Please recommend doctor for empty nose syndrome (ENS)

[Top718]

My brother believe that he has ENS due to nose surgery 3 months ago. His symptom include depression, anxiety, dry nose, wake up at 3 am for a month. He went to see Bumrungrad ENT doctor twice and doctor say everything looks fine.

 

For the last 5 days, he keeps telling me that he is desperate and asking for my help. Today, I book an appointment with Assoc.Prof. Paraya Assanasen as recommended by Sheryl. The fastest queue is January 27, which he can’t barely wait. Please recommend doctors in Bangkok that treat ENS.

 

Thank you for your help

[Sheryl]

Prof. Paraya is the only one I know of in Bangkok that is likely to have even heard of it.

 

Depression and anxiety are not signs of ENS per se, especially not depression. And anxiety in ENS would be secondary to a sense of being unable to breathe, which you do nto mention.  I wonder if he may nto have either an unrelated psych problem, or mild ENS combined with a psych problem.

 

Waking up in the middle of the night can be a sign of an anxiety disorder.

 

Suggest you look at the Mental health resource list, several good counselors in Bangkok

https://forum.thaivisa.com/topic/90910-mental-health-resource-list/

 

 

[James Skinner]

Actually anxiety, depression, and sleep problems are very common in ENS patients.

I recommend you look over my ENS getting started guide https://nasalcripple.com/nowwhat 

The first few months of ENS can be very hard adjusting to difficulty breathing.

Edited December 26, 2020 by James Skinner

[Top718]

Thank you for your comment James Skinner

 

Yesterday, he went to see ENT doctor at bumrungrad, Dr looks inside his nose and said everything looks fine. He recommends my brother to see a psychiatrist. He believes that the dry nose problem is due to his anxiety.

Edited December 27, 2020 by Top718

[Chomper Higgot]

I recommend Dr Somchai ENT specialist at Samitivej Hospital Sriracha.

 

I had major sinus surgery with him, he sorted long term health problems that a Harley Street Surgeon couldn’t solve.

 

I cannot recommend Dr Somchai highly enough.

 

[Top718]

Thank you for recommending Dr Somchai @ Samitivej Sriracha, I will have him on my list.

This webboard is awesome, every answer are so helpful.

[James Skinner]

On 12/27/2020 at 7:47 AM, Top718 said:

'He recommends my brother to see a psychiatrist. He believes that the dry nose problem is due to his anxiety.'

 

The majority of ENTs don't recognize ENS.  You can't diagnose ENS by visual inspection, the nose often looks normal.  Sadly, telling a patient to see a psychiatrist who in fact has ENS is common.  The dryness is likely due the surgery.  Do you know what was done during the operation on his nose?  Do you have a CT scan of his nose after the operation?   Here is a list of common symptons https://nasalcripple.com/ens

[Airalee]

I have ENS myself
 

1.  Read this.  Written by an Aerospace Engineer that I know who also has ENS.

 

https://emptynosesyndromeaerodynamics.com

 

2.  Give it time.  A year or more.   It will potentially get better over time if the primary reason for ENS is nerve damage. My symptoms have subsided by probably 60-80% over the last 3 years.  It is now tolerable.  
 

3.  Don’t let doctors futz around in there if they don’t know what they are doing...which is most doctors.  Many will talk about PRP (platelet rich plasma) injections which according to the very few experts that work in the field, don’t work long term.  You can make things worse.

 

4.  Eat healthy and exercise.  I cannot stress this enough.  
 

5.  For the anxiety, that is caused by the uncomfortable sensation of suffocation and not feeling like you can take a “full breath”,  and the depression that will come from lack of sleep, disrupted lifestyle etc, see a psychiatrist and get the necessary medications to help. 

6.  Had I gotten treatment...which fortunately I did not...there is only ONE doctor that I would consider seeing.  That doctor is Jayakar Nayak at Stanford University in California.  The author of the study (linked to above) was immensely helped by him (via implants).  Beware of the charlatans out there...there are some for sure.

7.  To add...for the dry nose, sleep with a humidifier.  That will help a lot.

Any questions you have, feel free to ask. 

 

Edited January 5, 2021 by Airalee

[Sheryl]

2 hours ago, Airalee said:

 

5.  For the anxiety, that is caused by the uncomfortable sensation of suffocation and not feeling like you can take a “full breath”,  and the depression that will come from lack of sleep, disrupted lifestyle etc, see a psychiatrist and get the necessary medications to help. 

 

 

 

Agree, the condition does not directly cause anxiety, that is a reaction to the symptoms (as can occur in any condition)

 

However there is no indication that the OP's brother is having this subjective sensation of suffocation and rather he may simply have an anxiety disorder.

 

Even if not, counselling can help him better handle things without becoming anxious and/or depressed.

