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ENS is a condition where the sides of the nose no longer have shelves called turbinates that warm and moisten the air. The nose is dry, crusted, and repeatedly infected. The reason for the infection is that there are no longer nasal cilia to wash away the bacteria. Persons who have ENS feel that they are not getting enough air and this is depressing to them. The situation is like a garden hose – if you narrow the opening, the stream goes far and hits the roses 10 feet away. But if you open the opening widely, the stream dribbles at your feet and doesn't reach the roses. This gives the ENS sufferer a feeling of not getting enough air.
The best way to prevent ENS is by avoiding surgery if possible, hence these non –surgical approaches for sinus relief.
The reason we have ENS is that doctors have been taught that if there isn’t adequate room to breathe, make room for breathing. This is fine if the nasal septum is severely crooked, or the nasal bones are crooked. Unfortunately, the doctor looks into the nose, sees swollen turbinates, and orders the surgery without due consideration.
Doctors are supposed to know that the turbinates warm and moisten the air on its way to the lungs. They are supposed to know that these are buffers that direct the air stream where it will signal the body about good breathing and breath. Removing turbinates can be the cause of major troubles.In the worst case of ENS, all three turbinates have been removed from right and left sides of the nose.
The turbinates are bony shelves lining the air passages of the nose. They normally both enlarge and shrink. They especially enlarge with an infection or a cold, because blood is coming to the mucosal linings of the air passages to help fight disease or to warm the air going to the lungs. The turbinates enlarge with allergy, becoming pale and swollen.
When you visit a doctor you may complain that your nasal breathing feels blocked. Your turbinates may be swollen, and it makes sense to reduce their size with treatment.
Turbinates warm and humidify your inhaled air before it enters the lungs. They are covered by millions of cilia, which defend the body against dirt and irritants in the inhaled air. Without turbinates, you'd have dryness, crusting, and sensations of burning painNearly everyone has some degree of deviated nasal septum – that’s the cartilage/bone in the middle that divides your right and left nostril. Sometimes the septum is so displaced that it completely blocks the airway. Or it may be deviated so that it blocks sinus drainage. Sometimes, it's well to have surgical straightening of a deviated septum in order to avoid chronic sinus disease. One need for straightening a deviated septum is if it is causing sleep difficulty.
A most important function of the septum is that of turning you when you sleep. Normally, a person sleeps, say, on his right side. By gravity, the turbinates fill, and the left turbinate now presses on the septum. This signals the body to turn over to the left side, until the right turbinate fills and signals the body to turn. This is how you avoid bedsores. If the septum is deviated, this essential mechanism is disabled, and the patient doesn't get restful sleep.
In ENS this essential sleep aid is disturbed. The turbinates no longer swell and press on the septum for sleep. Thus, in ENS the sleep cycle is disturbed. Today’s treatment for ENS stresses aid to normal sleep.
There are procedures that can reduce the enlarged turbinates that block breathing. These include submucous resection of the turbinate bone, using radio frequency to reduce the tissue under the mucosa and minimal tissue removal. Doctors can use a tiny drill that only removes tissue under the turbinate skin, then leaves room for airway without affecting cilia. Laser is not recommended because it can affect the nasal membranes.
Symptoms can be improved however. Most important is to keep the bedroom moist. Pans of water, a nebulizer, all these help. Moisturizing gels are very helpful. If you have ENS you are more sensitive to odors and dusts, therefore using a moisturizing gel such as Breathe.ease XL Nasal Gel before you garden or dust is a good idea to prevent those particles from contact with your nasal tissue.
Dust proofing the bedroom is beneficial so that less dust irritates the nose. Avoid odors in the bedroom.
Pulsatile irrigation is helpful because the wave action of the pulsatile irrigator acts as a substitute for the absence of nasal cilia. Today, instead of using antibiotics orally for subsequent nasal/sinus infections, doctors merely add the antibiotics to the pulsatile irrigator so that the antibiotic goes directly to where it is needed, bypassing the stomach.
The real problem in ENS is that once the turbinates have been removed, they can not be replaced. This factor can be a significant cause of depression to the ENS patient. In the worst case of asthma, there are periods of relief, medications that reduce symptoms. But not in ENS. Therefore if you are planning to have sinus or nasal surgery you should be very definite in discussing the problem of ENS with your surgeon. Make sure your doctor is fully aware of ENS and its prevention. Be sure to discuss before any sinus surgery if Pulsatile Irrigation might clear your condition and avoid surgery. You can download the 30 + medical journal articles that recommend Hydro Pulse for sinus disease at http://www.ent-consult.com/irr_bibliog.html to show your doctor.
Christopher Martin, an ENS patient has written an excellent book on ENS entitled, Having Nasal Surgery? Don't be an Empty Nose Victim. Since he himself is an ENS patient, many persons find his book of value.Copyright© 2009 Dr. Murray Grossan
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