Severe Empty Nose Syndrome can affect far more than nasal comfort. Research documents substantial impairment in quality of life, sleep, work, anxiety and depression, and one prospective ENS study identified suicidal thoughts in a sizeable subgroup of patients. This article examines that evidence without treating suicide as an inevitable consequence of turbinate surgery or assuming that every reported death was caused by ENS.
Turbinate reduction does not ordinarily lead to ENS, and ENS does not mean that a person will become suicidal. The relevant medical finding is narrower: patients with established ENS can carry a heavy psychological burden, and clinicians should assess depression, anxiety, sleep disruption and suicidal thoughts when symptoms are severe. Historical patient stories on this page are presented as accounts, not as proof of causation.
Why this subject needs careful language
The original version of this page asked why some patients had died after nasal surgery and presented several Chinese media reports and patient accounts. The underlying subject is real and serious, but the question needs to be framed more carefully. A death occurring after septoplasty, turbinate reduction or another nasal procedure does not by itself establish that the operation caused the death. Likewise, a patient who develops depression or suicidal thoughts after surgery may have several interacting medical, psychological and social factors.
What can be said with considerably more confidence is that Empty Nose Syndrome (ENS) is associated with a substantial burden in a subset of affected patients. Published studies describe paradoxical obstruction, a sensation that the nose is too open, suffocation or air hunger, dryness, burning, poor sleep, reduced quality of life, anxiety and depression. A prospective study of 62 patients with ENS specifically evaluated suicidal thoughts and found them in 23 patients before reconstructive surgery. That result is clinically important, but it should not be generalized into a statement that a particular percentage of all turbinate-surgery patients will become suicidal.
This updated article therefore keeps the human stories and historical material that gave the original page its purpose, while separating three different kinds of information: findings from peer-reviewed ENS research; established principles of nasal physiology and postoperative care; and individual or media-reported accounts that may be meaningful but cannot prove medical causation on their own.
What Empty Nose Syndrome is
ENS is an acquired condition most often described after surgery that reduces the volume of the inferior or middle turbinates. The classic paradox is that the nasal cavity may appear objectively open while the patient experiences obstruction, suffocation, dryness or an abnormal absence of airflow sensation. The term “empty” is therefore misleading if interpreted literally. A person does not need to have complete turbinectomy or a visibly hollow cavity to experience an ENS-like symptom complex.
Modern research has moved away from a purely geometric explanation. The pathophysiology is not fully established, but recurring research themes include altered airflow distribution, reduced mucosal cooling in important regions, impaired trigeminal sensory function, changes in the relationship between nasal resistance and perceived breathing, mucosal changes, hyperventilation in some patients and significant interactions with sleep and psychological health.
This matters when discussing severe distress. If the condition were simply “a large nasal cavity,” symptom severity would be expected to track closely with how much tissue had been removed. Studies instead show considerable individual variability. Some people tolerate substantial anatomical change while others experience profound symptoms after more limited procedures. Anatomy is important, but anatomy alone does not explain every case.
Why the turbinates matter
The inferior turbinates are vascular, mucosa-covered structures along the lateral nasal walls. They help shape airflow, warm and humidify inspired air, support mucociliary clearance and provide a large sensory surface. Their volume changes as part of the normal nasal cycle, so the resistance of the nose is dynamic rather than fixed.
Turbinate surgery is usually performed because this tissue has become persistently enlarged and contributes to nasal obstruction despite medical treatment. The clinical objective is therefore not to preserve every millimetre of tissue at any cost; it is to improve obstruction while preserving enough mucosa, structure and function to maintain a comfortable physiological airway. Techniques differ greatly in how much tissue they remove and whether the surface mucosa is preserved.
The older version of this article used the analogy that the turbinates act as a “humidifier, purifier and air conditioner.” That is simplified, but it captures an important idea: the nose conditions and senses inspired air. A larger opening is not automatically synonymous with better breathing, especially if airflow is redistributed in a way that reduces mucosal interaction or if sensory feedback has been altered.
The symptom burden that can drive distress
Patients with severe ENS commonly describe more than ordinary stuffiness. The ENS6Q focuses on six characteristic symptoms: dryness, lack of airflow sensation, suffocation, a feeling that the nose is too open, crusting and burning. Other studies and clinical series describe sleep disturbance, fatigue, concentration problems, reduced exercise tolerance, anxiety, depressed mood and major impairment in daily activity.
The combination can be unusually intrusive because breathing cannot be avoided or set aside. A painful knee may hurt during movement; a nasal breathing disorder may be noticed during every quiet moment, every attempt to sleep and every breath taken while resting. Some patients report that activity temporarily distracts them from the sensation while stillness makes it more prominent. Others experience the opposite because exertion increases ventilation and air hunger.
Severity varies. The existence of profoundly affected patients should not be used to imply that all postoperative nasal symptoms progress this way. But it is equally unhelpful to dismiss the severe end of the spectrum simply because the nasal cavity looks open on examination.
Paradoxical obstruction and loss of airflow sensation
One of the most disorienting features of ENS is the mismatch between objective patency and subjective obstruction. A clinician may see an open cavity while the patient describes suffocation or an inability to sense a satisfying breath. Research using computational fluid dynamics has demonstrated altered distribution of airflow in ENS, and studies of trigeminal function have reported impaired sensitivity to menthol or cooling stimuli in some patients.
This does not mean that every ENS patient has the same nerve injury or that one sensory receptor explains the entire syndrome. It does provide a physiological framework for understanding why “your nose is open” is not necessarily a complete answer. Nasal breathing depends on what the airway does to the air and on how the nervous system senses that interaction.
The 2022 study of suicidal thoughts in ENS found that the ENS6Q item “nose feels too open” was significantly more severe in the group reporting suicidal thoughts. That association does not prove that the open sensation itself causes suicidal thinking, but it highlights how central paradoxical nasal perception can be in severe disease.
Dryness, burning and persistent discomfort
Dryness and burning can become persistent sources of distress. Mucosal surface area, local airflow velocity and the location of airflow all influence evaporation and cooling. In some patients, a large open cavity may expose remaining mucosa to patterns of airflow that feel irritating even when measured room humidity is normal.
Historical patient accounts often use vivid language to describe this discomfort. Those descriptions should be understood as subjective testimony, not literal measurements of tissue injury. Still, pain and burning are legitimate symptoms and can contribute to sleep loss, vigilance, fear of dry environments and withdrawal from work or social activity.
Crusting, altered mucus, recurrent irritation and secondary infection may also occur in some patients, particularly when mucosal health is compromised. These problems require direct ENT assessment because similar symptoms can arise from infection, inflammatory disease, medication effects, septal perforation or primary atrophic rhinitis.
Sleep disruption and exhaustion
Sleep is one of the strongest links between a chronic breathing symptom and wider psychological deterioration. ENS research has documented substantial sleep impairment, and studies examining psychological burden have found relationships between sleep problems, symptom severity, depression and anxiety. A person who sleeps badly for weeks or months can develop impaired concentration, emotional instability, reduced pain tolerance and a sense that ordinary daily tasks are unmanageable.
