far as the respiratory system. Turbinates surface and internally have vital nerves that signal to the brain that you are breathing. Once these nerves and tissues become damaged (even with conservative methods) it is irreversible with severe degenerative health consequences.
If inferior turbinate tissue transplant can be done it is reversible I want research on it please support me
We need a solution .
Yes, the solution would be to ban these procedures and have legislators bare these type of elective procedures as they are not performed for life threatening purposes. The fact that turbinate reductions ( both minimal and aggressive) can cause irreversible harm to ones nasal organ, resperitory, nervous system, and a plethora of health issues should be enough for change and justice for those who have been injured and misled by Ent drs and those complicit such as their
governing bodies/societies. Each victim needs to be helped regeneratively and compensated for the amount of suffering caused.
@@Vrga-en3sg I agree they need to be held accountable. ENTs and their governing boards will not go out of their way to tell you about reporting them to the medical board, FDA, contacting your representatives.
that will nver happen. stop epecting them to care.@@Vrga-en3sg
"doctor" who gave me ENS spent about 2 minutes looking into my nose through the mirror. after that he made an operation which turned my life into hell
Did you do Vivaer turbinate laser to the traditional turbinectomy ?
@@morm2173 yes that was laser turbinate surgery
@themortu go see the Beverley Hills plastic surgeon Dr Paul Nassif he's the best ENT in California and he discovered how to fix ENS 2 months ago
@themortu going to be very expensive but Worth it
@@themortu take a pay day loan if you need to
I suffer from empty nose syndrome now 14 years , I will get transplant this year if I would know the side effects from nose operations I would never done the operations my life has changed/ stopped.
Thank you for this podcast.
As an ENS patient myself, I feel gratitude for Dr. Nayak's research on this topic!
Don't you see that this site is maintained by fake researchers? On all their videos there is the image of smiling doctors with false hopes!
Never get operated on anything, especially not on the nose, they will mutilate you. Your nose is perfect!
His research is flawed. He only focuses on air flow which not all ens patients deal with. He has no clue about tissue health, blood flow to the nose, atrophy, or nerve damage.
He's thrown the ens community under the bus when ENTs and his colleagues have discussed in seminars, published, pushed the false "psychological" narrative to cover the truth. This isn't helpful at all. Anyone who truly suffers from ens (both conservative and aggressive injuries) knows it's nasal organ damage caused by a pseudoscience procedures that do more harm then good. Hope more law firms catch onto this scam as turbinates injuries/ens are not discussed in detail and not properly reported.
This is one of those....The operation was a success but the patient died. ..... The Nose Is an ORGAN! It has, in my opinion, the most important physiologic protective role than any other human organ. Highly recommend reading...BREATH...by James Nestor. Unfortunately most specialists view the nose as a simple conduit. It's not.
Appalled to hear a lot of old outdated fallacies regarding ens through this webcast. Dr. Nayak and most of the ENT world is still very behind when It comes to this topic and fails to mention or discuss injuries related to conservative turbinate procedures. The septum is also very important and is heavily innervated by important nerves/mucosal tissue function just like the turbinates. Ents still only scratch the surface in understanding the totality of these structures and how it greatly impacts other organ systems/nuerological components once damaged. Do your own research about the resperitory system and nasal turbinates and you will be more enlightened to know there is crucial information that is not given to the average patient.
Exactly my point, Dr. Nayak thinks ENS can be solved by shoving dead cartilage tissue into the nasal floor to redirect airflow upwards, but he obviously fails to mention that most airflow naturally occurs in the inferior meatus which he blocks off with his surgical procedures. He does not use CFD studies to back up his research and only uses subjective input from patients that rely on many falsified surveys. He thinks he is funny tricking people into believing he has a cure when the real cure is bioengineering and growing turbinate tissue in a lab that has living cells.
Yes but this has come along way than it doesn’t exist. Soon they will stop surgery and apologize
I think the elephant in the room is the m word, which is slowing medical progression, but it’s understandable these are peoples lives on both sides
of this pandemic.
I think we the ENS sufferers should all be outraged and shout into the loud speaker of what they have done to us... Truly medieval tortures in the 21st century...
Easy with the pitchforks, they are learning with us.
I had turbinat reduction, fess , polyp extraxtion my nose is crooked, chronic headache dry nose itching pain breathing problems inflammation cold air cold nose cant handle cold air due to pain burning nose to much air
Dr Nayak, why do you consistently overlook the multiple studies showing that ENS sufferers sustain significant nerve damage?
