
Is Empty Nose Syndrome Real? If Not, Why Are People Killing Themselves Over It - r721
https://www.buzzfeed.com/joeloliphint/is-empty-nose-syndrome-real-and-if-not-why-are-people-killin
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elmalaak
Something about this syndrome reminds me of tinnitus. Tinnitus often occurs
due to destruction of the cilia in the ear canal, causing the brain to
overcompensate by constantly sensing the frequencies the destroyed cilia would
have responded to. (At least, this is one commonly hypothesized theory.) While
this may be a bit of reasoning by analogy, I wouldn't be surprised if
something similar were at work (particularly to the extent that nerves or
other sensitive apparatuses are involved).

~~~
LanceH
I just had this done in February. My turbinates have always prevented me from
breathing through my nose. When I was 19 (20+ years ago) I broke my nose.
Which is to say that I haven't breathed through it for pretty much my entire
life.

A week after the surgery when the splints came out it felt like a draft
through the center of my head. Maybe people who have always been able to
breathe through their nose are accustomed to this, but for me it was entirely
foreign. On top of this, the inside of my head felt cold; headache inducing
cold. I can imagine this could get interpreted a variety of ways, especially
for people who have never had those senses developed at all.

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Overtonwindow
This sounds like one of those fine lines of medicine between what the patient
thinks they have, what the doctors think is wrong, and the quandary of
psychology and a disease based model to diagnosing and treating patients.

~~~
arkades
In fairness: the patient has typical anxiety and depressive symptoms, focused
on a prior medical intervention, with fairly typical manifestations. It's the
nature of these sorts of conditions that they have enormous and interesting
heterogeneity in particular focuses of obsession for the patients.

It doesn't make his suffering, or the suffering of patients with similar
ailments, any less real or traumatizing. Its effects aren't any less tragic.
However, fundamentally, there isn't really a great model of care for people
who won't or can't believe that their ailment is psychological and requires
psychological treatment ("But he didn’t stick with them or the psychologist.
He felt like no one was listening to him. His head wasn’t the problem —
someone needed to fix his nose!")It doesn't help anyone to keep making up new
diagnoses for every manifestation of depression and anxiety, just so people
can feel "acknowledged" \- and validated in not treating the underlying issue.
So many of these emerging conditions ultimately show little response to their
supposed underlying mechanisms, and normal responses (for depression and
anxiety) to anti-depressants and cognitive behavioral therapy. (" He spent
most of his time alone in his bedroom with a humidifier. After doctors treated
him with cognitive therapy and an antidepressant, many of his symptoms cleared
up.")

Of more interest to me, personally, is the frequency of post-surgical anxiety.
I've seen it in enough patients to know that it's not restricted to turbinate
reductions, it doesn't always correlate to pre-existing mental health
problems, and that it can often resolve when the surgery is "fixed" (e.g.,
removing lap-bands). This is a general phenomenon that receives little
attention, causes a lot of suffering, and would help a lot of patients if we
understood it better. Chasing down rabit-holes by pretending the anxiety is
something /else/ doesn't help anyone.

~~~
haberman
On what basis do you dismiss the physical sensations felt by these people as
nothing but anxiety resulting from surgery?

How do you explain the fact that this only appears to manifest when turbinates
are reduced, and not as a result of any other surgical interventions on the
nose?

Would you similarly dismiss phantom pain and prescribe anti-depressants and
CBT?
[https://en.wikipedia.org/wiki/Phantom_pain](https://en.wikipedia.org/wiki/Phantom_pain)

~~~
arkades
First of all, because anxiety and depression are well known to manifest with
physical symptoms. Which is why if you present with physical symptoms, anxiety
and depression are diagnoses of exclusion, coming long after everything else
has been exhausted. Notably, I didn't say they're /imaginary/ \- just
psychogenic. Anxiety is well known for significantly reducing the threshold
for attention to stimulus: someone having an anxiety attack can feel things
without somatic prompt, or they can feel something horrible with an underlying
somatic prompt that, if they weren't having an anxiety attack, they'd never
have even noticed. Generally people don't get brushed off as having mental
disease. Although that's the popular narrative, again, (1) it's usually the
last dx, and (2) even in these people's narratives, they go from physician to
physician. Doctor after doctor looks at them and detects nothing.

This doesn't mean nothing is there, of course, but mystery illness is rare and
anxiety is very common. It would be bad medicine to overlook the prevalent
condition that explains your symptoms.

