Turbinate Reduction Euphamism

Turbinate Reduction Euphamism
As some of you may know, I received a “turbinate reduction” electric cautery with outfracture. The technique for cautery was the most destructive kind, monopolar (vs. Bipolar) since this cause circumfrential damage. I received 4 passes on each side 2 centimeters deep each pass, basically frying my submucosal tissue. I did not know this operation/destruction was going to take place on me, when I went in to get my broken nose fixed. I have been suffering ENS since week 1 after my surgery 9 months ago. I have seen 7 ENT’s in my area since the surgery, and have also flown out to Cleveland to see Doctor Houser. Every doctor has told me in my area has told me “your nose isn’t empty”; “ENS classically is presented by crusting, foul smell, bloody discharge, and completely amputated turbinate”. I’m told that the term was “coined” by Doctor Kern. All I know is my nose does not feel or operate normally and I feel every symptom described by ENS as defined on this website. My fear is that the ENT’s think they have outsmarted ENS, by their “advances” in reduction procedures vs. Turbinectomies. Basically I have been left with the bone, but don’t have the right amount of soft tissue. I don’t know how long “reductions” have been going on, but their seemingly rise in popularity and apparently “normal” CT scan post operatively, is contradictory to the established “Empty Nose Syndrome”. Perhaps, this needs to be supplemented with an additional name “Turbinate Surgery Syndrome”.

It's really a euphemism and there is no point arguing with them about it. All you need to claim is that electric cauterization is a destructive procedure which has fallen out of favour by many ENT surgeons precisely because of it's destructiveness to the remaining tissue. There was no need to use it in your case as there are much more careful and tissue preserving techniques - like sub mucosal reduction using a knife, or somnoplasty. Your problem is that your IT submucosa has been scorched badly and this prevents your ITs (although they are sufficient in size) from properly congesting and decogesting and from participating in the nasal cycle. In all likelihood, your condition probably improve spontaeously (although it will be slow and may take several years). It's difficult to say how much improvement there may be though, although my personal opinion having seen your pictures is that it will be significant enough for you to feel much better than now. Look at it as a bad burn (which essentially is precisely what it is) it will take time. One good thing is that it is a submucosal burn. Had it been to your outer mucosal layer you would have felt even worse and the chances of that ever going away would have been much smaller.

hoosemec i agree with you, they emphasize ENS as a result of radically reduced IT's but i strongly believe the symptoms occur even if tiny part is touched, because the airflow is damaged and too much space and so on. i have 'only' 25% reduced one side and it's hell like..(another side is about 40%) it's a huge piece of tissue each side! what they do they touch the heads of IT's, the most important part for proper function of nose! they do crime! they kill us! anyway good luck to them, something has to be changed in healing noses, we should stop touching the turbinates in either way, how comes the energy is so low and mind so dull like you are dead! and it all just because you cant normally feel the base in your nose as the result of 'help' from doctors. is it fair? dont think so. we dont need this help! they literally kill us, with this kind of energy it's hard even to protect yourself! you become too overwhelmed with your nose and so miserable, so unsure and sheep-like cuz it hurts in cavities! sorry if offtop, just thoughts, my experience. i think the anatomy of nose has to be reviewed as most of them seems dont understand it and other healing has to be developed. they do easy job touching turbinates, they dont want to think! and dont want to listen! i came to the doctor with bone damage instead i got the cure which made my living hell, thank you doc! really appreciate it! too bad, you keep doing this job..

hoosemec i agree with you, they emphasize ENS as a result of radically reduced IT's but i strongly believe the symptoms occur even if tiny part is touched Evgeny, Facts: 1. The symptoms of emptiness and loss of aerodynamic and dryness/atrophy are much worse the more the turbinates are resected. The impact of "small resections" is therefore much less. 2. Much of the impact of "small resections" is temporary as they can regenerate to a degree and compensate, although may take a few years. 3. "Small resections" means that the turbinate intself can be augmented with Alloderm if wished, and this is much better than having to reconstruct a look alike turbinate structure out of thin air, which is the only option left to radically resected patients. While I understand the need that many with "small resections" here have to claim that their symptoms are just as bad, it is very wrong to do so. How do I know all this? - Because most here with radical resection began with "small resections" and because of continuous mis judgements of their surgeons who didn't understand the new symptoms they were resected further. They ALL -*test*-('")ify that further resection made their ENS symptoms much worse and they'd kill to return to a lesser resected state. So, I think it is not only wrong scientifically to keep on claiming what you just said and serves to confuse the message about ENS patients, it also is morally wrong as it trivializes the suffering of people that are much more resected and have lesser chances of ever getting over it. Please refrain from doing so. I hope you understand 8)

