10 ms·

Is Empty Nose Syndrome Real? If Not, Why Are People Killing Themselves Over It

64 points by r721 11y ago

powera 11y ago
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 11y ago
  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 11y ago
    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.
- mitchtbaum 11y ago
  It seems partly related to a wider, ongoing wrestling match between those who want\need to approach things with an "and not or" view point versus those who arrogantly and/or ignorantly insist "something must be one thing and not another".
Overtonwindow 11y ago
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 11y ago
  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 11y ago
    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
Joof 11y ago
Are there nerves / neurons in there that might have been removed there? Possibly some with an important function for some people?
- StavrosK 11y ago
  My first thought would be that they removed hairs and follicles, so you can't sense the air moving. Maybe I'm way off base, though.
- azakai 11y ago
  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.
elmalaak 11y ago
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 11y ago
  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.
akeck 11y ago
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. :-(
tromp 11y ago
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...
deleted 11y ago
[deleted]
canttestthis 11y ago
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 11y ago
  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 11y ago
    Yes, OCD, same as the guy in the article who commits suicide. But my doctor also knows this and didn't say anything.
  - deleted 11y ago
    [deleted]
tacos 11y ago
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.
mitm2mitm 11y ago
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 11y ago
  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 11y ago
    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.
deleted 11y ago
[deleted]

64 points by r721 11y ago

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 11y ago
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 11y ago
  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.
mitchtbaum 11y ago
It seems partly related to a wider, ongoing wrestling match between those who want\need to approach things with an "and not or" view point versus those who arrogantly and/or ignorantly insist "something must be one thing and not another".

Overtonwindow 11y ago

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 11y ago
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 11y ago
  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

Joof 11y ago

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

StavrosK 11y ago
My first thought would be that they removed hairs and follicles, so you can't sense the air moving. Maybe I'm way off base, though.
azakai 11y ago
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.

elmalaak 11y ago

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 11y ago
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.

akeck 11y ago

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. :-(

tromp 11y ago

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...

deleted 11y ago

[deleted]

canttestthis 11y ago

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 11y ago
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 11y ago
  Yes, OCD, same as the guy in the article who commits suicide. But my doctor also knows this and didn't say anything.
- deleted 11y ago
  [deleted]

tacos 11y ago

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.

mitm2mitm 11y ago

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 11y ago
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 11y ago
  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.

deleted 11y ago

[deleted]