Second, post-surgical anxiety is quite common for a variety of conditions. I
actually addressed it at the end of the post I suspect you didn't read. You
presume this is somehow unique to turbinate reduction; that is an untrue
assumption.

~~~
haberman
> I actually addressed it at the end of the post I suspect you didn't read.

Are all medical professionals (which I presume you are) this condescending, or
just the ones on this thread?

> Anxiety is well known for significantly reducing the threshold for attention
> to stimulus: someone having an anxiety attack can feel things without
> somatic prompt, or they can feel something horrible with an underlying
> somatic prompt that, if they weren't having an anxiety attack, they'd never
> have even noticed.

Right. So how do you know that this isn't the result of a real physical
stimulus that manifests primarily in anxious people because they are more
sensitive to that stimulus?

How do you know that anxiety/depression are the "underlying issue", and not
merely something that surfaces/amplifies the true underlying issue?

~~~
Dylan16807
Everyone has slight physical discomforts. If it's being magnified
tremendously, the magnifier is the problem.

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mitm2mitm
Unrelated but I also gave up on fixing my problem: For the past ~8 years I
have a constant feeling that one of my nostrils is almost closed and hard to
breath. I went to several doctors, did all kinds of exams and they found
nothing.

I feel like I need to blow my nose all the time and it drives me crazy
sometimes. It gets worse when I have a flu. Sometimes it even bleeds a little,
like it's irritated.

My family thinks I'm crazy so I stopped mentioning a long time ago, and one of
the doctors even laughed at me.

~~~
maxerickson
An ear nose and throat doctor (otolaryngologist) should be able to inspect the
opening quite well by sticking a scope in your nose (I recently had this
done). One of the reasons I visited the doctor was a persistent feeling of
fullness in one of my nostrils.

With a Face and Jaw CT they would be able to walk you through it all visually
(ask how much it will cost up front though, it varies a lot).

~~~
mitm2mitm
I did, they said I have a slightly deviated septum, but that's common for most
people and there's no need for surgery. And that I shouldn't even feel
anything.

I also checked my lungs and everything was fine.

It might be related to a mental disorder or something. I have anxiety and
maybe other stuff that I never bothered to fix.

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Joof
Are there nerves / neurons in there that might have been removed there?
Possibly some with an important function for some people?

~~~
azakai
The article says yes:

> No one knows for sure why some turbinate reductions result in ENS and others
> don’t, but there are currently two prevailing theories. Houser’s theory
> argues that for ENS to occur, turbinate tissue must be removed or damaged,
> and then the sensory nerves in that area must regenerate poorly. Some
> methods of turbinate surgery can damage the nerve-rich mucosal layer more
> than others.

------
tromp
Funny that in the nearby Tesla thread
[https://news.ycombinator.com/item?id=11650967](https://news.ycombinator.com/item?id=11650967)
people avoid getting killed because of the empty nose...

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akeck
This sounds like the sensation people with acute bronchial spasms have. Maybe
his issue was further down than his nose, so the sinus surgery gave him a more
open feeling, but he still wasn't getting enough air. :-(

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powera
I feel like we have an article where a person is convinced they have a medical
condition and no doctor will agree with them literally every week here. I'm
not sure why it's interesting at this point.

And regardless of the physical situation, this guy _most definitely_ had
serious psychological problems.

~~~
vonklaus
because the medical system is poor, and many relate to it. In fact, I am
personally going throug this right now. No doctor "agreed" with me, and I am
currently programatically trying to aggregate my test data because it is
frustrating. I, and many people, can relate to being dismissed by doctors or
having the medical system fail them.

To be clear, for > 6 months and 4 appointments I was told I was fine. I
finally think what I have was an auto-immune disease which was what the 2nd ER
doctor I saw thought my symptoms were, and her tentative diagnosis. Obviously,
she could only run preliinary tests because if she ran the confirmation
panels...well...she would have to follow up with me and that isn't her job.

~~~
tacos
If a preliminary test shows something they're happy to run more tests. It's
how they make money. ER is triage. If it's not something they can fix with a
needle and a bag (or a needle and thread) rolling you in for expensive tests
and specialist consultations is their entire business model. Your commentary
doesn't make sense.

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tacos
It's not hard to identify the paragraphs in this piece that an experienced,
real news organization wouldn't publish. From the headline to the structure,
I'm _very_ uncomfortable with this type of material. When the comments to an
article are filled with obvious attention-seeking nutjobs maybe that's a
warning sign that you're not doing appropriate journalism, BuzzFeed. This
isn't the type of "engagement" that Pulitzer rewards.

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canttestthis
Uh oh. I have a septoplasty + turbinate reduction coming up in a few weeks and
my doctor never even mentioned this as a potential side effect...

~~~
driverdan
Do you have any pre-existing mental health conditions? The article makes it
sound like there is a strong correlation between mental health issues and this
syndrome.

~~~
canttestthis
Yes, OCD, same as the guy in the article who commits suicide. But my doctor
also knows this and didn't say anything.

