Septoplasty and turbinate surgery can be appropriate treatments for selected patients, but they change structures that contribute to airflow, humidification, mucosal health and nasal sensation. This guide reviews common and uncommon complications, the specific concern of Empty Nose Syndrome (ENS), and the questions worth asking before irreversible nasal surgery.
This page was rebuilt from an earlier personal lecture. Claims that every septoplasty or turbinate procedure causes nerve injury, autonomic dysfunction or permanent mucosal failure have been removed or reframed. The medical literature supports recognized surgical complications and an association between excessive turbinate tissue loss and ENS, but individual risk varies by anatomy, indication, technique and extent of surgery.
What this guide covers
Nasal surgery is not one procedure. Septoplasty reshapes or removes selected portions of the nasal septum. Inferior turbinate procedures range from lateralization and submucosal reduction to partial or, much less commonly, extensive resection. Rhinoplasty can alter external and internal support. Sinus surgery changes other regions again. The likely benefit and the possible complications therefore depend on exactly what is proposed.
The central point is not that nasal surgery should never be performed. Many patients obtain meaningful relief when surgery is used for a well-defined structural problem after an appropriate work-up. The point is that the nose is a functional organ, not simply an air tube. Creating a larger cavity does not automatically create more comfortable breathing, and removing living mucosa cannot be treated as physiologically neutral.
For a patient considering surgery, the most useful discussion is therefore specific: What is causing the obstruction? Is the problem fixed or variable? Which structure will be altered? How much tissue will be preserved? What are the surgeon's alternatives if the first-line operation does not help? And which long-term complications are relevant to that exact procedure?
Why nasal structure matters
The turbinates and septum shape the narrow, irregular passages through which inspired air travels. Their mucosal surfaces warm and humidify the air, trap particles, participate in mucociliary clearance and provide sensory information that contributes to the perception that the nose is open. The turbinates also contain vascular tissue that changes volume as part of the nasal cycle.
Normal nasal breathing therefore involves a balance between openness and resistance. Too much obstruction can make breathing difficult, but very low resistance or an abnormal distribution of airflow can also be uncomfortable for some patients. Modern ENS research is especially interested in this second problem: patients may have a widely patent cavity while reporting obstruction, suffocation, dryness or a lack of airflow sensation.
Computational-fluid-dynamics studies in ENS have found that total resistance can be lower than in healthy controls while airflow is redistributed away from areas normally stimulated during breathing. Trigeminal testing has also identified impaired menthol/cooling sensitivity in some ENS cohorts. These findings do not mean that one measurement explains every case; they show why the subjective experience of breathing cannot be predicted from cavity size alone.
Before surgery: diagnosis and alternatives
A strong surgical indication begins with a strong diagnosis. Nasal obstruction can arise from septal deviation, turbinate hypertrophy, nasal-valve compromise, inflammatory rhinitis, chronic rhinosinusitis, polyps, medication effects or a combination of factors. Symptoms may also vary with the nasal cycle, body position, exercise, season and allergen exposure.
That variability matters. A single CT scan can document anatomy and sinus disease, but it cannot by itself establish how much of a patient's day-to-day obstruction is caused by a particular structure. Clinical examination, history, endoscopy and—when useful—objective airflow testing should be interpreted together. Medical treatment for inflammatory disease is often appropriate before irreversible reduction of normal tissue.
For turbinate hypertrophy, published reviews describe a graduated approach. Techniques differ in how much mucosa and submucosal tissue they disturb. A longstanding principle in the literature is to reduce tissue conservatively and preserve functioning mucosa whenever possible. The fact that many procedures are available is itself a reminder that there is no single operation that is optimal for every patient.
Septoplasty: intended benefit and recognized risks
Septoplasty is commonly performed when a deviated septum contributes substantially to nasal obstruction. The operation usually requires elevation of mucoperichondrial flaps so cartilage or bone can be reshaped, repositioned or removed. When successful, it can improve airflow on the obstructed side. It is nevertheless real surgery, with recognized short- and long-term complications.
Reported complications include postoperative bleeding, infection, septal hematoma or abscess, adhesions, septal perforation, persistent obstruction, altered smell or sensation and structural deformity such as saddle-nose or tip changes. Rare but serious complications have also been described. The absolute risk of each complication depends on the procedure and patient, so a list of possibilities should not be interpreted as a prediction that they will occur.
Persistent obstruction after septoplasty can have several explanations. The original deviation may not have been the only cause; residual deviation may remain; scar tissue may develop; the nasal valve may be weak; or changes in support may affect the geometry of the airway. When turbinate surgery is performed at the same time, postoperative symptoms cannot automatically be attributed to the septum alone.
Mucosa, septal flaps and healing
The nasal septum is covered by living mucosa supplied by blood vessels and sensory nerves. During septoplasty, the surgeon works beneath this lining. Mucosal tears can occur, and opposing tears increase the risk of a persistent septal perforation. That is one reason careful flap elevation and preservation are emphasized in surgical technique.
The earlier version of this page stated that a tear necessarily leaves the mucosa permanently without meaningful vascular supply or sensation. That is too absolute. Tissue injury can damage vessels and nerves, but healing, revascularization and sensory recovery vary. Some injuries remain symptomatic; others heal without major long-term functional consequences. It is more accurate to discuss specific complications—perforation, scarring, crusting, altered sensation—than to assume a uniform outcome.
Healing is also influenced by smoking, inflammation, infection, previous operations, topical medications, autoimmune disease and the extent of dissection. A patient with persistent dryness, bleeding, crusting or pain after septal surgery deserves direct examination rather than reassurance based only on the fact that the septum looks straighter.
Nasal valve and structural support
The internal and external nasal valves are narrow regions that make a major contribution to nasal resistance. A person can have a straight septum and still struggle to breathe if the lateral wall collapses or the valve angle is compromised. Conversely, changing septal support can sometimes reveal or worsen valve problems that were not obvious before surgery.
Nasal-valve collapse is therefore an important differential diagnosis both before and after septoplasty or rhinoplasty. Evaluation can include inspection during quiet and forced inspiration, targeted maneuvers that support the lateral wall and, in selected cases, objective testing. If the valve is the dominant problem, simply removing more turbinate tissue may enlarge the cavity without addressing the site of collapse.
