是否真的有「空鼻症」？
2 个回答
空鼻症是真的吗？如果不是，那为什么人们通过自杀来摆脱它呢？
This medical mystery — a byproduct of common nasal surgery — has stumped many doctors and scientists, some of whom suspect the suffocating condition may just be imaginary. But that isn't making the people who feel suicidal over its horrific symptoms feel any better.
这个医学界的谜题，这个常规鼻腔手术所产生的副作用，已然难倒了诸多医生和科学家。而他们中的一部分人，怀疑所谓的窒息感仅仅是患者的臆测。然而，这种说法却不足以说服那些因为术后并发症饱受煎熬甚至不惜放弃生命的人们。
Posted on April 15, 2016, at 9:37 a.m.
Joel Oliphint BuzzFeed Contributor
When Brett Helling turned 36 on January 29, 2015, he was living in his parents’ basement in Worthington, Ohio, a well-heeled suburb of Columbus. His mom made him his favorite dinner: roast beef and mashed potatoes with Texas sheet cake for dessert. Brett’s friends sent him happy birthday messages on Facebook. Some asked where he’d been, why they hadn’t seen him in so long. Down the road at Natalie’s Coal-Fired Pizza and Live Music, where Brett had been working fewer and fewer bartending shifts, his co-workers texted him, begging him to come celebrate. But he didn’t want to be seen. He couldn’t do anything but lie on the couch, listless, trying to ignore the sensation of suffocation that had been plaguing him for nearly a year.
在2015年1月29日，当Brett Helling （布雷特赫林）到了36岁的时候，他居住在他父母的在地下室中，俄亥俄州沃辛顿，一个在哥伦比亚富有的郊区。他的妈妈给他做了他最喜欢的食物：烤牛肉，碎土豆，和德克萨斯薄片蛋糕作为点心。Brett（布雷特）的朋友们在他的脸书中私信他生日快乐。有的人还问他最近怎么样，为什么这么久不和他们联系。在Natalie（地名）的Coal-Fired和Live Music的乐队，Brett曾经工作的地方，现在他越来越少去了。他的队友们发短信给他，请求他过来庆祝和他们一起庆祝他的生日。然而Brett不想见任何人。他什么都做不了，除了躺在睡椅上面，尝试着去忽略这个困扰着他将近一年的窒息感。
It started in middle school with allergies that only got worse over time. As an adult, Brett struggled with sinus infections that refused to go away. They clogged his ears, gave him headaches, and led to restless nights. It got so bad that in February 2014 he decided to have an ear, nose, and throat doctor perform a septoplasty, a routine sinus surgery to correct a deviated septum. His older brother had undergone the same surgery.
从初中时开始他就有了过敏的问题，随着时间的迁移情况越来越糟。成年后，Brett（布雷特）一直在和他的不愿意离开的鼻炎做斗争。鼻炎让他耳闷，给他头痛，并且让他晚上无法休息。 这些情况变得越来越糟糕，（终于）在2014年的2月份的时候，他决定在让一个耳鼻喉大夫来做一个鼻中隔成型手术，一个常规的鼻腔手术来修正他的鼻中隔偏曲。他的哥哥曾经经历过同样的手术。
After lying low for about a week, Brett returned to his bartending gig. He told his doctor in follow-up appointments that something felt too “open.” The doctor assured him that barely anything was removed during the surgery, but over the next several months, Brett couldn’t shake the feeling that something was very wrong. His breathing was all messed up. In fact, he couldn’t even feel himself breathing through his nose. Instead of steady, rhythmic breathing, he felt like he was constantly coming up for air. And it was more than that. His senses felt dulled, like he’d had a lobotomy. Emotions he used to access easily now seemed far away, out of reach. Everything felt like nothing.
在休息了一个星期左右，Brett重新回到他的乐队当中。他在后续就诊中告诉他的大夫他有种太过“开放”的感受。他的医生确切得告诉他，手术中几乎没有取出任何东西。但是在他接下来数个月中，Brett无法改变关于有什么东西不对劲的感受。他的呼吸一片混乱。事实上，他甚至无法感觉到空气从经过他的鼻子。取代稳健和有规律的呼吸，他感觉自己在不断得在寻找空气。然而情况不仅仅如此，他觉得自己的感官变得愚钝了，就像做了前脑叶白质切除术一样。他过去可以轻易得感受到情感，但是现在却大大得不一样，几乎感受不到。一切（对他）都变得无关紧要了。
Brett and his girlfriend had recently moved into an old house, so at first, Carol Helling attributed her son’s symptoms to dust and other allergens. Plus, Brett could be a bit of a hypochondriac. He was always collecting vitamins and supplements to treat various ailments, and he was extremely sensitive to over-the-counter medications. He claimed he could tell the difference between Tylenol and generic acetaminophen.