We even biopsies shoeing the nerve damage; autonomic, sensory and trigeminal.
I don’t understand how you could miss these studies and continue to insist that ENS results only from resection of tissue!! This is not fair to patients to have to listen to an agenda, not an opened-minded, well-sourced, discussion.
Because it's a mafia, they know it but they get paid for it!
Even with chronic problems, surgeries will only make people worse!
There are always natural solutions, I always say, relearn nasal breathing yes the nose unclogs easily!
The nose is sacred, no one should touch it! 😮
Nayak has a history of turning away patients who have nerve, mucosal, neurological injuries caused by conservative turbinate reduction procedures. Even those who have visited him with an existing diagnosis from ens friendly drs has refused to acknowledge that there is more to surgical turbinate injury that expands further from just tissue loss. He is either playing deaf to play damage control or truly is stuck in the past.
@@Vrga-en3sg. I agree with you !
try to find out a possible solution with a good cosmetic surgeon. If they perform a bilateral osteotomy of the nasal bones and the nasal dorsum is lowered a little, the turbinates will automatically be close to the septum since as they arise from the walls of the nasal bones, as they narrow, the nasal cavity becomes smaller. That way you should improve the air pressure and feel the flow. At the same time, the humidity should improve a little.
Quelle folie! Ne vous faites jamais opérer ! 😮
Thank you Dr. Nayak for continuing research on empty nose syndrome!
His "research" only fits the narrative of his colleague's and the AAO-HNS/ARS. They will never fully admit how dangerous and unecessary turbinates procedures are. Several Ens sufferers had reached out to his office regarding new studies and they cared less.
False, there is no "non-invasive" method!
They know everything but say nothing! They will never perform these operations on themselves, be sure!
He really doesn't know much about ens. He is not up to date on other forms of turbinate injury from surgery and how it impacts other organs.
I definitely have those symptoms you mentioned. I always notice when my nasal cycle is switching sides. I think I have inferior turbinate hypertrophy. I had out-fracture procedure to help resolve my symptoms. But it did not work and my symptoms feel the same as it did previous to surgical intervention. My right nostril still swells and then I have facial pressure on the right side. Can you please fix my right nasal congestion symptoms dr. Nayak?
Had u surgery??
Arrêtez les dégâts, il est encore temps pour vous !
Ne vous mettez plus entre les mains d'un ENT.
Don't you see that this site is maintained by fake researchers? On all their videos there is the image of smiling doctors with false hopes!
Never get operated on anything, especially not on the nose, they will mutilate you. Your nose is perfect!
Can a septoplasty cause ens ?
By definition ENS is caused by turbinate reduction. Septoplasty can present problems similar to ens and most doctors reduce the turbinates when doing septoplasty anyway
any thing that damages the turbinates can cause ens snorting cocaine etc also people have different severity of ens some have it much worse then others it usually gets worse in the future
@@mikeodee1164I did coke once, sinuses definitely felt fucked for a few weeks
@@mikeodee1164I did it 1 month ago and I'm from Indonesia and I don't know the worst risks. But it was too late for me and I can't regret it. Now I feel quite disturbed in my sleep, I wake up 5-6 times a night, my nose and throat feel dry, my breathing also feels heavy and there is a cold sensation in my throat. And this happens 24/7.. When I checked my nose with another hospital and saw from the monitor that my nostrils were fine and the results of the operation were almost closed again.. But I felt what I mentioned earlier. It really bothered me and he said I just had an anxiety disorder and then referred me to a psychiatrist as if I was a crazy person who was making unreasonable statements. Please tell me is what I am experiencing a symptom of ens? I was very afraid because I had just married and had a very young child that I had to raise. I don't want my life to be ruined and I hope that a miracle will come for me and my healing... Your answer really helped me
@@muhammadamsari4082 could be does your breathing from your nose stop completely for about 3 min or longer meanning u r not able to breath threw your nose at all for 3min or longer at times yes or no or do u struggle to breath from your nose all day and night in the winter in your house with the heat on or do u feel very cold when u breath in cold air many incompitent drs do misdiagnose people alot
Dr. Jayakar is spot on, and I wish my ENT doctor (which happened to be a surgeon where he trained in Pittsburgh) wanted to go straight to Bilateral Turbinate Reduction and Septoplasty instead of conservative means. As Dr. Nayak stated, I had no rapport built with the surgeon and ultimately was not at all comfortable and cancelled the surgery, and through conservative means, I improved to the point where I barely use anything to deal with my nasal obstruction.