Revision surgery for valve dysfunction can involve grafts or structural reconstruction. Because revision surgery adds another episode of dissection and healing, the best time to recognize valve weakness is before the first operation whenever possible.
The septal swell body
The anterior septum contains a vascular structure often called the nasal septal swell body. It lies close to the internal nasal valve and can contribute to airway resistance. Recent research has examined reduction procedures for selected patients with swell-body hypertrophy, while anatomical reviews note that its full physiological role is still not completely understood.
The previous version of this article treated injury to the swell body as an inevitable consequence of septoplasty and assigned it a specific sensory role in ENS. Current evidence does not justify that generalization. The structure is relevant to airflow and vascular regulation, but whether and how alteration of the swell body contributes to ENS in an individual patient remains uncertain.
For informed consent, the useful question is simply what tissue the planned operation will affect. If the surgeon intends to reduce the septal swell body in addition to correcting the septum, that should be described as a separate component of the procedure rather than disappearing under the broad label "septoplasty."
Turbinate reduction: benefits and trade-offs
Inferior turbinate enlargement can contribute significantly to nasal obstruction, particularly in chronic rhinitis. Surgical reduction is generally considered when appropriate medical therapy has not provided adequate relief. Techniques include outfracture, submucosal reduction, radiofrequency or other energy-based methods, microdebrider-assisted turbinoplasty and partial resection.
These techniques are not equivalent. Some primarily reduce submucosal volume while trying to preserve the surface mucosa; others remove mucosa and bone. Published surgical reviews repeatedly emphasize limited tissue reduction and mucosal preservation. Radical resection has long been associated with secondary atrophic changes and with the syndrome now referred to as ENS.
Conservative surgery does not mean zero risk. Bleeding, crusting, adhesions, prolonged dryness, altered sensation and recurrent obstruction can occur after several techniques. Conversely, the existence of ENS does not mean that every turbinate reduction produces ENS. The clinically important issue is proportionality: the indication, the amount and location of tissue altered, and the patient's preoperative anatomy and physiology.
Empty Nose Syndrome
ENS is an acquired postoperative disorder characterized by a striking mismatch between nasal anatomy and nasal breathing sensation. Common symptoms represented in the validated ENS6Q include suffocation, burning, a sense that the nose is excessively open, crusting, dryness and impaired sensation of air moving through the nasal cavities. Many patients also report sleep disturbance, fatigue, concentration difficulties and marked anxiety associated with breathing discomfort.
ENS has most often been described after substantial loss of inferior turbinate tissue or volume, although symptom severity does not correlate neatly with a single anatomical measurement. The 2021 systematic review of ENS pathophysiology found evidence across airflow, sensory, mucosal, cognitive and psychological domains but concluded that the overall mechanism remains incompletely understood.
This uncertainty is important. It means that clinicians should neither dismiss ENS because a CT scan looks open nor tell a patient that every symptom must be caused by one unproven mechanism. The diagnosis is clinical and multidimensional.
Airflow, mucosal cooling and the sensation of breathing
The feeling of nasal patency is partly sensory. Cooling of the nasal mucosa during inspiration activates trigeminal pathways, and compounds such as menthol can make the nose feel more open even without a large structural change in resistance. This helps explain why a purely geometric view of nasal obstruction is incomplete.
In ENS, CFD studies have reported altered airflow distribution, including concentration of flow in regions different from healthy controls. Studies have also found impaired trigeminal sensitivity in some patients. Cotton placement in the inferior meatus can improve symptoms within minutes in selected ENS patients, and CFD work shows that cotton changes both resistance and local airflow distribution.
The key message is not that turbulence is always harmful or laminar flow is always desirable. Real nasal airflow contains complex laminar, transitional and turbulent features that change with flow rate and anatomy. The clinically relevant question is whether postoperative flow patterns and mucosal stimulation still support comfortable, well-conditioned nasal breathing.
Breathing pattern, hyperventilation and carbon dioxide
Some ENS patients describe rapid breathing, air hunger or difficulty reaching a satisfying respiratory pause. Hyperventilation has been measured in at least one prospective ENS cohort: among 22 patients who completed the full evaluation, 17 met criteria for hyperventilation syndrome. That study is important, but it should not be expanded into the claim that every ENS patient chronically hyperventilates.
When ventilation exceeds metabolic need, arterial carbon dioxide can fall. Hypocapnia can cause cerebral vasoconstriction and respiratory alkalosis and can contribute to dizziness, tingling, chest discomfort and a sense of breathlessness. These are established consequences of hyperventilation physiology generally. Whether a given ENS patient's symptoms are mediated by hypocapnia requires actual measurement rather than assumption.
The earlier lecture also claimed that low nasal resistance prevents the lungs from filling normally and that air moves through the lungs too quickly for gas exchange. That is not an established ENS mechanism. Ventilation and gas exchange are regulated by respiratory muscles, lung mechanics, perfusion and neural control. Nasal resistance may influence breathing sensation and pattern, but it should not be presented as the sole determinant of alveolar gas exchange.
Dryness, crusting, mucosal injury and infection
Dryness and crusting are among the core ENS symptoms. Loss of turbinate surface area, altered airflow distribution and postoperative mucosal changes may all contribute. Some patients develop secondary atrophic-rhinitis features, recurrent crusting or bacterial colonization. Others have severe sensory symptoms without dramatic crusting on examination.
Humidity can therefore matter greatly to symptom burden. Moisturizing strategies—saline, gels, humidification and individualized topical care—are commonly used as conservative treatment. Persistent foul discharge, focal pain, fever or purulent crusting should be evaluated for infection rather than assumed to be "just ENS."
It is also important not to claim that recurrent infection is inevitable after turbinate surgery. Most patients undergoing modern conservative procedures do not develop secondary atrophic rhinitis. The risk concern is greatest when tissue loss or mucosal damage is substantial.
