The main cause of dyspnea in ENS- loss of nasal resistance
OK folks - this is now official: I have finally secured the proof that confirms that the main and most important problem in ENS is chronic shortness of breath, or dyspnea, caused by too much loss of normal rates of nasal resistance. All the rest, the dryness, the loss of airflow sensation, etc', are secondary to this problem, as this is a much more serious problem which can severely impact health. Turns out that normal rates of nasal resistance are crucial for maintaining normal levels of lung capacities and arterial oxygenation, especially during phases of slow breath. Just thought you'd all like to know, after three years of discussion and literary research and speculations, in my opinion it all boils down to this. Loss of nasal resistance is the single most important hall-mark of ENS. For more information look up the following article: Lancet. 1988 Jan 16;1(8577):73-5. Oronasal obstruction, lung volumes, and arterial oxygenation.Swift AC, Campbell IT, McKown TM. University Department of Otorhinolaryngology, Royal Liverpool Hospital. The effects were studied on lung volumes of partial (chronic) nasal obstruction, total overnight nasal occlusion with a nasal pack, and interdental wiring for 6-8 weeks. Total lung capacity, functional residual capacity, and residual volume decreased significantly with total nasal occlusion and with surgical relief of chronic nasal obstruction. All three volumes increased with interdental wiring. It is concluded that these effects are a result of changes in oronasal resistance: lung volume is enlarged by an overall increase in resistance and diminished by a decrease in resistance. These findings imply that the resistance to expiration provided by the nose helps maintain lung volumes and so may indirectly determine arterial oxygenation.

Yep, this is certainly what I believe. All the other things are a hindrance and 'irritating', but are secondary(by a mile) to this problem.

JR, read this article. It states which -*test*-('")s they took to prove this. You can perhaps prove your shortness of breath with such -*test*-('")s. The researchers were from the UK, The Royal Liverpool Hospital.

TE, How do you get access to the full article?

TE, I would be interested in knowing if you get the same amount of oxygen breathing through your mouth as you would through your nose. I have the one implant that Dr. Houser did in the right side (the second one should be done later this summer) and during the day I can breathe pretty well with my mouth closed. Usually, I am sitting at my desk at work. However, I can't sleep with my mouth shut. I don't know whether it's force of habit or because the left side hasn't been fixed yet. I'm always tired in the morning even though most nights I sleep like a rock. I'm beginning to wonder if I'm getting enough oxygen. Additionally, when I get on the treadmill and start walking fast I have to open my mouth because I'm not getting enough air through my nose. It's then that I feel like I am suffocating. I'm beginning to think that once I get the second implant I am going to have to retrain myself to shut my mouth and breathe through my nose at all times. What are your thoughts on this?

you touched on so many issues. Could you be more specific as to what it is you want me to comment about?

Amazing observation, TE. I feel terribly short of breath trying to fall asleep. I keep having to adjust myself, by sucking back mucus, blowing my nose, more irrigation, etc etc to get a clear airway that feels just right.

actually it's not a new observation. My posts from 3 years ago were erased about 18 months ago. Had you seen them you'd notice that that was my initial conclusion when we began this forum. The problem was that I got confused by many patients who posted their symptoms here who made it sound that their main concern was dryness. Dryness is a problem in ENS, but it's not the main cause of dyspnea. I have come to understand that there are two types of ENS, beyond the former sub-classing of MT, IT and Both: I think that there are those who have ENS that effects mainly their nose, and those which have their lungs effected too. I think that the more one had more of their IT's missing the more they have lost resistance to their lungs and over time a true reduction in lung elasticity and capacity emerge, resulting in actual dyspnea. I think that those who are ENS-MT tend to have more dryness and pain related issues but not as much dyspnea as in ENS-IT. I have urged this before with little response so I gave up, but I will try again: It would be most helpful if everyone here, all types of ENS, go to have a full series of all the vital lung-function -*test*-('")s. It would be most valuable to get some sense of what scale of problem we are facing here. If I am right then this form of some disturbance to lung function should come up in a significant amount of patients, mainly in ENS-IT and Both, but possibly in ENS-MT too. I appeal to everyone on this board to have their lung-functions -*test*-('")ed, which includes lung functions during and after physical activity and includes -*test*-('")s for asthma. If I am correct and our lung functions have been damaged this will force ENTs and pulmonologists to take ENS and implant surgery much more seriously. If you feel that you are constantly out of breath - go and have your lung functions -*test*-('")ed. This shortness of breath cannot be limited to the nose. thanks.

I would consider doing a lung -*test*-('"), but I am guessing my lungs are in good shape (although maybe a bit of a different story 3 years ago, before the implants). The implants provide quite a bit of resistance and my lungs generally don't feel taxed.

I'm of course referring to ENS patients who did not have implants yet, although it is still worth while for you having a lung -*test*-('"), because you did live with extreme ENS for 8 years prior to your implants, and this can cause some long-term reduction in lung capacity.

TE said: "Turns out that normal rates of nasal resistance are crucial for maintaining normal levels of lung capacities and arterial oxygenation, especially during phases of slow breath." So is there ways to improve one's lung capacity and arterial oxygenation? I am really worried since I have asthma from athropic rhinitis (caused by ens)

I wonder if their is a -*test*-('") that can determine or pin-point the amount of loss in terms of arterial oxygenation from ens. I had a lung -*test*-('"), about 1.5 years ago, It was very straining with my ens, and I have to say they never really were able to tell me how the ens is effecting me.

The problem with all these -*test*-('") are that they are focused in a few minutes and you are asked in a short time to exert yourself. Of course when we exert ourselves we reach the required amounts but they don't understand that we have to put much more effort to reach those required amounts than normal breathers do. Perhaps if we were to wearan a sophiticated oximeter that not only registers saturation levels but also heart beat and blood pressure, for like 2 three days and during sleep, they would notice that there are dangerous and abnormal flactuations in the levels of oxygen. Yuo can perhaps ask to do this -*test*-('"). I am planning on trying it myself soon.

I currently don't have health insurance and I honestly don't know if I will ever be able to get it. But anyway, if I do get my own health insurance I will look into getting the oxygen -*test*-('").