Brett和他的女友最近搬到一个老房子里，在刚刚开始，Carol Helling（卡罗尔赫林）认为她的儿子的症状主要是由粉尘和其他的过敏引起的。另外，她觉得Brett可能有点疑病症。（Brett）他一直在收集维他命和其他补养品来对待各种各样不适，他对离柜的药物非常敏感。他声明他可以分辨出泰诺和通用的对乙酰氨基酚的区别。
Brett also tended to obsess over things, and Carol says obsessive-compulsive disorder runs in the family. As a toddler, he wouldn’t eat dinner until all the kitchen cupboard doors were closed. From high school through adulthood, he was notorious for his 45-minute-long showers; he had to wash in a certain order — neck, left shoulder, right shoulder — and if the routine got screwed up, he’d start over. He wore two or three T-shirts at a time, usually in hard-to-miss, lollipop colors.
Brett 对事物有种强迫性，Carol（卡罗尔）说家里面一直被强迫症笼罩着。在孩童时，他就以45分钟的洗澡时常而臭名昭著；他不得不以一种特定的顺序洗澡，— 脖子，左肩膀，右肩膀，一旦次序被打乱，他就必须重新开始。他把2-3件T恤同时穿在一起，通常是难以忽略的，亮亮的棒棒糖色。
Courtesy Helling Family
Brett and his nephew Preston in 2011.
Brett 和他的外甥2011
But for most of his life, Brett’s quirks were more endearing than concerning. In fact, other than his family and some close friends, no one would have suspected he battled anxiety and depression, which surfaced most often in winter. He drank frequently, and breakups could send him into an emotional tailspin. But no one was overly concerned about Brett before his surgery. He played guitar and bass, gigging often with several bands. He was a cheerleader for his friends, especially his bandmates and others in the Columbus indie-rock community. At work, regulars would come to Natalie’s just to see him.
但是在他的生活中，Brett的怪癖受到的欢迎胜过担心。事实上，不仅仅是他的家人和一些亲近的朋友以外，没有人会怀疑他在与焦虑和低落做斗争。（这些情况）在冬天出现的更多。他经常醉酒，分手可能把他带进了一个情感的混乱中。但是在他做手术之前没有人过多得关注他的这些问题。他玩吉他和贝斯，并且经常和几个乐队一起演奏。他还是他朋友们中的拉拉队队长，特别是对于他的乐队和其他的哥伦比亚的独立摇滚队友们来说。在他出演时，老粉丝们会只是为了见到他来到Natalie（地名）。
It wasn’t until summer that Brett’s friends and family started taking his complaints seriously. He worked fewer hours, spent more time at his parents’ house, and stopped showing up to band rehearsals. While researching his symptoms online, Brett came across something called empty nose syndrome, a rare, controversial condition that can occur after surgical procedures on cylindrical structures inside the nose called turbinates. At first, he was relieved — empty nose sounded horrific. Good thing he’d had surgery on only his septum, not his turbinates. And yet the symptoms these patients talked about sounded so much like his own. The nasal dryness. The paradoxical open-yet-suffocating feeling. Panic. Insomnia. Fatigue. Anxiety. Depression.
直到这个夏天，Brett的朋友和家人们才开始认真对待他的抱怨。他很少演出了，在父母家里花的时间更多，并且经常不在乐队排练得时候出现。当他在网上查找他的症状的时候，Brett发现了一个叫做空鼻症候群的，少见的有争议的疾病（英文简称ENS下文统称空鼻症，译者注），可能发生在在对鼻甲（一种鼻腔内的圆柱体结构）进行外科手术的并发症。在刚开始他很释怀，空鼻症听起来很可怕。但是好消息是他只在做了鼻中隔成型手术，鼻甲没做改动。但是他越发觉得这些病人讨论的症状挺起来喝他自己的很像。鼻腔干燥，矛盾的开放而又窒息感，恐慌、失眠症、疲劳、焦虑、抑郁。
In August, Brett dug out his surgical report. There, alongside the septoplasty, were the two words he feared most: “turbinate reduction.” He fell to his knees, hugged his dog, and cried. He hadn’t paid attention to the other, supposedly routine procedures his doctor had glossed over. They were presented to him as fine print, as nothing to worry about.
在八月份，Brett 翻开了他的手术报告。在那里，在鼻中隔成形术旁边，出现了让他最恐惧的两个词：“鼻甲缩减。”他跪下了他的膝盖，抱住了他的狗，开始哭泣。他之前没有注意到其他的东西（鼻甲缩减），他相信他的医生可以轻易做好这种常规手术。他们给他表述得很轻巧，就像完全不用担心得样子。
Brett was convinced his surgery had given him empty nose syndrome, but his doctor disregarded his concerns. Another ENT physician told him he was just having anxiety. It was a conservative surgery, nothing to worry about. “Breathe through your mouth,” the doctor told him.