Sleep, autonomic symptoms and psychological burden
Severe breathing discomfort is difficult to compartmentalize. ENS studies report substantial sleep disturbance, anxiety and depressive symptoms in many patient cohorts. These findings are clinically important because poor sleep can amplify pain, autonomic arousal, fatigue and the perception of respiratory effort.
Psychological symptoms should not be used to dismiss physical nasal complaints. At the same time, treating anxiety, depression or insomnia can be an important component of comprehensive care. The most constructive model is not "physical versus psychological" but recognition that persistent sensory and breathing symptoms can interact with sleep, attention, threat processing and mental health.
Some research has used functional MRI and other tools to investigate how ENS patients process breathing sensations. Such work supports the idea that central processing is relevant, but it does not establish that ENS is purely a brain disorder or that the symptoms are imagined.
How ENS is evaluated
There is no single blood test or CT measurement that diagnoses ENS. Evaluation begins with the history: prior turbinate or nasal surgery, the timing of symptoms and the characteristic paradox of obstruction or suffocation despite an open airway. Endoscopy and imaging can document anatomy and exclude other causes.
The ENS6Q is a validated six-item questionnaire designed to distinguish ENS-type symptoms from ordinary nasal obstruction. In clinical studies, a score of 11 or higher is commonly used as a screening threshold. The office cotton test temporarily adds volume to the inferior meatus; a clinically meaningful improvement in ENS6Q score supports the diagnosis and may help identify a target for augmentation.
The cotton test is not infallible. A 2025 blinded stepwise version, the SENSE test, was developed partly because placebo responses can occur. This is a useful development: a careful diagnosis should combine symptoms, anatomy, targeted testing and clinical judgment rather than rely on a single unblinded maneuver.
Treatment after ENS develops
Conservative management is individualized. Common approaches include humidification, saline and moisturizing products, treatment of crusting or infection when present, sleep support and management of associated anxiety or depression. Avoiding irritants and maintaining comfortable environmental humidity may help some patients.
For carefully selected patients with a positive cotton response, reconstructive procedures can add bulk to the inferior meatus or other target areas. Materials reported in the literature include autologous cartilage, acellular dermis and several synthetic or injectable materials. Systematic reviews show improvement on average after surgery, but outcomes vary and no single graft material has demonstrated universal superiority.
That variability reinforces the importance of conservative primary surgery. Preventing excessive functional tissue loss is more predictable than trying to reconstruct a complex sensory and aerodynamic system afterward.
Questions to ask before septoplasty or turbinate surgery
A patient does not need to become an expert in rhinology, but informed consent becomes more meaningful when the proposed operation is concrete. Useful questions include:
- What objective finding is believed to explain my symptoms?
- Which part of the septum, turbinate or nasal valve will be altered?
- Is turbinate surgery necessary, and which technique will be used?
- How much mucosa and turbinate volume is expected to be preserved?
- What non-surgical treatments have been tried or remain reasonable?
- What are the risks of persistent obstruction, dryness, crusting, perforation, valve problems and ENS?
- What is the plan if breathing is worse rather than better after surgery?
These questions are not an argument against surgery. They are a way to ensure that the intervention matches the problem and that the patient understands both the intended benefit and the meaningful long-term risks.
Audio version of the earlier lecture
The original version of this material was also published as a spoken presentation. The audio embeds are preserved below as part of the site's archive. They reflect the wording and interpretation used at the time and should be read alongside the evidence corrections in the updated article above.
Research and further reading
- Empty Nose Syndrome Pathophysiology: A Systematic Review
- Abnormal nasal aerodynamics and trigeminal function in ENS
- Validation of the ENS6Q
- Cotton test and ENS6Q clinical interpretation
- Surgery of the turbinates and “empty nose” syndrome
- Complications and management of septoplasty
- Systematic review and management algorithm for ENS
Open the earlier long-form lecture/transcript preserved from this site
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Welcome. In blog post, we will uncover the harsh truth about modern nasal surgery performed for nasal congestion—the truth that today’s surgeons do not want you to know about before agreeing to the procedure. The reality is that these surgeries, even when technically successful, can severely disrupt the autonomic nervous system—not just locally in the nose, but throughout the entire body. For many individuals, this leads to life-altering consequences, shattering their lives completely.
Many patients suffer lifelong and severe breathing problems as a result of these procedures, often in the form of paradoxical obstruction—a condition where, due to nerve damage and loss from the surgery, the nose will always feel blocked, even when it is physically open. This condition triggers an overactivation of the sympathetic nervous system, causing chronic stress and severe sleep disturbances.
Additionally, these surgeries frequently lead to complications involving the remaining nasal mucosa. The problem is not only what is removed but also what is left behind. After an aggressive turbinate reduction, the remaining mucosa often dries out, leading to degeneration. A common consequence is recurring nasal infections, which further deteriorate the mucosa. Over time, the mucosa becomes so dry that affected individuals can no longer tolerate normal environments without extreme discomfort and nasal pain.
The situation is made even worse by the fact that surgeons systematically withhold information about these risks and complications before the surgery. The only risks typically mentioned are bleeding and infection related to the procedure itself. All long-term, irreversible consequences—many of which are almost guaranteed—are deliberately omitted to avoid scaring patients away.
Before we dive into the full presentation, I want to emphasize that the reason behind this video is my own irreversible iatrogenic injury to my nasal mucosa and function following a routine, modern nasal surgery involving turbinate and septum reduction. After realizing the extent of the damage, I have spent thousands of hours researching this issue. In this video, I will present my findings to protect others from ending up in the same devastating situation—one that has completely destroyed my life.
Empty Nose syndrome / Iatrogenic Nasal Dysfunction
The condition I am about to describe is referred to in the medical literature as
Empty Nose Syndrome
(ENS). However, I personally prefer to call it
Iatrogenic Nasal Dysfunction
, as the term
Empty Nose Syndrome
falsely implies that the nose must be completely void of structures for someone to develop the condition. This is incorrect. A person who has undergone turbinate or septal surgery can still develop the condition, even if a significant portion of their turbinates remain intact. A more accurate term would be
Iatrogenic Nasal Dysfunction
, since
iatrogenic
refers to harm caused by medical treatment. This term better describes the root cause of the condition—a dysfunction of the nose and its structures resulting from a medically induced injury, specifically nasal surgery.
