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BackTable / ENT / Podcast / Episode #89

Turbinates, Nasal Congestion, and the Dreaded Empty Nose

with Dr. Jayakar Nayak

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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Turbinates, Nasal Congestion, and the Dreaded Empty Nose with Dr. Jayakar Nayak on the BackTable ENT Podcast)
Ep 89 Turbinates, Nasal Congestion, and the Dreaded Empty Nose with Dr. Jayakar Nayak
00:00 / 01:04

BackTable, LLC (Producer). (2023, February 14). Ep. 89 – Turbinates, Nasal Congestion, and the Dreaded Empty Nose [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Jayakar Nayak discusses Turbinates, Nasal Congestion, and the Dreaded Empty Nose on the BackTable 89 Podcast

Dr. Jayakar Nayak

Dr. Jaykar Nayak is a a professor of otolaryngology head and neck surgery at Stanford in Palo Alto, California.

Dr. Ashley Agan discusses Turbinates, Nasal Congestion, and the Dreaded Empty Nose on the BackTable 89 Podcast

Dr. Ashley Agan

Dr. Ashley Agan is an otolaryngologist in Dallas, TX.

Dr. Gopi Shah discusses Turbinates, Nasal Congestion, and the Dreaded Empty Nose on the BackTable 89 Podcast

Dr. Gopi Shah

Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.

Synopsis

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.

Transcript Preview

That's the idea of empty nose syndrome though, is that the dissatisfaction of the nasal breathing and the breathing experience and these new symptoms that are very disturbing, again, related to turbinate surgery.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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