no, i dont agree with you, i have a small resection and the impact is huge. i cant live the way i lived before, i am very limited in everything i do because of this feeling in my nose as well as my energy, it's hard to explain but you know what i am talking about. it feels as something grasped my cavities and pulling down painfully with a cold there(that what they call emptiness, yes this is emptiness, tissue is missing), it's terrible, i literally shut off during conversations because of broken chemistry and cant do sport normally, huge tension etc. etc. lots of things. not enough endorfine, almost no serotonine, dont see a big difference compared to full resection, anyway same hassle everywhere even with this small amount of reduced. all i want to say that even small amount of inferior turbinates being reduced is deadly for living, they are the most crucial for function and energy and it's not scientific routine, it's my experience. and for two years nothing regenerated but become worse, and i am not able to devote whole my life controlling this, probably in a state of yoga it's not so bad, agree, but i need to work and make money, and i want to enjoy the activities and whatever i always did and it's nearly impossible with my current state, so this how it is, and again 'only' 25-40% of IT's has been reduced each side. and, TE, we really talking about obvious things here, they do crime, no need to narrow so much i think, but you right, more reduced - worse symptoms, but of course it's a part of our body it has to be here :) for those in need we just pray, tissue engineering will come soon, god bless it but we also should stop them making this, if only those in power were on this forum..

Evgeny, First of all 40% reduction is not "small resection" like you keep on saying. My problem with the things you say is how you say it. If you are referring to yourself you should say "partial resection" not "small resection" and there is a big difference there. Secondly, I have no doubt that you suffer terribly - all I'm saying is that if you would have had more resected than it would have been even worse. This is common logic and is backed by clinical observations and from your last reply I see you agree too. Now, I saw a need to respond because you you say that you think that ENS should be represented by all types of turbinate reductions - as if if someone has a turbinate reduction they automatically have ENS. That's a very mistaken approach to argue when trying to promote ENS awareness amongst the ENT community. Why? - because almost every type of nasal surgery for obstruction involves some trimming of the turbinates. In the US alone it is reported that close to 1,000,000 people per year have some kind of turbinate reduction. Do you think they will all develop ENS? - I wouldn't count on it because most of these reductions are done very conservatively with the surgeon's attempt to conserve as much as possible. True, many of them still resect too much (like in your case) but most of them do it partially and try to leave more than 60%. Studies show that after a few years there is some growth and compensation in inferior turbinates that a significant enough portion of them (usually more than 60%) remain and I want to say this carefully because it also depends if the natural shape of the turbinate (which is most crucial) was maintained too and if the mucosa and submucosa were not badly scarred. But generally speaking - these people will experience improvement over the years if they develop slight ENS symptoms, and when balanced with their prior state of obstruction it's often a reasonable price to pay, although I agree that there is no justification to do a reasonable job in any type of surgery because every job should be done perfectly, after all these are people's lives and everyone deserves the best. However - we have to be practical and accept that right now - "small resections" as you put it are today (and probably be for always) considered as a legitimate procedure. If we try to argue categorically against this no one (icluding Dr Houser) will take us seriously. Individual cases of unnecessary resection (in cases when it was not needed) can be made, yes, but categorically arguing that they are all wrong is not logical, is not moral (because some people do badly need it and there is no other alternative), and is foolish because it confuses everyone as to what really ENS is and how severe the symptoms can really be. This has nothing to do with partial and especially subtotal and total turbinectomies which do most often cause ENS symptoms - however there is a scale of severeness in symptoms here too and it must be vocalised and noted - otherwise if doctors think that ENS can be as bad no matter how much they cut and that it develops in some and not in others for mysterious reasons that have nothing to do with the degree of resection (like some here tried to argue for their own selfish interests) then nothing will prevent those doctors from further and more radical resections - as this argument is effectively teeling them that the amount of turbinate tissue that is resected doen't matter because what matters is the actual resection/trimmin/reduction and following this logic you're effectively teeling them that 5% and 90% effect the patients the same way... see the problem here? What I think you are failing to comprehend is that ENS is only a name given to a symptom complex. The symptoms themselves and their intensity is what counts and not the lables and names.

sorry, hard to read, too much text. i will try to answer later. just wanted to say - that i have developed emptiness, i feel the lack of tissue. i also developed tension, i believe because nose tries to compensate, so the pressure in cavities very-very high and it gives impact on my health and thinking, my teacher says i always look stressed out and she is right(she is probably first person who told me about it, others just ignore). i dont think this is healthy to 'be compensated' this way. i think those people with very small reductions are also affected, probably not so much to go to specialists, but i am sure their energy falls after this. these heads of IT's are unique, they do so much important functions to our body, and touching them is a crime and i will keep saying this. if doctors dont understand this they should try this on themselves and then they will see what it means to live in 'heaven'. it's not a good thing what they do, really.. i dont know, it's all may be too complicated to summarize, may be i am wrong and some cases really need these procedures but not mine, 100%. i dont understand why i even can't sue him, why these practices are so undeveloped in canada, nothing here.. i'll keep searching but now i dont see the way out. and are they really so stupid to understand the seriousness of such procedures? stop defensing them! they should start thinking! they make money, they are professionals and they should work professionally not like dumbs! and they should bear responsibility for damaging us, me in my case and whole my life! i am seriously tired of this. what the hell of corruption is this?

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