For simplicity, we will continue referring to the condition as
Empty Nose Syndrome
in this video, using the abbreviation
ENS
moving forward.
ENS is a severe condition that affects not only the nose but the entire body—both physically and mentally. The condition is highly likely to occur if a surgeon performs an aggressive turbinate or septal reduction, damaging, burning, or removing too many sensory neurons from the nasal mucosa. ENS is therefore primarily a nerve-related disorder, though other contributing factors exist, which we will explore later.
ENS encompasses several different issues, the most defining being
paradoxical obstruction
. This occurs when, due to nerve damage and sensory loss, the nose
feels
congested despite being physically open. Patients with this condition can no longer perceive airflow in their nose, meaning their brain no longer registers nasal breathing. This results in a constant sensation of air hunger and breathlessness, which is mentally and physically exhausting since the sensation is often persistent.
Other common issues in ENS include a lack of normal airway resistance, leading to shallow and rapid breathing. This not only causes mental distress but can also negatively impact oxygenation on a physiological level. You can learn more about this in my previous videos, which are linked in the description below.
ENS also includes complications related to the remaining mucosa, such as chronic dryness, recurrent nasal infections, pain, and discomfort from dry air. Many ENS sufferers experience extreme sensitivity and pain triggered by odors, airborne particles, and smoke. As a result, many are forced to rely on humidifiers 24/7 to compensate for their nose’s inability to produce adequate secretions. Additionally, ENS often disrupts the nasal cycle, causing either an abnormal, painful cycle or a complete absence of one. In many cases, both nostrils remain constantly wide open, further worsening mucosal dryness.
Since ENS frequently leads to severe sleep disturbances and chronic stress, it also accelerates aging and increases the risk of secondary health conditions. If you want to read about all known ENS-related complications, please refer to the link below.
Empty nose syndrome, a Guide to Diagnosis and Management for Medical Professionals
After researching this condition for several years, I can say that affected individuals suffer immensely. Many are unable to work, and many have lost both friends and partners. It is also not uncommon for severely affected individuals to take their own lives. During the years I have studied this condition, I have personally been informed of about ten people who ended their lives due to their suffering—and of course, I am not aware of all cases. Unfortunately, in most cases, the condition is irreversible, which is why the best treatment is prevention: never developing it in the first place. In other words, one should avoid nasal surgery and instead treat nasal congestion through natural methods. This is because Empty Nose Syndrome (ENS) can only develop as a result of nasal surgery. While it can also occur due to a prolonged and severe infection of the nasal mucosa, this is typically secondary to the dryness and immunosuppressive effects caused by the original surgery.
What many people struggle to understand is that ENS can either begin immediately after nasal surgery or develop gradually over time. It is not uncommon for affected individuals to experience severe symptoms only years after their initial surgery, making it difficult for them to link their problems to the procedure. This happens because the surgery itself damages the nose’s ability to keep the mucosa moist and healthy, leading to its gradual degeneration due to dryness. The timeline for such degeneration—or whether it occurs at all—depends on the extent of tissue damage and whether the nasal cycle is still functional, allowing each nostril to rest and recover in shifts. It also depends on the environment in which one lives—those in dry and warm climates may experience degeneration more rapidly.
Additionally, surgery on the turbinates and nasal septum often results in weakened immunity within the nose. This is because the procedure removes or damages nasal tissue that contains goblet cells, which produce mucus rich in antibacterial substances such as lysozyme, lactoferrin, nitric oxide, and antibodies—all of which have strong antibacterial and antiviral properties. As a result, it is common for affected individuals to eventually develop infections in the nasal mucosa, further damaging it and worsening airflow sensation and dryness, as even more goblet cells are destroyed.
After researching this condition for over four years and speaking with and reading the testimonies of hundreds of patients, I can also conclude that ENS almost always leads to severe sleep disturbances. Many affected individuals struggle to sleep more than one to two hours at a time before waking up gasping for air, even when taking sleeping pills. These medications frequently cause anticholinergic side effects, which exacerbate the pre-existing nasal dryness caused by the surgery. The anticholinergic effects also lead to additional problems, such as dry eyes, dry mucous membranes, dry mouth, and gastrointestinal issues due to reduced mucus production in the intestines.
Surgeons Blaming Poor Healing After Surgery = Gaslighting
What makes this condition unique is that it can only develop as a direct result of surgery. Some surgeons try to claim that poor healing is to blame. However, this is a lie designed to shift responsibility from the surgeon to the patient. On the contrary, the surgery itself is 100% responsible for the damage and the condition. The more aggressively a surgeon cuts away, trims, or burns nasal tissue during the procedure, the more severe the complications the patient will have to endure—either immediately or years later when the remaining mucosa has degenerated.
We must remember that during the surgery, the surgeon is cutting, trimming, or burning away sensory neurons in the nasal mucosa. In doing so, they destroy the nerves responsible for detecting airflow in the nose, which is essential for comfortable and relaxed breathing. When the patient later returns with problems, the surgeon often claims that poor healing is to blame. This is as absurd as saying that a patient’s inability to walk is due to poor healing after having their left leg amputated. This is medical gaslighting of the highest order—just like claiming that the turbinates are still present after a radiofrequency treatment and that it is impossible for the patient to have developed ENS as a result.
ENT Departments – How They Operate
N
ow, let’s move on to the next topic and examine how ENT (Ear, Nose, and Throat) departments function. Understanding this is crucial for any patient considering surgery. When a patient visits their local ENT specialist, they are not typically seeing a general physician who is primarily interested in investigating the root cause of their nasal congestion on a systemic level. Instead, the first person they meet is often a surgeon. These surgeons are employed mainly to perform nasal surgeries—whether or not they are truly necessary.
In fact, a large part of ENT department operations revolves around performing surgeries; the entire system is heavily dependent on this. To maintain their annual budget from the government, a certain number of nasal congestion surgeries must be performed each year. If fewer of these procedures are carried out, the department’s budget will decrease over time, eventually leading to job losses among surgeons. Additionally, many surgeons now work as consultants, selling their services to hospitals—meaning they have a personal financial incentive to perform as many and as extensive surgeries as possible.