This is particularly relevant when evaluating severe postoperative distress. Insomnia should not automatically be interpreted as evidence of a primary psychiatric disorder, but neither should it be treated as a minor secondary complaint. In ENS it can be part of the condition’s functional burden and can also worsen psychological vulnerability regardless of the original trigger.
Good clinical care therefore needs to ask about more than the nose: how many hours the person sleeps, whether they awaken with air hunger or dryness, whether daytime function is collapsing and whether sedating medications, decongestants or other treatments are affecting symptoms.
Breathing dysregulation and hyperventilation
Breathing difficulty in ENS is not always explained by blockage. In a prospective French study, 22 of 29 referred ENS patients completed a full evaluation and 17 of those 22 met the study definition of hyperventilation syndrome. The investigators used a hyperventilation provocation test, end-tidal carbon dioxide and other cardiopulmonary assessments. Five patients completed a respiratory rehabilitation programme and showed improvement in SNOT-16 scores.
This study is important because it demonstrates that breathing regulation can be abnormal in some ENS patients. It does not establish that 77.3% of all people with ENS have chronic hypocapnia, nor does it show that hyperventilation explains every ENS symptom. The cohort was small and highly selected. Still, it supports evaluating breathing pattern and carbon-dioxide regulation when a patient reports persistent air hunger, rapid breathing, dizziness or symptoms disproportionate to measured obstruction.
Hyperventilation itself can produce light-headedness, tingling, chest discomfort, a sense of dyspnoea and heightened arousal. When superimposed on abnormal nasal sensation and sleep deprivation, it can amplify the overall experience of threat. Respiratory rehabilitation may therefore be useful for selected patients even though it cannot replace assessment of the underlying nasal problem.
Work, relationships and loss of normal function
The functional burden of ENS has been measured directly. In a 2018 study of 53 people with ENS, participants reported substantial impairment in work productivity and other daily activities. ENS symptom severity correlated with depression, anxiety, pain/discomfort and difficulty with activities of daily living.
This type of impairment is important when trying to understand why some patients describe a loss of identity after surgery. Work, exercise, travel, conversation, sleep and intimate relationships may all become harder when breathing is constantly uncomfortable. The condition can also be difficult to explain to others because the patient may look physically well and routine examination may not show an obvious obstruction.
Social disbelief can add another layer of distress. That does not mean every clinician who questions an ENS diagnosis is dismissive; careful differential diagnosis is necessary. But patients with severe symptoms benefit from clinicians who can hold two ideas at once: objective testing and diagnostic caution are important, and a patent-looking airway does not invalidate the patient’s reported suffering.
What research shows about depression and anxiety
Several ENS studies have documented high rates of depression and anxiety. A 2025 systematic review and meta-analysis included 11 studies with 401 patients. The pooled prevalence estimates were 76.6% for depression and 77.0% for anxiety, although the confidence intervals were wide and the included studies differed in methods and patient selection. In studies that directly compared ENS with chronic rhinosinusitis, depression was more common in the ENS groups.
These figures should be interpreted as evidence of a major mental-health burden in clinically identified ENS cohorts, not as universal probabilities for every person with the diagnosis. Specialist centres often see patients with more severe symptoms, and different questionnaires use different thresholds.
The same systematic review found that psychological outcomes after augmentation surgery were inconsistent depending on which questionnaire was used. Some depression and anxiety measures improved significantly while others did not. This is another reason to avoid a simplistic narrative in either direction: reconstructive treatment can help selected patients, but surgery is not a guaranteed cure for either nasal or psychological symptoms.
What the 62-patient study found about suicidal thoughts
The most direct ENS evidence on this subject comes from a prospective case series published in 2022. Sixty-two patients with ENS were evaluated with the SNOT-25, ENS6Q, Beck Anxiety Inventory and Beck Depression Inventory-II before and six months after nasal reconstruction surgery.
Before surgery, 23 of the 62 patients reported some degree of suicidal thinking on the relevant BDI-II item. Twenty reported thoughts without intent to act, two selected the next higher response category and one selected the most severe category. Six months after surgery, four patients reported the lowest-level suicidal-thought response and 58 reported none.
The group with suicidal thoughts had higher preoperative SNOT-25, ENS6Q, depression and anxiety scores than those without suicidal thoughts. The study therefore links suicidal thinking with greater overall ENS symptom burden and psychological distress. It does not prove that ENS was the sole cause of the thoughts, and the authors explicitly noted limitations including the small sample, self-reported measures and incomplete assessment of other psychological factors.
Clinically, the conclusion is straightforward: suicidal thoughts should be asked about directly in severely affected ENS patients. Identifying them is part of proper medical care, not a reason to reclassify the nasal symptoms as imaginary.
Association is not the same as a proven causal chain
The older version of this page sometimes moved too quickly from surgery to ENS, from ENS to psychological symptoms and from psychological symptoms to death. Real cases are more complicated. A postoperative death can involve pre-existing mental-health factors, acute pain, medication effects, insomnia, social stress, medical complications, diagnostic uncertainty and other variables that may never be fully reconstructed.
Peer-reviewed ENS studies can establish associations at the group level. They can show that depression, anxiety, sleep problems and suicidal thoughts are common in certain ENS cohorts and that symptom severity correlates with psychological burden. They cannot retrospectively determine the cause of death for every individual named in a news article or patient memorial.
The responsible approach is therefore neither to minimize these deaths nor to use them as simple proof that a particular surgical technique inevitably causes a fatal outcome. Each individual story deserves accurate sourcing, and causal statements should be limited to what medical records, legal findings or peer-reviewed evidence actually support.
Why recognition and validation matter
A recurring theme in ENS patient reports is difficulty being believed. The paradoxical nature of the disorder partly explains this: a clinician trained to look for obstruction may see a large airway and assume that breathing should feel easy. ENS research shows why this assumption can fail, but it does not remove the need to investigate other causes of dyspnoea, pain, dryness or anxiety.
Recognition means taking the symptom pattern seriously enough to investigate it. A structured assessment can include surgical history, nasal endoscopy, ENS6Q, SNOT measures, Cotton testing, review of imaging, evaluation of mucosal condition and consideration of alternative diagnoses. Patients with substantial psychological burden should also receive appropriate mental-health assessment in parallel.
Psychological support should be presented as treatment for a real burden, not as evidence that the nasal condition is unreal. The same principle applies in chronic pain, tinnitus, vestibular disorders and other illnesses where physiology, perception, sleep and emotional health interact.
Treatment and multidisciplinary care
There is no single treatment that works for every ENS patient. Conservative management may include humidification, saline, gels or other measures intended to protect the mucosa, treatment of coexisting rhinitis or infection when present, and avoidance of irritants. Some patients benefit from breathing rehabilitation, particularly when hyperventilation or dysfunctional breathing is identified.
For selected patients with a positive Cotton test and a compatible symptom pattern, augmentation procedures can increase intranasal volume and redirect airflow. Materials and techniques differ, and published studies are mostly observational rather than randomized trials. Systematic reviews report improvement in patient-reported outcomes in many surgical series but also emphasize the limited quality and heterogeneity of the evidence.
Severe insomnia, depression, panic, anxiety or suicidal thoughts require treatment at the same time as the nasal disorder. This may involve a physician, psychologist or psychiatrist familiar with chronic medical illness. The objective is not to choose between “physical” and “psychological” explanations; it is to reduce every modifiable contributor to suffering and improve safety while nasal treatment is evaluated.
