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Medical Forum / Diseases and Disorders / Sinusitis / October 2003

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Dr. Grossan (or other experts) - Important Empty Nose Syndrome question

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Charles Stanton - 27 Oct 2003 20:00 GMT
The best way to ask my question is to take 2 examples.

Let's take an example where a surgeon cuts out (resects) 50% of a
turbinate with a knife....I guess we can then say that the turb. is
reduced 50% by cutting. This specific scenario has certainly been
implicated in Empty Nose Syndrome (ENS) ---- in other words it doesn't
take a full turbinectomy to cause ENS.

Now let's take a cautery/RF example where the IT is reduced 50%
submucousally by cautery. The reduction in the IT is 50%, however,
this method is not implicated in ENS.

I don't understand.....both methods reduce the turb. by 50%, however,
cautery/Radiofrequency does not cause ENS. The only variable here is
that the mucousa is spared in cautery (assuming sub-mucousal which I
understand is the method of choice) where the other resection cuts the
mucousa --- do I have this right?

I know I'm simplifying but if we reduce an IT by 50% in both examples
how can only 1 example seem to be associated with ENS.  If you take
1/2 of a turbinate away with Somno/cautery --- couldn't that be a
potential cause of ENS?  Is the absense of the mucousa in a resection
the reason for ENS and even a 50% loss can cause these debilitating
ENS symptoms?

I think, and I'm sure others would agree, that this is a CRITICAL
concept and we need to understand it better.

Thank you.
ENTconsult - 28 Oct 2003 05:50 GMT
All depends on the area of excisiion. You can go in and remove the entire bone
and much of the material under the skin of the turbinate. As long as the skn
and its mucus making ability is intact you don't get ENS.
But if you simply excise and remove the good mucosa or skin, you could ger much
more than 50 % damages re healing, etc.
Murray Grossan, M.D.
http://www.ent-consult.com
http://www.hydromedonline.com
Charles Stanton - 28 Oct 2003 14:06 GMT
Isn't it the "material" under the skin/mucosa that is actually
responsible for feeding the skin/mucosa in the first place?

I'm thinking of this as cutting off a food supply.  If we are to
RF/cauterize the supply under the skin aren't we actually hurting the
mucosa in the process?

Or am I totally off base here.  Can the skin/mucosa actually live on
it's own without the material & bone underneath (or at least much less
material/bone as a result of rf/cautery)?
turbinates - 28 Oct 2003 22:07 GMT
Dr grossan,
which method produces more pain and what is the average healing time
for each method?

with the removal of the mucosa by mean of simple cutting, one would
expect to see loss of mucus production, the cut surface would also
become scarred (loss of cilia hair) and harden (loss of elasticity) as
well as nerve damaged. thus the new airways would be defined by
different materials, which will not provide enough lubricant to ease
air friction (patient would feel burning sensation), to soften the
pressure/OR OPEN UP THE AIRWAY UNDER STRONG INHAE/EXHALATION (ABNORMAL
OBSTRUCTION, NOISY air movement/KNIFE CUT PAIN), and the mechanic for
SELF CLEANING (due to loss of cilia hair) will also be DISRUPTED
(FREQUENt INFECTIONS, constant irritation) ?

there will also be  an array of secondary problems such as chest/neck
pain (something to do with the getting the right amount of air to the
lungs),  irritated pharynx (from dried cold air), craninal, facial and
ear pain (due to abnormal air pressure/air movement, nerve damaged),
and of course sleep dysnea dizziness, etc ?

Since the simple trimming method is inherently damaging (it could be
a disaster for allergy people), why is it still being used?

will the damaged skin ever grow back normal again?

what would be the long term effects to the lower respiratory system?
cardio vascular system? and ultimately on the life-span of the poor
patient?

your clarifications will be immensely appreciated.

> All depends on the area of excisiion. You can go in and remove the entire bone
> and much of the material under the skin of the turbinate. As long as the skn
[quoted text clipped - 4 lines]
> http://www.ent-consult.com
> http://www.hydromedonline.com
 
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