It’s also important to understand that the highest-ranking individuals within ENT departments are typically those with the most education. Since surgeons generally have the most extensive medical training, they often become department heads, further steering the department’s focus toward more surgeries. As a result, the structure of the ENT field is unfortunately built in a way that is detrimental to individual patients. Because the goal is to perform a high number of surgeries, ENT specialists often fail to investigate the actual cause of nasal congestion before recommending surgery. A proper investigation would likely reveal that at least 90% of cases could be resolved naturally, without surgery.
There are many systemic causes of nasal congestion that can be treated without surgery. While this video is not intended to cover all of them, it is essential for patients to research and gather information before considering an operation. However, before we move on, let’s briefly mention some of the most common non-surgical causes of nasal congestion.
Natural Causes of Nasal Congestion
Some natural causes of nasal congestion include allergies (IgE- or IgA-mediated), food intolerances with IgG activation, and inflammatory conditions in the body such as autoimmune diseases. Mold, dust, pollen, or other irritating chemical substances in your environment can also contribute. Additionally, hormonal changes in the body can cause nasal congestion, particularly in women during pregnancy when estrogen levels rise. Another cause can be a deficiency of the DAO enzyme, which breaks down histamine—a compound that can trigger nasal congestion.
Long-term use of nasal sprays is another major cause. Nasal sprays themselves irritate the mucosa, and over time, their decongestant effect can lead to an increase in blood vessels in the mucosa to compensate for a chronic lack of blood supply. Moreover, the preservatives used in nasal sprays have been shown in laboratory studies to have cell-damaging effects, which can irritate and damage the nasal mucosa.
Many people are unaware that certain foods and beverages can cause nasal congestion. Examples include foods and drinks high in histamines, sulfites, or tannins. In general, aged foods tend to contain high histamine levels—such as aged cheese, canned tuna, fermented dairy products, non-fresh seafood, canned foods, and processed meats. When it comes to drinks, wine and beer are well known for causing nasal congestion. Additionally, processed foods, unhealthy oils, and fried foods like French fries can trigger congestion indirectly by promoting systemic inflammation. The same happens when consuming foods that trigger an immune response due to the presence of specific antibodies. Even healthy foods can cause issues if a person has an individual intolerance to them.
It is therefore recommended to conduct an IgG food intolerance test privately, as this is not typically offered in standard healthcare. Faster allergic reactions (IgE- or IgA-mediated) can be tested through regular healthcare services, but these are usually easier to identify since they occur shortly after consuming the triggering food. IgG reactions, on the other hand, can manifest hours or even days after exposure, making testing a more reliable approach for detection.
As you can see, there are many natural causes of nasal congestion that can be addressed without surgery. However, ENT (ear, nose, and throat) clinics are primarily focused on nasal surgeries, so they do not conduct such tests. If they did, many patients would likely be removed from the surgical queue—something that surgeons naturally want to avoid. Instead, some questionable tactics are used to promote surgery, which we will examine later.
Regardless, the prevailing message from healthcare providers is that the only risks associated with nasal surgeries are infection and bleeding. Unfortunately, this is far from the truth. The reality is that these procedures almost guarantee damage and complications rather than just risks. The real question is not whether you will experience damage, but rather the extent of the damage and how much it will affect you. These consequences are what we will now explore—since the medical field deliberately avoids informing you about them
Why Is It Difficult to Breathe Through the Mouth When the Nose Is Blocked?
Let’s begin. If you are reading this, you have likely experienced nasal congestion at some point and found it uncomfortable. But have you ever wondered why it feels so difficult? Have you ever questioned why complete nasal blockage is stressful and exhausting? Have you ever thought about why it is hard to sleep with a congested nose?
After all, you can always breathe through your mouth, which allows even more airflow than your nose ever could. So why does mouth breathing feel so uncomfortable?
This is where one of the biggest misconceptions in healthcare becomes apparent. The fact is that nasal breathing stimulates the parasympathetic nervous system—the part of the autonomic nervous system responsible for relaxation, recovery, digestion, and healing. Mouth breathing, on the other hand, activates the sympathetic nervous system, which is dominant during physical activity, movement, and stress responses.
When we breathe through the nose, nerve endings in the mucosa—called receptors or sensory neurons—are stimulated as air flows along the surface. These receptors act like sensors in a self-driving car, collecting data that helps the body's control system make appropriate responses. They transmit information to the brain’s respiratory center via the trigeminal nerve (cranial nerve V), allowing the brain to process breathing-related stimuli and regulate respiratory function accordingly.
There are many types of receptors in the nasal mucosa, each responsible for detecting different sensations and conditions. Without going into excessive detail, it is essential to know that the nasal mucosa has a high concentration of parasympathetic nerve fibers connected to the brain via the trigeminal nerve. These fibers are sensitive to various stimuli, including airflow and temperature changes. When these fibers are stimulated by nasal breathing, they trigger a parasympathetic response that promotes relaxation and well-being.
In this sense, nasal breathing can be seen as a continuous soothing massage for the brain and the parasympathetic nervous system. It is no coincidence that most meditation techniques emphasize slow, deep breathing through the nose. Nasal breathing helps maintain dominance of the parasympathetic nervous system, supporting healing, recovery, digestion, sleep, and relaxation. Numerous studies have also shown that nasal breathing enhances cognitive function, improves decision-making, and boosts memory—all due to the mechanical stimulation of these parasympathetic nerve fibers as air flows through the nasal mucosa.
Before undergoing nasal surgery, it is crucial to understand that such procedures do not just affect the nose itself but also impact the entire autonomic nervous system. In other words, nasal surgery is indirectly a procedure on the brain and nervous system—something surgeons conveniently avoid mentioning.
What happens to the nasal mucosa if you undergo surgery on the nasal septum or turbinates?
Yes, even if surgeons don’t say it, all surgery on the turbinates is essentially aimed at destroying them. Either they are partially or completely cut away, or they are burned using various heat-based methods that destroy the tissue and cause it to shrink.