What patients considering nasal surgery should ask
The existence of ENS is not an argument that medically indicated nasal surgery should never be performed. It is an argument for precise diagnosis, conservative tissue handling and meaningful informed consent. A patient considering turbinate reduction can reasonably ask which turbinate is being treated, which technique will be used, whether the surface mucosa is preserved, how much tissue is expected to be reduced and what non-surgical options have already been tried.
For septoplasty, the key questions are different: how clearly does the septal deviation correlate with symptoms, is there nasal-valve disease, is the obstruction constant or variable, and what structural support will be preserved? If combined procedures are proposed, each component should have a clear indication rather than simply being added because the patient reports nasal blockage.
No surgeon can promise zero risk. But transparent discussion of expected benefit, alternatives, common complications and uncommon but serious long-term problems helps patients make a more informed decision.
The historical Chinese reporting preserved in this article
The original article was built largely around Chinese-language reporting about nasal surgery, private hospitals, medical advertising and people who believed they had developed ENS after treatment. That material is historically relevant to this site because it documents how ENS was discussed publicly in China during the 2010s.
It should not be treated as a substitute for peer-reviewed prevalence research. News reports often combine interviews, legal allegations, family interpretations and medical statements from different sources. Some of the original claims—for example a broad numerical claim that more than 20% of nasal operations cause ENS—could not be substantiated from the peer-reviewed ENS literature and are not repeated here as established facts.
The source material is nevertheless preserved below because it shows the patient perspective, the controversies around informed consent and the consequences of poor postoperative communication. Readers should distinguish direct quotations and legal findings in those reports from the author’s commentary around them.
Zhang Rui: what the historical report actually establishes
One of the central cases in the archived Chinese reporting concerns Zhang Rui, a 27-year-old woman in Urumqi who sought treatment for rhinitis in 2016. According to the translated report preserved by this site, she underwent several nasal procedures during the same treatment episode, including septal surgery and turbinate treatment. Her family reported severe postoperative pain, insomnia and marked changes in her mental state before her death less than three weeks later.
The report also describes a forensic medical appraisal that criticized aspects of the diagnosis, scope of treatment, informed consent and adherence to stepwise treatment principles. According to the translated account, the appraisal attributed a partial contribution to medical fault. That is more specific evidence than a family belief alone, but it still does not establish that Zhang Rui had a formally confirmed diagnosis of ENS or that ENS was the sole medical cause of her death.
The case is therefore best used to illustrate the importance of conservative indications, informed consent, postoperative follow-up and rapid response when a patient develops severe pain, insomnia or psychiatric symptoms after surgery. It should not be turned into a universal prediction about turbinate reduction.
Sun Sulin and other patient testimony
The archived material also includes testimony from Sun Sulin, who described severe dryness, loss of airflow sensation, breathing discomfort, headache and major functional impairment after partial turbinate surgery. Her account became prominent in Chinese reporting about ENS and has been reproduced on several patient-information sites.
Patient testimony is valuable because it describes dimensions of illness that may not be captured by endoscopy or CT. It can reveal the intensity, continuity and social consequences of symptoms. At the same time, individual testimony cannot establish the prevalence of a complication, prove the mechanism of every symptom or determine whether another person’s outcome had the same cause.
For that reason, the current site preserves testimony but places it next to clinical research. The two forms of evidence answer different questions: personal accounts show what an experience can be like; studies help estimate patterns, associations and treatment outcomes across groups.
Claims from the older article that should not be treated as established facts
The archived text contains several assertions that are either too broad or not supported by the research sources available to this site. These include the idea that a fixed percentage of all nasal operations leads to ENS; that public tertiary hospitals in China had universally stopped certain nasal procedures; that loss of turbinate tissue necessarily causes systemic oxygen deficiency; or that every instance of depression after surgery is directly produced by reduced nasal resistance.
Those statements have therefore been removed from the main article. The updated evidence supports a more specific picture. Excessive turbinate tissue loss is a recognized context for ENS, but not every turbinate operation causes it. ENS cohorts show high psychological burden, but causation is multifactorial. Hyperventilation is documented in some patients, but not every patient has it. Reconstruction can improve symptoms in selected cohorts, but treatment response is variable.
Precision strengthens the case for taking ENS seriously. The condition does not need exaggerated physiology or unsupported prevalence figures to justify careful surgical technique, informed consent, specialist assessment and compassionate care.
Research and source material
- Suicidal thoughts in patients with empty nose syndrome (2022)
- Depression and anxiety in empty nose syndrome: systematic review and meta-analysis (2025)
- The functional and psychological burden of empty nose syndrome (2018)
- Hyperventilation syndrome in patients with ENS (2017)
- ENS pathophysiology: systematic review (2021)
- Systematic review and management algorithm for ENS (2024)
- Historical Chinese article referenced by the original page
- Translated document preserved by the original site
Open the earlier translated source material and commentary preserved from this site
Link to the original Chinese article
Download the translated article
I saw a news report: At the end of August 2016, a 27-year-old woman named Zhang Rui found a hospital in Urumqi through a Baidu search. She underwent a bilateral anterior ethmoid nerve block and nasal septum correction. Following the surgery, she developed psychological disorders and psychotic symptoms. Half a month later, she jumped to her death. Her family believes that the failed surgery caused Zhang Rui to suffer from "Empty Nose Syndrome." How painful is "Empty Nose Syndrome"? It seems that this suicide is not an isolated case.
Due to the interview titled "The Empty Nose Syndrome Group Behind the Bride-to-be's Death in a Fall, Where Breathing Felt Like Being Stabbed by a Knife," I recently came into contact with some patients and suspected patients of Empty Nose Syndrome who have not yet been diagnosed. Let me share my preliminary thoughts.
1. Rhinitis is not the same as Empty Nose Syndrome; the two concepts should not be confused.
2. Academician Han Demin, a domestic expert in the field of nasal treatment, stated that more than 20% of nasal surgeries result in Empty Nose Syndrome.
3. The treatment of Empty Nose Syndrome remains a global challenge, and there is no cure currently available.
4. Domestic tertiary hospitals have largely ceased performing local nasal excisions and similar surgeries. However, private hospitals, especially those in Putian, continue to perform these surgeries. Individuals who did not have Empty Nose Syndrome have developed it as a result. For example, Sun Sulin initially sought treatment for ear itching, but after surgery, developed Empty Nose Syndrome. Zhang Rui’s family reported that Zhang Rui was initially only treated for rhinitis, but the doctor irresponsibly performed nasal surgery. Following heavy bleeding and unbearable pain, she committed suicide by jumping off a building half a month later.
5. Empty Nose Syndrome patients appear physically normal, without missing limbs, but they are in constant pain.
"Every second feels like a knife stabbing into the brain," said Sun Sulin, an Empty Nose Syndrome patient. She particularly understands Zhang Rui's suicide. "I wanted to commit suicide every day for more than a year. If it weren't for my family watching me closely, I would have succeeded long ago." The key issue is that many people mistake them for being mentally ill. For example, Sun Sulin’s family initially treated her as a mental patient. Sun Sulin mentioned that another Empty Nose Syndrome patient left a suicide note before taking their life, which read, "Don’t think I am mentally ill; this is the greatest insult to me."
