Empty Nose Syndrome [case study]

26 years old, Mr. Alex Wong had undergone surgery for deviated nasal septum before 2 years. 2 weeks following the surgery he started developing symptoms of dryness in nasal cavity and had difficulty breathing. After about one month, Alex had difficulty in exercising as he was unable to breathe comfortably through his nose. He would feel suffocated and had a hollow sensation in his nasal cavity. He also suffered from headaches occasionally. His symptoms progressed gradually and within a year he started breathing through his mouth. He complained of altered sensation of smell which was beginning to take a toll on his psychological well being. Alex also found it difficult to concentrate on his daily activities and had fatigue due to lack of adequate sleep during night time. Visits to ENT specialists did not prove useful in relieving his symptoms.

ENS is an iatrogenic condition which results due to over resection of inferior or middle turbinates. The symptoms are chronic dryness of the nose and pharynx, shortness of breath, altered nasal sensations (over openness of nasal mucosa/congestion).

The turbinates are recognized as a source of nerve growth factor. When turbinates are removed or damaged, the source of this factor may predispose the nose to poor nerve healing and poor sensation to airflow. The nasal turbinates are also rich in sensory receptors, and resecting a turbinate deprives the brain of their input and can thus damage a patient’s quality of life.

ENS is a considered to be a physically, cognitively and emotionally debilitating condition as good nasal functions are crucial for proper lung functions and breathing, cognitive functions, and sense of well-being.

Various materials have been used for nasal mucosal tissue expansion, including autologous materials (eg, bone, cartilage, muscle, and fat) and biomaterials (eg, Teflon, Plastipore, Bone Source, Orthofix, Gore-Tex). Use of surgical acellular dermal implant (alloderm) and injectable liquid alloderm (cymetra) for ENS have shown stable results, however, the condition is not entirely cured.

A newer treatment option being explored to reduce the symptoms of ENS is injection of Mesenchymal Stem Cells (MSC) and Platelet Rich Plasma (PRP) into the nasal cavity. Mesenchymal stem cells have multi-differentiation capacity and have paracrine properties that stimulate biological healing. Additionally, PRP which is a source of growth factors, chemokines and cytokines, aid in restoring the nasal mucosa to a healthier level. A combination protocol using mesenchymal stem cells, stromal vascular fraction, biological scaffold and PRP was administered in order to stimulate the regeneration of the turbinates and other atrophic areas in nasal cavity.

Alex underwent 2 sessions of cell based therapy at StemRx Bioscience Solutions Pvt. Ltd over a period of 6 months. He noticed improvement in breathing ability within a month following the first session of treatment. 40% regression in turbinate growth was observed and the 2nd session of treatment was planned to be carried out after a period of 5 months. Dryness in nasal cavity has reduced to a considerable extent and Alex experiences lesser degree of nasal crusting and discharge. He is now able to sleep well and is able to perform daily chores comfortably.

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