I have previously made a YouTube video explaining how heat-based methods destroy the mucosa, so I won’t go into too much detail here, but I refer to my earlier video. In short, the sensory neurons that detect airflow are located on the surface of the turbinates. When these structures are burned, the surface where these receptors are located is destroyed as well. The tissue is transformed into scar tissue, and the affected individual loses all sensation of airflow in that area. The same thing happens if the turbinates are cut away—this guarantees that all receptor types in that area are permanently lost. Deep inside the nose, there is still a nerve connection to the brain via the fifth cranial nerve, but the outer nerve fibers that once detected airflow on the turbinates are gone. So even though the nerve connections to the brain remain, the brain can no longer receive information about airflow from this now-amputated region.
This raises the question: how much tissue can be burned or amputated before so many nerve fibers are lost that the brain can no longer receive a satisfactory signal that breathing is occurring through the nose? The patient will only find out the answer after the surgery. No surgeon can guarantee this in advance or determine where your personal threshold lies.
Additionally, it’s important to understand that the turbinates have other functions that are lost when they are burned or surgically removed. The surface of the turbinates contains goblet cells that produce mucus containing antibacterial substances. This mucus keeps the mucosa moist and healthy while protecting it from infections. If the turbinates are removed or burned, this function is also lost. The turbinates also have cilia, tiny hair-like structures that help clear the mucosa of dust, particles, bacteria, and old mucus by rhythmically moving it backward toward the throat, where it is swallowed and neutralized by stomach acid. This function is also destroyed when the turbinates are removed or burned.
Beyond this, the turbinates have several physical functions. One of these is increasing the mucosal surface area in the nose, which enhances the perception of airflow and stimulates parasympathetic nerve fibers, promoting a calming and relaxing effect on the nervous system. A larger mucosal surface also means more goblet cells, which produce mucus to keep the mucosa moist. Moreover, the turbinates play a role in the nasal cycle, which alternates airflow between the left and right nostrils, allowing one side to rest while the other handles breathing. This also maintains consistent breathing resistance despite the shift between sides.
As I have described in some of my previous videos, several research studies have confirmed that mechanical airflow stimulation of sensory nerve fibers in the left and right nostrils affects the brain differently. For example, left-nostril breathing has been shown to stimulate the right hemisphere of the brain, which is more involved in emotional and creative processes. It has also been found that left-nostril breathing can increase activity in the limbic system, including the amygdala, which influences emotions and stress responses. Meanwhile, stimulation of sensory nerve fibers in the right nostril activates the left hemisphere, which is more associated with analytical thinking, language, and logical processing. Right-nostril breathing has also been found to influence activity in the prefrontal cortex and temporoparietal regions, which affect concentration, attention, and cognitive functions.
All of this is directly linked to the fact that sensory neurons in the left and right nostrils have different connections to the brain. Hopefully, you can now better understand that nasal surgery is not just a local procedure but also an operation on the brain and nervous system. In fact, nasal surgery can even alter your personality and cognitive functions if these sensory neurons are destroyed. After thousands of hours of research, I can conclude that many people with Empty Nose Syndrome (ENS) experience cognitive difficulties such as issues with attention, concentration, and memory.
So, to answer the initial question—why is it difficult to breathe through the mouth when your nose is blocked? The answer is that the sensory neurons in the nose, which are connected to the parasympathetic nervous system, are not being mechanically stimulated by airflow along the mucosa in this blocked state. The brain is thus deprived of this neural stimulation and signaling, leading to sensations of breathlessness and tension. In such a situation, the only thing a person can think about is using nasal spray to open the nose. Only then can they feel comfortable and at ease again.
Now, knowing this, one should ask: is it really a good idea to operate on the nose and surgically remove or burn away these sensory neurons? Of course not. When enough of these neurons are destroyed, the individual will always feel congested, even though their nose is now physically open.
Laminar Airflow in the Nose Transitions to Turbulent Flow
Furthermore, it should be noted that the nasal turbinates, through their shape, size, and placement, transform laminar airflow upon inhalation into turbulent airflow deeper in the nasal cavity after the air encounters the turbinates. This turbulent flow better distributes odor molecules for improved olfaction while also enhancing airflow perception and prolonging the contact time between inhaled air and the mucosa. This allows for greater humidification and warming of the inhaled air, which is crucial for proper gas exchange in the lungs. The turbinates also ensure that the air is warm and humid before reaching the back of the nose and throat. When the turbinates are significantly reduced or removed, many individuals experience dryness and pain at the back of the nose and throat. Additionally, the turbinates reduce the open diameter of the nasal cavity, creating a Venturi effect that increases the velocity of inhaled airflow. To describe this effect: air enters the nose through the external nostril, where the diameter is large, and airflow velocity is relatively low. When the air later reaches the front part of the turbinates, where the nasal cavity's diameter is smaller due to the turbinates, the airflow velocity increases. This increased velocity results in greater activation of nerve fibers on the mucosal surface, including the turbinates themselves, the mucosa covering the nasal septum, the nasal floor, and the lateral wall. This leads to an enhanced sensation of airflow in the nose and stronger activation of sensory neurons. If the turbinates are removed or significantly reduced, the velocity of the air decreases significantly. Turbulent airflow now transitions into laminar airflow, reducing the perception of airflow even on the remaining mucosa that was not removed. This can contribute to the sensation of breathlessness, which is well documented in Empty Nose Syndrome (ENS).
Nasal Surgery and Its Impact on Airflow
It is also important to note that each nostril contains three turbinates: the inferior, middle, and superior turbinates. Air is distributed around and between these turbinates, and if, for example, the inferior turbinate is removed or significantly reduced, air will primarily take the easiest path to the lungs—along the nasal floor. Airflow towards the upper part of the nose, including the middle turbinate, the septal swell body, and the superior turbinate, will now decrease and mainly be of a laminar nature. This leads to a reduced perception of airflow in these areas as well. Reducing or removing the inferior turbinates, which is common in nasal surgery to treat nasal congestion, can therefore result in a decreased perception of airflow in other parts of the nose. This can exacerbate the effects of nerve loss from the cauterized or amputated turbinates, causing even greater problems with sensory loss and breathlessness.