I want to clarify that many people who initially only had mild rhinitis, which could have been treated with medication, were instead operated on by some doctors at certain hospitals (I emphasize some, not the entire medical community). A small number of them (again, a small number) developed Empty Nose Syndrome, and eventually, some attempted or committed suicide. Therefore, I must emphasize again that we cannot generalize or make sweeping statements. These are just my rough thoughts; please feel free to criticize and correct me.
I am a patient with Empty Nose Syndrome, so I have some personal opinions on this matter:
Why did the rhinitis patient Zhang Rui commit suicide due to the unbearable consequences of a failed surgery? I believe we should start with understanding the nasal conchae.
What are the nasal conchae?
The lower conchae, which are covered with a layer of mucous membrane, have a layer of mucus on the surface, and some cilia that are invisible to the naked eye. Most nasal conchae removal surgeries are performed on the lower nasal conchae.
What is the function of the inferior turbinate?
Simply put, the inferior turbinate functions as a supercharger, humidifier, purifier, and air conditioner. It maintains nasal resistance, regulates airflow, adjusts the temperature and humidity of inhaled air, and filters and sterilizes it.
What are the consequences of surgery?
Once too much of the inferior turbinate is removed, the most immediate sensation is a lack of nasal resistance, difficulty breathing, and a reduced sense of smell. If the nasal mucosa, mucus, and cilia covering the turbinate are damaged, the patient may feel that the throat area becomes particularly dry and the airflow is imperceptible. The lack of effectively filtered air can cause reflex headaches, and insufficient oxygen can lead to fatigue. The resulting depression, neurasthenia, and poor sleep quality are just a few of the many symptoms. With so many side effects, you can imagine how torturous life is for patients with Empty Nose Syndrome. I have now forgotten what it feels like to feel refreshed. Now you should understand why patients with rhinitis might commit suicide after a failed surgery, right? I don’t know how long I can hold on, but who would choose death if they could live well?
Reply to everyone's question about how to treat rhinitis:
1. The most direct and effective method is to move to a place with good air quality.
2. Regularly flush the nasal cavity with physiological seawater, and avoid drugs containing hormones or other substances that can irritate the nasal mucosa.
3. For those who have tried other treatments with no success and whose quality of life is severely impacted, "inferior turbinate submucosal resection" may be carefully considered.
4. If you have a deviated nasal septum and it is severe enough to cause respiratory arrest at night, then consider septum deviation correction surgery.
5. Always choose a reputable public tertiary hospital for surgery, verify whether the department is outsourced, and ensure the doctor has a valid practicing license. Keep all medical records in case of a medical accident.
6. Don’t trust Baidu! Don’t trust the Putian system! Don’t trust all medical advertisements and recommendations from “relatives and friends”! Resist temptation and think critically!
Zhang Rui, 27 years old from Urumqi was planning to marry her boyfriend that year when she jumped from a bridge ending her life
A 27-year-old woman sought treatment for chronic rhinitis before getting engaged. She underwent surgery on the day of her initial diagnosis and fell to her death 19 days later. Her family filed a lawsuit against the hospital and Baidu.
Why did this happen?
Last night, Shandong TV's "Investigation" aired a report titled "The Mystery of the Bride-to-Be Falling to Her Death After Being Treated for Rhinitis." Let’s review it together——
The woman in question was Zhang Rui, 27 years old, who lived in Urumqi and was planning to marry her boyfriend that year. No one expected that a woman preparing to embrace a new life would suddenly jump from her 14-story home one night, leaving behind a series of unsolved mysteries.
Half a year has passed since Zhang Rui’s fall, yet there is still a large mark left in the green belt where she landed. The police investigation concluded that the cause of death was a fall from a height. Residents of the community mentioned that Zhang Rui had been behaving strangely prior to her death, but the reason she fell from the building was not what the residents guessed. Zhang Rui and her boyfriend had been dating for eight years, and neither was originally from Urumqi. They started a software company in Urumqi and worked hard for more than five years, with their lives and relationship improving steadily. That was until a small check-up before their wedding. Zhang Rui's rhinitis was not particularly severe, only flaring up when she had a cold, causing a lot of clear nasal discharge. In August, she searched on Baidu for treatments for rhinitis in Urumqi.
At the end of August 2016, Zhang Rui searched for the terms "Urumqi" and "rhinitis" on Baidu and was directed to the website of Urumqi Edward Hospital. After making an appointment online, she went to the hospital on the 27th to see a doctor named Hu Jiankui for rhinitis treatment. On the day of her first visit,
Zhang Rui was diagnosed with allergic rhinitis, hypertrophic rhinitis, sinusitis, and a deviated nasal septum. He underwent a bilateral anterior ethmoid nerve block, turbinate ablation, and nasal septum correction. The surgery cost Zhang Rui more than 4,000 yuan. In the week following the operation, he spent hundreds of yuan each day on follow-up treatments at the hospital. On the morning of the seventh day, Zhang Rui experienced heavy nosebleeds. On the tenth day after the surgery, he returned to Edward Hospital to have the gauze removed from his nose.
According to Xiao Yang, Zhang Rui's pain persisted continuously from that day onward. She was unable to work or lead a normal life and experienced hallucinations, feeling as though someone was trying to harm her. Seventeen days after the rhinitis surgery, and two days before her fall, Xiao Yang took Zhang Rui to the psychiatric department. The medical record noted symptoms including slowed response, confusion, irritability, impatience, difficulty sleeping, and poor work performance. An investigation revealed that Zhang Rui had weak emotional control. Zhang Rui's family believed her fall was related to the rhinitis surgery and subsequently filed a lawsuit against Edward Hospital. Notably, Zhang Rui's family also included Baidu as a defendant in the lawsuit.
Zhang Rui's family attorney, Hong Li, explained: "When you type 'Urumqi rhinitis' into Baidu, the top three results are all Edward Hospital, which can give ordinary users the impression that it is the best hospital, potentially misleading them." After representing Zhang Rui, Hong Li had the search results notarized. The notarization shows that in September 2016, searching for "Urumqi rhinitis" on Baidu yielded several results for Urumqi Edward Hospital, with the last line of the search results indicating "v" and "advertisement." The Shuimogou District People's Court of Urumqi accepted the case.
The suicide of an unmarried bride-to-be is indeed tragic and regrettable. But this raises a crucial question: why did Zhang Rui's family sue the hospital that performed the rhinitis surgery, and even Baidu? How could a rhinitis surgery alone lead to a patient's suicide? To address these questions, we first need to understand a term in otolaryngology: turbinate ablation.
Turbinate ablation involves the removal of part of the turbinate. Can this procedure make someone so uncomfortable that they might consider suicide? We found a rights protection group for Empty Nose Syndrome sufferers, many of whom have undergone turbinate ablation. We spoke with a patient named Sun Sulin, who, at the end of 2013, spent over 4,000 yuan on partial removal of the middle and lower turbinates at a hospital in Shanghai due to ear pain. A week after the operation, Sun Sulin's symptoms closely mirrored those described by Zhang Rui.