@Brian B. Surtout ne te fais jamais opérer, ne consulte même pas de ENT.... C'est horrible ce que j'ai vu sur internet, tous ces témoignages..😮
Je connais beaucoup de méthodes naturelles pour se soigner de tous ces troubles.
Qu'as-tu fais pour toi? 😊
@@TerrenLiberte Unfortunately, my improvement was short lasted, and not as good as it needed to be. I was still having to use a low dose afrin every night on one side, then suffer alot of the day. After much thought, I rescheduled my surgery since my right side is mostly blocked all the time due to the deviation. Obviously, surgery should never be the first option, but I have been suffering most of my life with this and tried many things with no real success. I still have few more weeks to decide ultimately what I go with, if anything. But I wanted to keep my options open.
@@brianb2416What happened?
Say no to turbinate reductions
Wonder if you could help me, I'm done...ENT after ENT... procedure after surgery ..
My last ENT told me he couldn't do anything else for me .
I need help...I don't have ENS but swollen turbinates even after Vivear and surgery..
I'm just ready to die .
Only thing that helps is afrin... But I try....try not to use it all the time .. But it's hard when nothing else works . 😭
I read your reviews on Google, not good at all, that sucks !
Afrin caused heart problems for me
@@shawonahmed5775 oh wow! How much were you doing? I know it does raise your blood pressure.. what sort of problems were you having?
@@ShirleyCooper08 I used it for years.. maybe 2-3 years continuously cz I was addicted to it. I couldn't sleep at night. I'm having heart palpitations, restless, and slightly elevated blood pressure. Doctor said if I don't stop using Afrin, it may lead to serious problems. Now I'm totally dependent on Saline Spray, Steam, etc
You can try Blackseed oil, it helped me to slightly open my blockage, enough to sleep at night. Don't put directly in nostrils, cz it has burning sensation. Take an empty nasal spray bottle, pour Blackseed oil in it, and then use it as a spray once/twice daily. Blackseed oil has anti-inflammatory properties, there are researches.
@@shawonahmed5775 oh wow, interesting. I was addicted to it too.. for 5 yrs but I would use one spray on each side at night... I now only use it sparingly, when I just can't take it. I used saline sprays etc .. I'm so tired of this..😢 .. I hate night time, I hate trying to sleep, especially when you're trying to breathe and it becomes a job trying to. Ugh
Extraordinary how driven some people are in their careers!!!
Horrible how he still defends these procedures knowing how countless people have been severely harmed and even committed suicide. It is also disinformation spread when he and his colleagues say that Ens happens only when there are major reductions. Turbinate reductions have also devastated and injured patients who have had minimal reductions as well.
Driven... Ya right. Still backing these procedures even though he's seen countless cases of ens. Compliant and spineless would be better suited.
Wirh all due respect Dr speaks like a robot AI voice very difficult to understand what he says
Due to the situation I am in I learned so much about the function of the nose I understand what he is talking about . In the 14 years I become a patient specialist in know even more than the normal ENT I learned so much the working of the nose , lungs , brains , nerves system , and regeneration that I am a member of the ENT board to advice patients.
Sad that one of the hosts is giggling when bringing up ENS with the Dr. For those struggling with ENS, it’s no laughing matter.
Is clarifix/ cryotherapy safe?
Noooo! Even in case of chronic problems, surgeries will only worsen his condition!
There are always natural solutions, I always say, relearn nasal breathing yes the nose unclogs easily!
The nose is sacred, no one should touch it!
Thank you, I got my turbinates resected and now I’m in hell…then I almost let him do clarifix, I realized shortly before the surgery I developed ENS.
@@pcpc1617... For heaven's sake, why didn't you listen to me?😮
@@TerrenLiberte
What methods did they use on your turbinates & when did you start feeling symptoms of the syndrome?
@@muhammadamsari4082. I wasn't talking about myself, I don't have any nose problems, although I have a deviated septum that I discovered recently on a scanner but yet I always breathe very well through my nose!
You just need to learn to breathe through your nose by placing your tongue correctly on the roof of your mouth!