We have now discussed turbinate surgery and how it can result in breathing difficulties such as breathlessness and disrupted nasal airflow patterns. What we have not yet discussed is how septal surgery can have similar consequences. Many mistakenly believe that only turbinate surgery can lead to breathing issues, dryness, and ENS, but the fact is that any nasal surgery affecting the mucosa can impair the ability to perceive airflow in the nose. This impairment is the primary cause of the breathlessness associated with ENS. The question is how much tissue can be damaged before the problems become so severe that the brain no longer receives sufficient information that breathing is occurring through the nose. One thing is certain: the more mucosa that is damaged—whether it be the turbinates, the nasal septum, or other nasal mucosa—the greater the likelihood of nasal dryness and loss of sensation, and thus the higher the risk of developing ENS after surgery. A combined surgery involving both the turbinates and the nasal septum significantly increases the likelihood of experiencing issues with dryness, sensory loss, and chronic breathlessness compared to surgery involving only the nasal septum or only the turbinates.
It should also be noted that septal surgery is very often combined with partial removal of the inferior turbinates, frequently without informing the patient. I personally had the majority of my inferior turbinates removed during a septoplasty without my knowledge. Neither the surgeon nor anyone else informed me that a vital organ would be removed in conjunction with the septoplasty. I have heard similar stories from many other affected patients. It was not until four years later, during a private radiological examination, that I realized that most of my inferior turbinates were missing.
Now, let us proceed to examine how septoplasty can cause ENS-related issues. Firstly, it is essential to understand that having a deviated nasal septum is normal. Eighty percent of the world’s population has a more or less deviated septum, and this is a natural variation. Most people are born this way, and when born with a deviated septum, the turbinates adjust their shape and size according to the available space in each nostril. They become smaller on the concave side and larger on the convex side, which usually results in an equally open space for airflow in both the right and left nostrils. In most cases, a deviated septum is not the true cause of nasal congestion, but surgeons often do not explain this because they want to perform the surgery.
Risks and Complications of Nasal Septum Surgery
Yes, in my previous lecture, I explained how such a surgery can damage the mucosa. If you want to see this in detail, I refer you to that video, and I will leave a link in the description. However, I want to briefly mention a few things here that are very likely to occur.
First, it is common for a nasal septum operation to alter the external shape of the nose, and this is usually not for the better. The nose often becomes crooked and uneven, and it is very common to develop nasal valve collapse. Besides being aesthetically unpleasing when one or both nostrils collapse, this usually has a very negative effect on breathing and the perception of airflow. When the roof of the nose collapses, airflow to the upper part of the nose is completely or partially blocked. This makes it more difficult for air to reach the septal swell body, where many sensory neurons are located. It also makes it harder for air to reach the middle and upper turbinates and the upper part of the nose. This significantly reduces the sensation of having an open nose and experiencing comfortable breathing, which in itself can cause issues such as shortness of breath—even if no tissue has been removed or destroyed. It should also be noted that surgery to correct nasal valve collapse is extensive and highly invasive. I have personally heard many accounts of such procedures resulting in even greater problems than the original issues.
Septoplasty Causes Mucosal Damage – The Mucosa Tears Apart!
In addition to this, it is important to know that performing surgery on the nasal septum requires detaching the mucosa from the cartilage wall of the septum. This must be done in such a way that the connective tissue layer (perichondrium), which lies between the cartilage and the mucosa, is separated as a single unit along with the mucosa. This is crucial because the mucosa itself is delicate and can easily tear. Many surgeons neglect this and fail to separate them together in one piece, increasing the risk of the mucosa tearing apart. Even if the surgeon successfully detaches both the mucosa and perichondrium together, many surgeons are too aggressive and, at some point during the procedure, end up tearing the thin mucosa in multiple places. Such damage is irreversible.
When the mucosa tears, nerves and blood vessels are severed. The mucosa then loses sensation partially or entirely, and the large blood vessels that wind through it are cut and will not reconnect. The only blood vessels remaining in the septal mucosa are then the small capillaries. This makes the mucosa paper-thin and fragile. Since the larger blood vessels are now severed and partially or completely gone, the mucosa becomes dry and can no longer swell and contract in sync with the turbinates. As a result, the nose remains more open, which negatively affects the ability to sense airflow. This issue can be further exacerbated if the surgeon removes cartilage from the septum, making the nose even more open. From earlier in this video, we already know that the nose should not be too open, as this reduces airflow velocity to the point where the remaining functional sensory neurons struggle to detect that air is flowing along the mucosa. It should also be noted that reduced blood flow to and within the septal mucosa due to surgery leads to a drier mucosa.
Destruction of the Septal Swell Body During Septoplasty
Furthermore, it is common for this type of surgery to damage the area on the upper part of the nasal septum known as the septal swell body. This area, located in the upper part of the nose in front of the attachment of the middle turbinate, has a function similar to that of the turbinates. Sometimes referred to as the "fourth turbinate," it contains a high density of sensory neurons that are essential for the nose to detect airflow, providing an individual with a comfortable breathing sensation. The area also contains a large number of goblet cells that produce mucus to keep the mucosa moist, healthy, and free from infections. Surgery on the nasal septum often completely or partially destroys this area. The likelihood of damage increases if the mucosa is detached far back in the nose near this area or if the surgeon tears off the blood vessels and nerves connecting to the swell body during the procedure.
Finally, it should also be noted that the connective tissue layer called perichondrium, which lies between the cartilage wall and the mucosa, is vital for the cartilage cells of the nasal septum. The perichondrium supplies the cartilage cells with blood and nutrients. If this layer is stripped away on both sides of the septum, the cartilage cells will die. When this happens, a hole in the septum will form some time after the surgery. The size of the hole can vary depending on the affected area. In the worst-case scenario, the hole can become so large that both nostrils essentially merge into one. This weakens the cartilage wall and often leads to nasal valve collapse. As a result, airflow in the nose is disrupted, and it may also cause whistling or disturbing noises when breathing through the nose.