Sun Sulin reported to the media that for over three years, every breath she took felt like a knife was being driven into her brain and lungs. The air felt excessively dry and irritating. She explained, "I have to spray medicine constantly and carry it with me 24 hours a day. Despite this, it's only a temporary solution. The moisture is minimal, and it doesn't help with the issue. My nose has no sensation; I can't feel the airflow or breathing. Additionally, it has been aggravating my lungs and stomach. I constantly feel nauseous and have a cold stomach. My lungs are always coughing, and I frequently catch colds and have fevers. My immunity is compromised, allowing cold air and bacteria to go directly to my lungs. After the partial removal of the middle and lower turbinates, I suffered from stomach pain, headaches, shortness of breath, overall weakness, and lost my ability to work, requiring me to stay in bed for long periods. My husband had to resign from his job to take care of my diet and daily needs. I believe Zhang Rui committed suicide by jumping from a building because he could not endure the pain following his surgery."
Could partial removal of the middle and inferior turbinates lead to symptoms associated with Empty Nose Syndrome? What is the nature of this surgery in clinical practice? The reporter attempted to contact otolaryngology departments from hospitals in Beijing, Shandong, and other locations for clarification, but several experts declined the interview requests due to the lack of a clear national stance.
The Xinjiang Yunxiang Judicial Appraisal Institute conducted a forensic clinical assessment based on Zhang Rui's medical records from Edward Hospital and the mental health clinic records provided by her family. The assessment found that Edward Hospital committed medical errors in Zhang Rui's diagnosis and treatment, including insufficient clinical basis, violations of treatment principles and standards, failure to provide informed consent, and neglect of necessary precautions. The report stated: "In this case, the medical team should have adopted a step-by-step treatment approach. Instead, the patient underwent surgery with an expanded scope of operation. Therefore, the medical team committed errors that violated treatment principles and norms." The report also estimated that the hospital's medical faults contributed 25% to Zhang Rui's death. Edward Hospital's attorney responded by stating that they could not comment before the court trial.
Whether turbinate ablation causes suffering severe enough to be considered worse than death is a medical question that needs to be addressed by the authoritative medical community. Determining whether the surgery on Zhang Rui was appropriate and whether the hospital's treatment adhered to regulations are legal matters to be resolved by the court. This case bears similarities to the Wei Zexi incident, which attracted significant attention last year.
Last spring, Wei Zexi's name was frequently in the headlines, raising widespread concern about issues like outsourcing of public hospital departments and search engine bidding rankings. In Zhang Rui's family's lawsuit, Baidu was named as a secondary defendant, alleging that Zhang Rui was misled by Edward Hospital's paid search rankings for rhinitis on Baidu.
The reporter observed that Baidu's search engine now clearly marks commercial promotions and provides risk warnings. Zhang Rui used the search engine in August of last year, after these changes were implemented. Will Baidu still be held responsible?
Zhu Wei, a professor at China University of Political Science and Law, argues that internet users should be aware of advertisements in search results when using search engines like Baidu. He views this as common knowledge. If Baidu has reviewed the qualifications of those paying for search services and clearly marked these as advertisements, then under the Advertising Law, it should not be held responsible. Advertisements in search results should not exceed 30%, and if a website engages in false advertising, search engines like Baidu are obligated to verify and remove such links. Zhu Wei believes that even if hospitals engage in false advertising on their official websites, search engines like Baidu might not necessarily be held accountable.
The subpoena obtained by Zhang Rui's family indicates that the court will open the case on April 24, two weeks from now. However, the reporter has learned that the court might need to postpone the case due to the defendant’s objection to jurisdiction. The responsibilities of the hospital and Baidu in this case will ultimately be determined by the court. A year has passed since Wei Zexi’s death. We have seen that the country has taken a series of measures, and we hope that medical and internet advertising practices will become increasingly standardized, ensuring effective protection of patients' rights.
I had a nasal septum correction surgery at Shenzhen Peace Hospital in 2012. Before the surgery, the doctor described my symptoms as very severe, warning that without the surgery, a large number of nasal polyps would grow, making them difficult to treat later and potentially causing fungal sinusitis and other issues. In reality, I had suffered from rhinitis (primarily hypertrophy of the inferior turbinate) for many years. Aside from nasal blockage, I had never experienced other symptoms. The main goal of the nasal septum surgery was to alleviate facial pain and improve my quality of life.
When the doctor explained the surgical plan, he mentioned that removing part of the inferior turbinate would make the nasal mucosa unnecessary. The contact information and mobile phone number provided by the doctor who performed my surgery turned out to be false, and I was unable to reach him a month after the surgery. I received local anesthesia, and the doctor’s attitude was very casual and indifferent. During the operation, the doctor removed one-third of my right inferior turbinate. I also asked the doctor why he removed the right inferior turbinate when my nasal septum was deviated to the left. The doctor replied that it was "common practice."
After the surgery, the packing in my nasal cavity was removed within two days. However, there was significant bleeding after the packing was removed, and it had to be replaced. I contacted the surgeon at the time, but his response was very dismissive and impatient. He said it was normal and handed me a tissue to manage the bleeding.
It wasn’t until I went to a tertiary hospital and received hemostatic drugs that the situation improved. After being discharged, my nasal cavity felt constantly dry, and I experienced over-ventilation. My throat was always filled with dust. When winter arrived, my throat felt extremely cold, and I kept retching. No matter what I did, it didn’t get better. Initially, I thought it was just part of the recovery process, so I didn’t pay much attention. I continued using saline to rinse my nose, but two years later, not only did my nasal symptoms not improve, but my lung discomfort worsened gradually. I began to experience difficulty breathing and suffocation, even feeling labored when climbing stairs. My eyes were always filled with stars, and every breath felt like a knife in my lungs, as if they were burned by fire. I could hardly concentrate on my work, and my work efficiency was consistently low.
It wasn’t until 2015, when I learned about the term "empty nose syndrome," that I discovered the truth. It turned out that the doctor had removed one-third of the front end of my inferior turbinate, causing significant damage to my nasal mucosa. There were large scars left in my nasal cavity after the removal of the inferior turbinate. My nasal cavity lost its ability to filter small dust particles from the air, and the discomfort and pain in my lungs were due to inhaling excessive dust. I wanted to sue Shenzhen Heping Hospital, which turned out to be a "black hospital," but by the time I went there, it had been shut down. Specific link:
http://sz.house.qq.com/a/20131222/002313.htm
Here are a few things I want to say to all citizens:
1. Do not trust any non-Grade 3A hospital for surgery, and be cautious with Armed Police Hospitals or PLA Hospitals.
2. Empty nose syndrome is real, but the medical community has not yet clearly defined the condition. Although doctors abroad have researched it, the effectiveness of current treatments is uncertain.
3. Although empty nose syndrome is very distressing, you should not reject nasal surgery altogether.
When considering nasal surgery, it is best to discuss with the doctor whether they recognize empty nose syndrome. If they do, they will try their best to protect the nasal tissues during the operation to avoid this condition.
4. Nasal diseases can lead to many mental problems, but patients with empty nose syndrome are not "mentally ill." They are individuals who suffer from a condition that others often do not understand. Their emotional struggles and impulses are caused by the disease that torments them, not by any inherent "mental illness."
