Review of “Having Nasal Surgery? Don’t You Become An Empty Nose Victim! by Christopher Martin

How would you feel if you went into a surgical procedure to help alleviate a physical problem, only to learn after the surgery is completed that the surgeon created a much more devastating problem than the one you went into surgery to cure, even though the surgeon followed accepted medical practices? In fact you also later find out that over 50% of the people who come down with this artificially created illness meet the definition of clinically depressed, and this is on top of and because of the awful physical pain which was the result of the initial surgery. And the icing on the cake is that the problems caused in surgery cannot be reversed. The answer to this

question is obvious: you would feel miserable and probably depressed yourself.

Anyone who is contemplating sinus surgery should read this book. Also, anyone who has a friend, colleague, or family member who is facing sinus surgery should urge those people to read this book as well.

Christopher Martin has written an important book about ENS, or Empty Nose Syndrome. In layman’s terms what happens is this: during sinus surgery all or a portion of the turbinates in the nose are extracted. It has been fairly common practice in the past for turbinates to be cut out because they sometimes can block nasal passages. Not much was known about the functions of the turbinates, and it was felt that extracting them wouldn’t cause much harm. In fact the term ENS did not even appear until 1994 when Dr. Kern, formerly of the Mayo Clinic, coined the term when he was treating patients complaining about sinus infections and congestion, which was puzzling because their nasal passages were wide open, in fact they appeared to have an empty nose. These people felt so miserable that, according to Dr. Kern, two of the patients he was treating committed suicide.

Martin discusses the basics about how the nose works. He talks about mucous tissue, cilia, and how mucus in the nose is normally disposed of. Of course he discusses the turbinates and the functions they perform, such as directing air flow, providing air flow resistance, warming and humidifying air before it reaches the lungs, etc. He discusses the symptoms of ENS, traces the history of various nasal surgical procedures, even discusses the politics of ENS and why many ENT specialists are not very aware of it or don’t consider it seriously. He also talks about various surgery options and gives an opinion about which procedures are the safest and most risky in terms of ENS.

And of course he tells his own story. Here is a young man of only 27 years of age with a young family. He has had to deal with this condition virtually all of his adult life. Here is an excerpt: “While there are times I have felt confident and strong, I will concede there are times when I cried. I cried because of the severity of this problem and the constant management of it. I cried because I want to have more energy for my wife and children, for people other than myself, but I find myself preoccupied with my nose and depleted of such energy. It seemed selfish to be so consumed with my nose, but I could not avoid it. I wish I could say that I never complained, but I cannot. It is ENS with which I have been dealing and ENS is a difficult condition to endure.” Martin offers extensive commentary about how he personally deals with his condition and gives suggestions and encouragement for other ENS sufferers.

In the Introduction of the book, Dr. Wellington S. Tichenor, a medical specialist in sinusitis in New York City who often treats patients who have had surgery that did not work, says the following: “I have been overwhelmed by the devastation that ENS patients experience. As a result of an iatrogenic (caused by medical treatment) origin, the lives of these productive individuals have been profoundly affected. Before their surgery they could go about the lives with varying degrees of difficulty, but after it they were completely disabled.” He adds, “Too many surgeons today believe they can indiscriminately remove large amounts of turbinate tissue and, indeed, there remains controversy in the field whether this surgery can be done with minimal complications. I am a strong proponent of conservative turbinate surgery that consists of removing the smallest amount of tissue possible.”

If I were to criticize the book I would offer the opinion that Martin is sometimes too technical. I understand why he is doing this, as he wants to fully explain the condition and what to do about it. However, he often sounds like an ENT, which he is not. He clearly explains in his disclaimer at the outset of the book that he is not a medical professional, and I expect he had several ENTs review the book, and they apparently didn’t ask him to change what has been published. For all I know everything he says and every medical term he uses are correct, and I would not be surprised if that were the case. It just seems to me that he sounds at times like an ENT, and I would respectfully question his credentials to do so.

What is clear, however, is that he certainly has sufficient credentials to speak about ENS, and his message is powerful and important and clearly overrides the comments in the previous paragraph. I personally have had two sinus surgeries and consider myself lucky and thankful that Empty Nose Syndrome hasn’t happened to me. For a few dollars to buy the book and a couple of hours to read it, sinus sufferers who are considering surgery can learn a great deal about their condition and can possibly prevent themselves very serious problems in the future. It is certainly worth the time and money.