Opinions on ENS Implant Surgery
I have ENS and looking for implant surgery opinions if anyone underwent through Citardi/Das or any other doctor ?
21 years back I had a sinus + septoplasty nasal surgery (both my inferior turbinates were almost removed by doctor in that surgery - one side complete, other side almost - it is 90%+ turbinates removed on both sides. Actually for this surgery he should not remove but he removed), immediately after surgery I got ENS . This screwed up my entire life and I got many other health issues due to ENS. I used to have suffocation, no air sensation, no moisture, severe nasal dryness etc. Until few years back I dont know that these symptoms comes under ENS and through some doctor came to know about it and he suggested to meet Nayak. I got rib cartilage implants with Nayak few years back - it improved my symptoms but did not fix all my problems. I did not see much improvement in dryness even after implants - its almost same. I would say it brought me from severe ENS to moderate ENS in all symptoms except dryness. I have continuous dryness even now which impacts my productivity a lot. One reason is that on left nostril, tissues got broke during surgery, so Nayak could not implant much on left side and it is almost open. On the right side he implanted but still I have dryness, it requires further augmentation as there are gaps. Based on my understanding even 1mm less turbinate can cause huge difference in airflow. I was working with Nayak and he suggested I might require one more surgery. I scheduled follow up appointment last year to re-evaluate my condition but all of a sudden he went to Sabbatical and appointment was cancelled. I waited for him till now but based on discussion with his team he might not come back to see patients it seems.
To my knowledge, in USA Steven Houser, Nayak, Das and Citardi are doctors who treat ENS. Among them Houser is not taking ENS patients, Nayak is in Sabbatical and might not come back to see patients. Nayak is very good doctor for ENS but he is not seeing any patients now. So I met Citardi and he did cotton test which turned out to be positive and he told he would like to do surgery using Bovine Derived Collagen Matrix.
I had virtual appointment with Das too where he talked about rib implants, injection treatments to treat ENS and he wants me to visit in-person to evaluate further. I did not visit Das in-person yet.
ENS is very complex as materials (rib cartilage, alloderm, bovine derived collagen matrix - BDCM etc) being used, placement of material, surgeon experience in carefully creating submucosal pocket matters a lot. Rib cartilage is very good material for implants but not all doctors use it as it requires very technical expertise. Among Citardi and Das, Das uses rib cartilage implants whereas Citardi prefers BDCM. I asked Citardi explicitly if he is fine in doing rib cartilage - he told he prefers BDCM
Nayak uses IMAP (inferior meatus augmentation procedure) whereas Citardi uses Augmentation Turbinoplasty. Das does not do IMAP and he places rib cartilage implants at different place.
Based on my analysis I saw many negative reviews on regenerative treatments (PRP/Acell/Fat grafting etc). So I wanted to undergo implant surgery and unable to make a choice between Citardi and Das. I have seen many negative reviews on Das for injections and few negative reviews on his implants where he placed implant at wrong location which caused many more problems to patient. There is so much of confusion on which is right.
I wanted to know if anyone in this community can suggest their experiences with Citardi/Das and who is good for implants ? If anyone has undergone implants with any of these doctors kindly share your experience. Data with BDCM is very less and not sure if that material gets absorbed over a period of time requiring repetitive surgeries. I got many surgeries in my life and among them 5 are nasal surgeries. So I don’t want to have again and again. Rib implants if done correctly it will be for long term but only Das does that now. I dont see enough positive reviews on him for implants. Reviews on Citardi in google are good but those are general ENT related but not on ENS.
Also if there are any other doctors who can treat ENS condition (preferably rib cartilage implants), please kindly share it would be helpful.