To those who dismiss empty nose syndrome as a psychological issue without scientific basis: you are truly unworthy of your titles. To put it bluntly, you are not suited to study medicine, a field that requires objectivity and rigor.
Causes of Empty Nose Syndrome
The seemingly advanced technologies such as "laser" and "low-temperature plasma," combined with the promise of a "one-time cure," have given many patients with nasal diseases a false sense of hope. However, the reality can be harsh. After a brief period of symptom relief, many patients end up paying a heavy price: dry nose, nasal congestion, headaches, increased nasal discharge, and nasal reflux.
Are laser and low-temperature plasma technologies beneficial for patients with nasal diseases, or are they leading them into a deeper problem? To unravel this, we must first understand the treatment principles behind these technologies. Laser therapy employs the photothermal effect of stimulated radiation light on tissues. The treatment temperature is high (over 150°C), and it ablates the nasal mucosa by destroying its epithelial layer. Low-temperature plasma therapy uses high-frequency electromagnetic waves to ablate tissues at lower temperatures (around 40-70°C). A highly concentrated plasma zone forms around the electrode through a conductive medium, crushing the organic molecular chains in the tissue, reducing tissue volume, and causing targeted ablation. This method is often used to destroy the subepithelial layer of the nasal mucosa, with the advantage of less heat penetration.
Both treatments focus on the nasal mucosa, which is crucial for the nasal cavity's physiological function. The mucosal surface not only houses an important ciliary transport system that clears secretions and dust but also contains glands that secrete fluids to keep the nasal cavity moist. Additionally, various receptors in the mucosa respond to whether the nasal cavity is clear and the temperature is appropriate. Ablating the nasal mucosa and shrinking the nasal concha with laser and low-temperature plasma treatments inevitably impacts the function of the nasal mucosa, potentially leading to counterproductive results. While some believe that low-temperature plasma affects only the subepithelial layer and not the epithelial layer, thereby causing less trauma, the reality is that the mucosa's damage cannot be ignored.
Currently, laser and low-temperature plasma technologies are commonly used to treat inferior turbinate hypertrophy caused by rhinitis. The goal is to improve nasal ventilation by ablating the inferior turbinate. However, there are two primary types of inferior turbinate hypertrophy due to rhinitis: bony hypertrophy, caused by bone hyperplasia of the inferior turbinate, and mucosal hypertrophy, caused by mucosal hyperplasia. Bony hypertrophy of the inferior turbinate is unsuitable for treatment with laser and low-temperature plasma, which explains why many patients experience no improvement or even discomfort after such treatments. For patients with mucosal hypertrophy, a period of regular treatment with nasal hormones and other medications is generally effective, and they should avoid destructive mucosal treatments.
Laser and low-temperature plasma technologies do have their place in treating nasal diseases, but their indications should be approached with caution. For patients with severe mucosal hypertrophy of the inferior turbinate who have not responded to regular drug treatments, these technologies can be used to ablate the hypertrophic mucosa of the posterior segment of the inferior turbinate (but not excessively). They can also be used to block the anterior ethmoid nerve in cases of allergic rhinitis to temporarily reduce nerve sensitivity and improve symptoms. However, these technologies do not provide a radical cure. Additionally, they are effective in treating epistaxis, with bleeding points being closed with the aid of nasal endoscopes. Post-surgery, patients should rinse their nasal cavity with normal saline and use oily drops to keep the nasal cavity clean and moist, promoting mucosal recovery.
Patients who have undergone laser or low-temperature plasma treatments and experience symptoms such as nasal congestion, dry nose, excessive nasal discharge, or nosebleeds should use normal saline to rinse their nasal cavity regularly and consider medications that promote mucosal recovery and thin mucus, such as standard myrtle essential oil (Ginoton), to restore nasal mucosa function. Ultimately, patients should exercise caution when considering laser and low-temperature plasma treatments and consult a nasal specialist at a reputable medical institution before proceeding.
In 2012, I had mild chronic rhinitis. I searched for rhinitis hospitals on Baidu and clicked on the top result, Shanghai Fuda Hospital (a Putian hospital). The doctor there performed bilateral middle and lower turbinate ablation on me in the outpatient clinic. Later, I consulted Dr. Yu Hongmeng of Shanghai Otorhinolaryngology Hospital. He said that due to this operation, my nose could not be cured and expressed his concern. Nearly two or three years later, I began to experience symptoms of empty nose syndrome. Despite numerous visits to top hospitals in Shanghai and spending over 100,000 yuan on Chinese medicine, my condition did not improve. A minor rhinitis surgery had led to empty nose syndrome. It is crucial to approach rhinitis surgery with caution.
We must work together to raise awareness of empty nose syndrome, push for its recognition by national health authorities, include it in disease catalogs and medical textbooks, and encourage national research institutions to study its treatment methods. Ultimately, our goal is to find a cure for empty nose syndrome!
Actually, there are surgeries that are not related to rhinitis. However, I was misled into believing that ear issues were caused by nasal problems. I experienced discomfort in my ears whenever I heard a noise. Despite consulting numerous hospitals, they found nothing wrong with my ears. Eventually, I went to a private hospital where the doctor claimed my ear issues were related to my nose, and I believed him because I had studied ears but not noses.
The doctor recommended surgery that same day, and the invoice indicated unilateral ablation. However, during the local anesthesia, I realized both nasal conchae were ablated. After the surgery, there was edema for a while, and once the swelling subsided, my nose felt more ventilated. I started using cotton for a long time to manage it. While my body tolerated it somewhat, I could only sleep with my head down due to excessive ventilation. Every morning, my nose felt uncomfortable, and my ear issues remained unresolved.
I later discovered that the hospital had been involved in false advertising and did not have an official hospital grade. I went to another hospital, where the doctor informed me that I didn’t need surgery and that my nasal mucosa was eroded.
Doctor-killing incident in Wenling
Following the doctor-killing incident in Wenling, Zhejiang, empty nose syndrome, previously considered a mysterious condition, began to attract public attention. Lian Enqing, the perpetrator, was suspected to be suffering from empty nose syndrome. After a series of unsuccessful attempts to seek medical help and assert his rights, he attacked the doctor.
Before this incident, empty nose syndrome had been "avoided" by the medical community due to its association with sensitive issues like "over-medicalization." Furthermore, with no definitive treatment available globally, some desperate patients either committed suicide or harmed their doctors. Empty nose syndrome has thus evolved from a medical problem to a societal issue.
Otolaryngology: The Most Affected Area for Medical Injuries
After the Wenling incident, which led to nationwide protests by doctors, the doctor-killer Lian Enqing was quickly identified as a patient with empty nose syndrome by his peers.
Long before the Wenling incident, a group of empty nose syndrome patients had already formed in China. Due to the lack of epidemiological statistics, the exact number of affected individuals remains unknown.
Wang Xianzhong, a former otolaryngologist at Beijing Tongren Hospital, has studied empty nose syndrome and conducted exploratory surgical treatments on some patients. To date, he has diagnosed over 100 patients with empty nose syndrome, and his patient group includes more than 260 individuals. "The empty nose syndrome patients we know about are just the tip of the iceberg; we don’t know the full extent of the group," Wang Xianzhong estimated, suggesting there may be more than 10,000 cases.
