Dr. Eugene Kern’s Empty Nose Syndrome Lecture
“Empty nose syndrome (ENS), also known as ‘the wide nasal cavity syndrome,’ is a term coined by Dr. Eugene Kern of the Mayo Clinic (1994) to describe a rare and debilitating iatrogenic syndrome of chronic nasal physiological impairment following overzealous turbinate resections in the nose (turbinectomies).”
There is a growing disagreement that Empty Nose Syndrome is a rare condition. With approximately half a million turbinate reductions being performed yearly just in the United States, and an increasing outcry from injured patients, it is now suspected that injuries may number in the millions worldwide.
Dr. Kern himself saw hundreds of ENS victims during his thirty-year career at the Mayo Clinic. He is now retired. Around the year 2000, he gave a taped lecture on Empty Nose Syndrome to fellow rhinologists:
Bear in mind that the number of turbinate reductions being done in the U.S. has increased drastically since the year 2000: http://www.emptynosesyndromesite.com/?p=759
Dr. Kern is passionate in this lecture, imploring his fellow surgeons to be conservative in removing any tissue at all from the nose. He shares the before-and-after-surgery x-rays of his patients. “These patients represent a terrible problem” he says. “This is not an innocuous thing!”
“All of them share the same symptom complex…difficulty breathing, crusting, bleeding, pain, a change in their sense of wellbeing…”
“I had to deal with this medically and emotionally,” he says. He shares records of two patients who committed suicide.
Dr. Kern tells his audience that the nasal mucosa “is the organ of the nose.” He outlines the four main function of this organ: “Olfaction, defense, respiration, and cosmesis.”
‘Please think of it as an organ system, just as you think of the lungs, the liver…the kidneys, as organ systems.” He points out that his Empty Nose Syndrome patients lack cilia, lack functioning mucosa. “When we remove functioning tissue what happens?” he asks. “When we destroy mucosa…these respiratory functions and defensive functions can be significantly compromised. When we convert a nose to a mouth….it’s not aerodynamically efficient…wide open noses do not function…”
“How much tissue can you remove and still have normal function? We know you can remove probably eighty to ninety percent of a liver and still have normal liver function. You can remove a kidney…and have the second kidney and still have normal function. How much nose can be removed? I don’t think we know that.”
He says it took about six years, on average, following surgery, for the residual tissue of the nose to fail, in his Empty Nose Syndrome patients.
“Don’t be a turbinator!” he tells his fellow surgeons.
“You biopsy what’s left and…see squalmous metaplasia. That’s not respiratory epithelium anymore. It’s skin! You can’t have mucociliary transport anymore. It’s gone!”
“How are we gonna treat these poor patients?” he asks.
“Excessive turbinate tissue removal can result in the Empty Nose Syndrome.”
“These patients are nasal cripples…”
“This was for non-malignant disease…”
“Nasal obstruction, crusting, bleeding, recurrent infection, pain, odor, dysosmia and depression.”
“It took 6.1 years…for the functional, residual tissue to fail.”
“Be a conservative surgeon because the sequelae can be serious.”
“It’s skin in the nose now. No more respiratory epithelium.”