[Airalee]

6 hours ago, Sheryl said:

 

Agree, the condition does not directly cause anxiety, that is a reaction to the symptoms (as can occur in any condition)

 

However there is no indication that the OP's brother is having this subjective sensation of suffocation and rather he may simply have an anxiety disorder.

 

Even if not, counselling can help him better handle things without becoming anxious and/or depressed.

It’s hard to say.  I deal with anxiety (and always have), but when the ENS first hit after a month or so post turbinate coblation, I can guarantee you that it was nothing like I had ever experienced.  I literally wanted to jump off a roof.  There was no way that counseling without medication would have helped as it was a physical discomfort (hard to describe) that really is unlike any other .   The depression comes from the feeling of “is this my life from here on out?  Will I ever get better?”  When you look into the experimental treatments, they don’t (for many people) seem very promising (on a permanent basis).  Also, the lack of sleep...again...hard to explain as it’s not driven by a panic attack but rather the crazy sensation of not being able to take a full breath.

 

Also...some ENS is more nerve damage and less of what a full turbinectomy would give you (this is where implants are necessary) and over time, it gets better (as it did in my situation).  I’m certainly not 100% and some days are better than others...but at least I’m not where I was 4 years ago.  It truly was a living nightmare.

 

I probably shouldn’t say this...but if you want to experience what it’s like....shoot about 10 squirts of oxymetazoline (afrin) into each nostril....open your nose (a lot) more than the usual one or two squirts would provide...and you’ll understand.

[Sheryl]

However there is no indication the OP's brother has such symptoms. 

[Top718]

Sorry for late reply as I am too busy about my brother.

 

Thank you Airalee for sharing your experience and because of your comment, I just ordered resmed cpap an hour ago and will arrive on Thursday to help humidify his nose.

 

Last week he has visited Manarom and Bangkok hospital and currently admitted to Samitivej srinakarin, as of today he still feels anxious about his nose. Everyday psychiatrist(Dr.Amporn) visit him 1 hour each day for counselling and ENT 20 minutes at his patient room. All 3 ENT doctors@samitvej confirm that his nose is not the problem and focus on his anxiety and depression.

 

He is currently get sleep aid throught his vein, he talke less, and lost he weight.

 

He is so desperate to see Prof. Paraya for such a long queue, so lucky that today I can change his appointment from 26 to 19 Jan.

 

Thank your so much, as every comment can apply to real life.

[Top718]

Thank you, Sheryl for recommended Prof. Paraya, he is the best.

 

Visited him on Jan 19. Looking at his nose through endoscope, he confirms that he does not have ENS. He said that surgery make my brother breathe easier and better, but he does not use to it. He answers my brother repeated questions patiently. So much time was given to a patient, I am extremely impress.

 

He is now getting much better after seeing him, Thank you.

[Sheryl]

Glad it worked out well. Is your brother now getting counseling for his anxiety?

[Top718]

Yes, but at Samitivej Srinakarin every Saturday. 1 hour each counselling.

 

Thank your so much Sheryl 

[Sheryl]

10 minutes ago, Top718 said:

Yes, but at Samitivej Srinakarin every Saturday. 1 hour each counselling.

 

Thank your so much Sheryl 

 

If he is happy with the counselor/pyschiatrist please post the name here for future reference

 

All the best to him and you.

[nausea]

Never heard of ENS, live and learn. Actually, I have the opposite problem, my nose has suddenly become very mucuous prone and I sometimes experience a feeling of pressure, it seems to have been initiated by swimming. I put the source down to having my nose broke and reset many years ago, a bit like the tingly feeling I sometimes get on the right side of my face, again an area that took some damage; a nerve thing I guess. Weird that these things come back to haunt you in old age. I mentioned the nose thing to a doctor, he examined my nostrils and ascertained there was no obvious physical problem, then prescribed some anti-allergy drug, a cookie, one size fits all, solution if you ask me. I've never had a problem with allergies. 

[Sheryl]

A lot of people who never had allergies develop issues in Thailand especially this time of year. Air pollution.

[Top718]

Yes he is very happy with pyschiatrist that gave him counselling. Actually Dr.Amporn is his pyschiatrist for the past 5 years.

I believe that Dr.Amporn do not accept new patient due to her busy schedule.

 

https://www.samitivejhospitals.com/doctor/detail/amporn-benjaponpitak

[Sheryl]

52 minutes ago, Top718 said:

Yes he is very happy with pyschiatrist that gave him counselling. Actually Dr.Amporn is his pyschiatrist for the past 5 years.

I believe that Dr.Amporn do not accept new patient due to her busy schedule.

 

https://www.samitivejhospitals.com/doctor/detail/amporn-benjaponpitak

Thanks, very good to know