Wang Xianzhong’s diagnosis is primarily based on CT scans showing significant loss of the inferior turbinate, along with symptoms such as a dry and cold nasal cavity, hyperventilation, chest tightness, insomnia, and depression. The most crucial factor is evidence of destructive surgery on the inferior turbinate.
For many years, these surgeries have been regarded as convenient and effective means of treating rhinitis. However, the potential side effects of these procedures have often been underestimated. In a sense, empty nose syndrome represents a concentrated manifestation of these possible side effects.
According to media reports, Wang Xianzhong is not entirely certain that Lian Enqing also suffered from empty nose syndrome. However, he believes that the 2012 incident in Beijing, where a patient attacked doctors, is related to empty nose syndrome. On April 13, 2012, a patient named Lv Fuke stabbed Professor Xing Zhimin of the Department of Otolaryngology at Peking University People's Hospital, and a doctor at Beijing Aerospace General Hospital on the same day. Lv Fuke had undergone nasal surgery in Tianjin and sought a certificate from Xing Zhimin to claim compensation from the hospital. Wang Xianzhong noted that in the past three years, there have been at least ten violent incidents in ENT departments, with many perpetrators being patients with empty nose syndrome. Besides these violent incidents, there are countless other medical disputes. Wang Xianzhong argues that the rising number of empty nose syndrome patients has made the ENT department, which is generally a small department in hospitals, a "severely affected area" for doctor-patient conflicts.
A Southern Weekend reporter discovered that the medical assault at Shenzhen Pengcheng Hospital on September 4, 2012, which injured four people, also occurred in the ENT department and involved a rhinitis patient. However, since hospitals often handle such cases discreetly, the specifics of these incidents and their connection to empty nose syndrome are largely unknown to the public.
Incomprehensible Pain
According to a Southern Weekend reporter, "empty nose syndrome" is not yet officially recognized as a disease within the domestic otolaryngology community. The term "empty nose syndrome" (ENS) was first introduced by American doctor Kern et al. in 1994 to describe symptoms resulting from the loss of nasal tissue and normal anatomical structure. The condition is named "empty nose" because the nasal cavity becomes excessively spacious due to tissue loss.
Wang Xianzhong began studying empty nose syndrome in 2009. He observed that some patients who had undergone inferior turbinate surgery, especially those where the turbinate was excessively removed, experienced a peculiar symptom: their nasal passages became wider post-surgery, yet they still felt stuffy. This symptom, known as "paradoxical nasal congestion," is common in empty nose syndrome patients and is particularly distressing.
This was the case with the doctor who committed violence in Wenling. In March 2012, Lian Enqing had a "bilateral inferior turbinate submucosal resection" at the First People's Hospital of Wenling City due to hypertrophic rhinitis. Despite examinations showing that his nasal cavity was noticeably open, Lian Enqing continued to experience nasal congestion and frequently had to use clips or cotton swabs to open his nostrils to breathe. He also suffered from severe insomnia. Previously gentle, Lian Enqing became irritable post-surgery, feeling that "the whole world is only the nose."
Wang Xianzhong attributes the "paradoxical nasal congestion" in empty nose syndrome patients to inappropriate physical damage to the inferior turbinate, which disrupts the normal respiratory tissue structure of the nasal cavity. This disruption leads to deviations from the normal physiological state of nasal breathing, resulting in a series of respiratory system disorders and a lack of normal breathing perception.
Yu Hongmeng, an otolaryngologist in Shanghai, notes that the nasal mucosa contains various receptors that respond to nasal obstruction and temperature. Thus, treating rhinitis solely through mucosal ablation or shrinkage can have counterproductive effects.
Not all surgeries that excessively remove the inferior turbinate lead to empty nose syndrome. Some laryngeal cancer patients do not develop empty nose syndrome despite their nasal cavities being surgically hollowed out. Additionally, some empty nose syndrome patients do not require special treatment one or two years after surgery and recover on their own due to the body's compensatory mechanisms.
Patients with empty nose syndrome exhibit various "quirks." Some need to insert cotton in their noses to feel comfortable, others frequently rinse their nasal cavities, and some use hot water to "steam" their nostrils. A patient treated by Wang Xianzhong had to "chase air" for a period—every time he exhaled, he had to chase it forward to avoid discomfort.
Many patients have expressed a willingness to trade limbs or other organs for a healthy nose. Fan Qiu (a pseudonym), a Guangzhou patient with empty nose syndrome, told a Southern Weekend reporter, "It hurts, but we can’t show it. Unlike those with broken limbs who receive sympathy, we look normal but are in intense pain. No one believes us; they think I’m exaggerating."
Psychological pain often surpasses physical pain. The unexplained "paradoxical nasal congestion" leads many patients to be suspected of mental issues by doctors and advised to see a psychiatrist. Family members also struggle to understand the patients' suffering.
Some patients direct their frustration towards doctors. Yu Hongmeng believes that patients with empty nose syndrome often had certain mental disorders before surgery, and the surgery exacerbates their emotional responses. "Without surgery, they feel uncomfortable; with surgery, they feel worse. If surgery is performed, they desperately blame it for their problems," he explains. Therefore, he is cautious about performing surgery on such patients, even if they persistently request it.
It is noteworthy that some patients who develop empty nose syndrome due to inappropriate surgery become increasingly fixated on further surgeries, hoping to use new procedures to treat the condition caused by previous surgeries. Since 2012, a patient in Zaozhuang, Shandong, has undergone six surgeries, including inferior turbinate surgery, spending over 100,000 yuan, yet continues to seek treatment. On December 2, 2013, a patient named Liu, whose symptoms had improved through his own compensatory mechanisms, insisted on another operation from Wang Xianzhong due to discomfort in other nasal areas.
Diseases That Are Avoided
Xianzhong had undergone "low-temperature plasma" surgery, a popular treatment for chronic rhinitis in recent years. Compared to conservative treatments and other surgeries, it is very appealing to rhinitis patients due to its lack of bleeding, low cost, and no need for hospitalization. After the Wenling incident, some hospitals discontinued this surgery.
Yu Hongmeng believes that the benefits of low-temperature plasma surgery for chronic rhinitis have been exaggerated and often abused. In clinical practice, he found that while many patients experience short-term improvement in nasal ventilation, they later pay an irreparable price.
An anonymous otolaryngologist told Southern Weekend that the popularity of surgical treatments for rhinitis has deep-rooted causes. In his view, smaller hospitals, unable to perform major surgeries, rely on minor surgeries like low-temperature plasma for income. Revenue targets are set for departments and doctors, leading to "over-medicalization." With public hospitals implementing a zero-price difference policy for drugs, surgery has become more important.
A paper published in the Chinese Journal of Otolaryngology in 2001 reported that empty nose syndrome was identified in China as early as 1996. The authors warned that excessive turbinate resection with ENS is a serious and challenging iatrogenic complication, urging otolaryngologists to avoid unnecessary resection or damage to nasal mucosa and structures.
Empty nose syndrome has been included in China’s authoritative medical textbook, Otorhinolaryngology Head and Neck Surgery, published by the People's Medical Publishing House, since at least 2005, under the official name "iatrogenic atrophic rhinitis." The textbook emphasizes that this condition "should attract attention" due to the lack of specific treatments.