As you can see, nasal septum surgery can cause significant complications that may result in lifelong and troublesome issues—none of which your surgeon will tell you about. The only risks they will mention before surgery are those related to bleeding and infection.
It would be one thing if healthcare providers honestly informed patients about the consequences of this type of surgery, allowing them to make an informed decision on whether to take the risk or not. However, when this information is deliberately withheld to facilitate more surgeries or to avoid alarming patients and dealing with follow-up questions, it amounts to nothing less than medical malpractice. The real question is how society and politicians can allow the consequences of these surgeries to be concealed from patients. Shouldn't it be reasonable for a patient to receive complete information before undergoing a procedure so that they know what they are getting into?
The image below presents a summary of some follow-up studies conducted on nasal surgeries performed to relieve nasal congestion. This summary was compiled by Dr. Steven Houser, and the article is titled "The Diagnosis and Management of Empty Nose Syndrome." I have linked the article below in the video description for those who wish to read it in full.
Now, let us examine one of the studies mentioned in the article, namely "Moore et al., 1985." The study shows that patients who had their inferior turbinates completely removed experienced severe issues as early as one year post-surgery. The follow-up period spanned between two and seven years after surgery. The results revealed that eighty-nine percent of all patients had developed problems with dryness and crusting in the remaining nasal mucosa. Additionally, sixty-six percent had developed atrophic rhinitis due to the surgery—a degenerative condition where the mucosa deteriorates due to dryness. Furthermore, twenty-two percent had developed ozena, a form of atrophic rhinitis characterized by foul-smelling crust formation in the nose, typically caused by the bacterium Klebsiella.
To summarize, approximately nine out of ten operated patients suffered from dryness and crusting in the remaining mucosa, around seven out of ten developed atrophic rhinitis, and about two out of ten developed ozena. Given these statistics, how can it be acceptable for healthcare providers to perform these surgeries at all? More importantly, how can they mislead patients into undergoing these procedures without informing them of the consequences, when the likelihood of experiencing these issues ranges between twenty and ninety percent? This modern-day lobotomy in healthcare must come to an end, so do not be deceived into having your turbinates removed. They are essential breathing structures, and you need them. All mammals have turbinates. The only mammal that believes they can be removed is humans.
Unnecessary Surgery on the Nasal Septum and Turbinates
Finally, let us examine a method that surgeons use as a sales pitch to persuade unsuspecting individuals into surgery. They claim that nasal congestion occurs because the turbinates have grown too large, necessitating their removal or cauterization to restore normal breathing. But consider this: How many other organs in the body continue to grow uncontrollably large? Do you know of any? No? That is because the body does not work that way.
Let us look at how the process unfolds. The first step when evaluating a new patient is to send them for an X-ray. Often, the X-ray will reveal that the nasal septum is deviated and, therefore, must be surgically corrected. As you may know, eighty percent of all people have some degree of a deviated nasal septum. However, since this information is withheld from patients, surgeons can always claim that their nasal congestion is caused by the deviation and that surgery is necessary. If this claim does not succeed, and they still wish to push for surgery, they use another tactic. They argue, based on the same X-ray, that one or both nasal turbinates are too large and must be reduced.
This reasoning suggests that nasal structures, for some unknown reason, continue to grow uncontrollably until they must be cut away or burned down. However, that is not how the body functions. The organs of the body have predetermined sizes; they do not grow indefinitely. What is unique about the turbinates is that they are densely packed with blood vessels that can expand or contract in response to signals from the autonomic nervous system. This process is part of what is known as the nasal cycle. The nasal cycle causes the turbinates and mucosa on one side of the nose to swell while the opposite side contracts, alternating every few hours. Thus, it is impossible to take a single X-ray image in a fraction of a second and claim that one side's turbinates are permanently enlarged and obstructing airflow, necessitating surgery.
However, this is exactly how surgeons manipulate patients. They exploit the patient's lack of knowledge by presenting a single X-ray image showing swollen turbinates and claiming that surgery is required. If they were genuinely interested in proving that one side's turbinates are consistently enlarged and obstructing airflow, they would need to take multiple X-ray images over time to track nasal airflow throughout the nasal cycle. But since their goal is to operate on as many patients as possible, they deliberately omit this crucial detail. Instead, they use a single image to justify surgery, knowing that most patients are unaware of the nasal cycle.
On the screen, you can see two X-ray images of the same individual taken at different times, showing the nasal cycle shifting from one side to the other. In these images, it is clear that there is sufficient airflow space in both nostrils when the nasal cycle is in a contracted state. This proves that surgery is unnecessary. However, in standard practice, only one image is taken and shown to the patient to convince them that surgery is needed.
Your Body is the Surgeon’s Raw Material for Profit
How You Are Tricked into Turbinate Ablation via Coblation or Radiofrequency Ablation with Devastating Results
Finally, I just want to remind you that surgeons' main goal and purpose in their work is to make a lot of money and perform many surgeries. They enjoy cutting, slicing, and burning, and your body is their raw material, which they process to produce a finished product that results in money flowing into their accounts. Moreover, they are extremely protected by the current legal system, which means they are not even required to tell you what damage you will suffer from their surgery. In fact, they do not even have to fully disclose what they will do during the operation, because afterward, you will not be able to sue them when you are injured and have had parts removed that were not agreed upon.When it comes to nasal surgery, there is no standardized method that surgeons must follow. They have free rein to do whatever they want, as long as they describe their approach as a “proven and scientific method.” The problem is that this is considered a valid method whether the surgeon removes five percent of your lower turbinate or completely removes all three turbinates in each nostril. This means that even if the surgeon performs a procedure that was not agreed upon, you cannot later claim malpractice and win. The surgeon can always argue afterward that an unforeseen necessity arose during the operation, forcing him to expand its scope—for example, that the nasal cavity turned out to be narrower than he initially thought.
If you still doubt the truth of this information and are considering surgery as a solution for your nasal congestion, I urge you to take a few final minutes to read and listen to the stories of patients who have already been harmed. Listen and absorb the suffering they have endured, and take one last moment to consider whether you truly want to have your life irreversibly destroyed by a surgery that could have been completely replaced by natural treatments for nasal congestion.
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