Where is solution for this problem?? Practical not theoretical!!!
Even in case of chronic problems, surgeries will only worsen his condition!
There are always natural solutions, I always say, relearn nasal breathing yes the nose unclogs easily!
The nose is sacred, no one should touch it!
@svetlana.... What problem? Your nose before surgery or after with ENS ?
@@TerrenLiberteallergic rhinitis, what's the natural remedy that i should try...? Please can u suggest,
The solution is for ENTs to cease from performing these useless procedures.
Very informative podcast.
ENS isn’t that common in these surgeries? Did I hear that right?
Surprised I didn’t hear 10-20%
At least we’re focusing on alternative methods than immediately maiming people.
Happening more often then what ENTs regurgitate to patients and each other. They do not keep proper tabs on Ens cases.
@@dougferguson2563 French Department of Health has started tracking ENS cases last year
@@mick12495 Good news. Other nations need to follow lead.
What dr. Nayak would recommend to sufferers of Atrophic Rhinitis?
Even in case of chronic problems, surgeries will only worsen his condition!
There are always natural solutions, I always say, relearn nasal breathing yes the nose unclogs easily!
The nose is sacred, no one should touch it!😮
Hes no good. Only stuffs people with useless implants that will never recover a complex organ such as the turbinates. He also has very limited knowledge about less invasive forms of turbinate injury caused by surgery.
@@Vrga-en3sg. Exactly ! They know the truth but say nothing and lie shamelessly ! They would never perform these surgeries on themselves, rest assured !
He could care less about anything regenerative or innovative that has to do with complex turbinate problems. All he cares about is implants which does does not help those with non volume turbinate issues.
@Vrg 1:35 a-en3sg
So one out of a thousand get ENS, that is not rare at all.
Thats a .1% chance then…seems pretty rare to me
They conveniently dont keep track that's the problem. Then they make up random statistics to minimize the amount of injuries when there are many getting injured by turbinate reductions.
Well one out of a thousand he says, if that is what you consider rare. @@Ben-im2ev
@@KhalKhtri I think that's probably true for most ENTs. But if we're talking about Dr. Nayak or Dr. Patel, I'm sure they are very wary about ENS and DO keep track since they treat that condition.
@@Ben-im2ev All speculation from the ENT world. They run a muck without hardly any oversight to begin with. They have it better than politicians.
22:00
How are you, Juan?
45:20 For empty nose syndrome
To anyone suffering with ENT.. I just realized that this is probably what I have. I had deviated septum surgery and a turbinate reduction. I haven't slept *well* in months and I just went to a sleep doctor who determined I have both obstructive and central apnea. I do not want to get a cpap because I believe the body should be able to function naturally without something like that, however, what I'm seeing is that with diminished turbinates, it's not a possibility. All I want is a good night's sleep and I'll suffer through the day with ENT. So all of these TH-cam videos just describe the problem and never offer a solution. So here's a solution I'm going to test tonight: I'm going to break out one of my surgical masks leftover from the pandemic and I'm going to wear it overnight. My thinking is that the space inside the mask will emulate what the turbinates are supposed to do with regards to conditioning the air you breathe through your nose and provide air resistance. If this works ya'll can call it the AERDELMAN method. I'll report back tomorrow morning. Like I said, I haven't slept well in months and I can't even recall the last time I've had a dream. Here goes.
Night one: it went pretty good to start with. I noticed that with the mask on it functions as I'd thought. Air coming in is warm, there's a little bit of resistance so I don't feel like I have to think about breathing, it just happens naturally. I noticed my heart was beating steadily and it didn't feel weird to lay on my sides or back. I think what was happening was the same thing that happens when you breath into a bag to calm yourself, you rebreath your own CO2 which can regulate over oxygenated blood. What is nice to is that you can regulate the amount of air you let in through the mask by creating a bigger or smaller air gap somewhere on the mask. So I noticed I was calm and felt like I was on my way to a good night's sleep but I noticed it was starting to get hot and my body was sweating like as if I had a fever. I ultimately took the mask off and didn't really get any sleep. I'll make some adjustments and try again tonight.
@@sc0rpio79 have you tried it more?
I ended up getting a cpap anyways and I’m having a hard time keeping that going. I think the mask method is just another tool to use to help. It’s difficult for me to make it all night wearing it because it gets hot but it definitely seems to help.