However, due to significant financial interests and the discipline's image, empty nose syndrome has not received adequate attention in the industry. As one otolaryngologist put it, the domestic otolaryngology community tends to "avoid" the disease, leading to stagnation in academic research on empty nose syndrome.
Unrecognized Pain and the Challenges of Empty Nose Syndrome
Patients who have undergone inferior turbinate surgery often experience symptoms similar to those of empty nose syndrome, yet they may be unaware of this condition. Doctors usually avoid providing a clear diagnosis in medical records, opting instead for vague descriptions.
Since 2011, Wang Xianzhong has attempted to treat patients with empty nose syndrome using "filling" surgery, having treated more than 20 cases to date. According to him, two patients were cured, some showed improvement, and others experienced no effect. The controversial nature of the treatment has led to disputes with some patients. Despite this, Wang Xianzhong is not fearful of violent retaliation from patients with empty nose syndrome, as he ensures they are fully informed about the potential outcomes and risks of the surgery.
Yu Hongmeng remains pessimistic about the treatment prospects for empty nose syndrome. Nevertheless, he is favored by many patients because he honestly communicates the potential risks of inferior turbinate surgery.
Many patients with empty nose syndrome have reported that prior to their surgery, surgeons focused solely on the benefits and failed to mention possible side effects. "Regardless of whether there were issues with the surgery, our right to be informed was not respected," said Yu Jia, a patient from Wujiang, Jiangsu, in an interview with Southern Weekend. In October 2012, Yu Jia underwent bilateral turbinate cryotherapy for allergic rhinitis. The surgery altered the size of his nostrils, and he soon developed symptoms consistent with empty nose syndrome. Although he was convinced he had the condition, it was not confirmed by a doctor. Recently, due to persistent pain, Yu Jia had to quit his job and rest at home.
Southern Weekend reporters attempted to contact several otolaryngologists for interviews about empty nose syndrome, but most declined. One doctor stated that, following the Wenling incident, the hospital had explicitly instructed doctors not to accept interviews with reporters. Some patients with empty nose syndrome confessed to Southern Weekend reporters that they harbored intense anger towards doctors and felt urges to harm them.
Desperate Patients
"Destructive surgeries targeting the inferior turbinate are not exclusive to China; they are also performed in developed countries in Europe and America. Why don’t doctors resort to violence in those countries?" Wang Xianzhong asked during an interview. He attributed the violence in China to a lack of fairness in the medical system.
"Hospitals are places to treat illnesses, not to resolve disputes," Wang Xianzhong said. "Courts are the proper venues for such matters, but patients often distrust the judicial system." Many patients with empty nose syndrome have considered suing hospitals to seek justice, but most have abandoned the idea, believing that they would not prevail. Nevertheless, their resentment towards doctors remains strong. “Almost all ENS patients feel they have been treated unfairly,” Wang noted. “They feel abandoned by society and their families, which intensifies their despair and anger.”
Six months after undergoing partial inferior turbinate removal surgery, Lian Enqing began experiencing discomfort. He embarked on a prolonged quest for medical treatment and to assert his rights. Zheng Bijian, assistant to the director of Wenling First People's Hospital, recounted that at the end of December 2012, Lian Enqing approached him, complaining that "the surgery was ineffective." The hospital’s ENT department director reviewed the case and found no issues with the surgery. About ten days later, Lian Enqing returned to the hospital, requesting another surgery to alleviate his pain. However, after a departmental consultation, it was concluded that further surgery was unnecessary. Zheng Bijian admitted that Lian Enqing appeared extremely distressed during his visit, even kneeling in desperation. Dr. Wang Yunjie, who was later killed by Lian Enqing, was not the surgeon for Lian Enqing’s operation but had been involved in mediating the medical dispute.
Lian Enqing was convinced he had empty nose syndrome. During his inferior turbinate surgery, he also had "nasal septum correction surgery" at Wenling’s First People's Hospital. He believed something had gone wrong, thinking that the right side should have been operated on, but the left side was treated instead, according to his sister, Lian Chao. Zheng Bijian informed Southern Weekend reporters that the hospital had sought advice from Tang Jianguo, vice chairman of the Zhejiang Provincial Otolaryngology and Head and Neck Surgery Society, regarding Lian Enqing's case. The reporter attempted to verify this with Tang, but Tang declined an interview.
A deputy director of the Wenling Municipal Health Bureau admitted that Lian Enqing had also contacted the Health Bureau about the controversy surrounding his nasal surgery. According to his sister Lian Chao, in early 2013, she accompanied Lian Enqing to several tertiary hospitals in Hangzhou’s ENT departments, where doctors found no issues with his nose. By August 2013, they visited a top hospital in Shanghai, where doctors again found no problems. This led Lian Chao to suspect mental issues and she admitted her brother to the Shanghai Mental Health Center. “My brother didn’t want to go, and he attacked me and smashed my phone,” Lian Chao said.
Medical records show that on October 24, the day before the murder, and nine days after being removed from the Shanghai Mental Health Center by his family, Lian Enqing went for his final nose check. He saw Zhang Zhaohui, an otolaryngologist at Taizhou Municipal Hospital, and used a pseudonym on the patient registration form, suspecting collusion among doctors.
Southern Weekend reporters later sought an interview with Zhang Zhaohui about Lian Enqing’s treatment, but Zhang declined, stating that the interview required hospital approval. The hospital’s vice president also said that approval from higher authorities was necessary. The following day, Lian Enqing, a suspected empty nose syndrome patient, went to Wenling First People's Hospital armed with a knife and hammer.
The Broader Implications of Unaddressed Pain
The pain associated with empty nose syndrome is difficult for others to understand, as evidenced by the doctor-killing incident in Harbin.
Several years ago, I experienced rhinitis due to overwork and late nights. I sought treatment at the First Affiliated Hospital, where anti-inflammatory and expectorant drugs initially cured me. However, the symptoms recurred within half a month and eventually progressed to frontal sinusitis. I later went to the Second Affiliated Hospital, where the situation seemed to improve. But as I aged and my health declined, the nightmare began anew—weather changes, nasal congestion, frequent runny nose, severe throat infections, coughing, and breathing difficulties. After extensive research, I discovered that 80%-90% of those who undergo surgery face such sequelae, which are often incurable. Doctors attribute this to individual resistance.
Reflecting on this experience, my advice is as follows: unless absolutely necessary, avoid surgery. Rely on your body’s natural resistance unless it is a life-threatening situation. Diseases fall into three categories: incurable, self-curable, and treatable. Seek out the right doctor—those who rely solely on surgery may not offer the best solutions. You must become an expert in your own health.
There are many quack doctors and charlatans today; it’s essential to use your own judgment.
1. Chinese medicine’s claim of omnipotence: Reflect on whether any disease is truly incurable.
2. Medicine’s progress: What were once considered the best solutions may be replaced by better ones due to adverse events. Medicine is not infallible; self-care and resistance are crucial.
3. Complexity of organisms: Individual differences necessitate precision medicine, highlighting our limited understanding of biological mechanisms. Advances are still needed.
4. Impact on medical staff: While 60% of medical staff are dedicated and life-saving, they also need to support their families. Tolerance and patience are necessary, and we await improvements in the medical insurance system to address growing needs.
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