Brett 开始确信他的手术给他带来了空鼻症，但是他的大夫无视了他的顾虑。另外一个耳鼻喉医生告诉Brett，他不过是有点焦虑罢了。这是一个保守的手术，没有什么可以担心的。“用你的嘴呼吸，”他的医生这么告诉他。
That fall and winter, all Brett could think or talk about was his nose. He was constantly fussing with it — rubbing it, wiping it. Co-workers who used to crave his attention began pawning him off on whomever had the time and patience to handle his obsessive rants about turbinates. By mid-October, he had checked himself into the ER and told the nurse, “I need to sleep or I’m going to die.” None of the nurses or doctors had heard of empty nose syndrome. They diagnosed him with depression, but Brett told them it was an ENT emergency. According to Brett, the ER doctor replied, “The head of ENT here doesn’t think so and will not see you.”
那个秋天和冬天，Brett所思所想都是他的鼻子。他不断得烦躁得擦它，擤它。他的同事们过去会请求他把注意力从急切得不停地抱怨他的鼻甲上面转移开。在十月中旬的时候，他来到急诊室并且告诉护士：“我需要睡觉，不然我将会死掉。”没有医生和护士曾经听说过空鼻症。他们诊断他是焦虑症，但是Brett 告诉他们这是一个耳鼻喉的急诊。根据Brett的口述，急诊大夫如此说：“耳鼻喉的主任并不这样认为，而且不会见你。”
A few days after Brett was discharged from the ER, he began calling around to ask for painkillers and tranquilizers. Concerned friends started calling Brett’s bandmate Sean Gardner and Gardner’s wife, Mollie, who had known Brett for years and dated him in her early twenties. Mollie called Brett’s girlfriend, who told her she knew he needed help, and that she’d tried over and over again to help, but Brett wouldn’t listen to her. The Gardners decided to go see him.
在Brett （布雷特）被急诊室拒收后，他开始四处寻求止痛药和安眠药。关心他的朋友们开始打电话告知Brett 的乐队队友Sean Gardner（西恩加德纳）和他的妻子，Mollie（茉莉），Mollie是Brett多年的朋友，并且在她的20岁出头时的时候和他约过会。Mollie打电话给Brett 的女朋友，她告诉茉莉她知道Brett需要帮助，她也一直尝试着去帮助，但是Brett从来不听从她的话。Gardner（加德纳）夫妇决定去看看他。
“Right when we got there, we were like, ‘Oh, shit,’” Mollie says. “The dog immediately jumped into my arms. Brett’s like, ‘Sorry, he’s just looking for some normalcy. I’ve been a little crazy.’”
“当我们刚到了那里得时候，我们得感受就像吃了翔一样，”茉莉说。“他的狗马上跳到了我的怀里。Brett解释道‘抱歉，他只是看见了一个正常人，因为我一直表现得像一个疯子。’”
“He kept asking for beer,” Sean says. “We were listening to records, and he was turning them up super loud while we’re trying to talk to him. He’s pacing and kept saying the same five-minute conversation about turbinates. Over and over."
“他一直在要啤酒喝，”Sean 说道，“我们在听他的录音，当我们尝试和他说话的时候，他就把声音调得非常高。他不停得踱着步并且重复着五分钟同样的关于鼻甲的谈话，周而复始。
“He wasn’t showering, not eating, not sleeping,” Mollie says. “All he could do was this loop.”
“他不洗澡，不进食，不睡觉，”茉莉说道“所有他可以做的就是这个流程了。”
Eventually, the Gardners convinced Brett to check himself into Harding Hospital, Ohio State’s psychiatric treatment center, where Mollie works as a nurse. “He kept joking that he was kind of excited because now he would have his One Flew Over the Cuckoo’s Nest story,” Sean says.
最终，Gardner（加德纳）夫妇说服了Brett在Harding（哈丁）医院检查自己的情况。俄亥俄大学的精神诊断中心，也是茉莉作为护士工作的地方。“他一直在开玩笑（说）他有点兴奋，因为他现在将会有他自己的 飞跃疯人院 的故事了，”Sean（肖恩）说道。
他给他的母亲说他的鼻腔像一个中空的南瓜。他发疯得尝试去解释这种感觉，他抓住母亲的手指然后把它们插进自己的鼻孔里面。
Brett stayed at Harding about a week, and when he got out, his friends and family were hopeful. They thought he might start sleeping, and maybe the prescribed antidepressants would do the trick. But he didn’t stick with them or the psychologist. He felt like no one was listening to him. His head wasn’t the problem — someone needed to fix his nose!
Brett(布雷特) 在Harding 待了一个星期，当他出院得时候，他的朋友们和亲人觉得是相当有希望的，或许处方抗抑郁药会起到作用，他们也觉得他可以开始睡觉了。但是Brett无法忍受他们和他的心理医生，他觉得根本就没有人在倾听他说话。他的大脑完全没有问题——他只是需要有个人来修复他的鼻子。
In December, Brett and his girlfriend broke up. He tried to tend bar, but working while feeling on the verge of drowning was torturous. To get through a shift, he’d sometimes run to the liquor store across the street to buy a pack of gum, which helped force him to mouth-breathe. And even though music was his greatest love, he stopped playing guitar. He moved back into his childhood home, where he spent his days and nights pacing the house with Kleenex stuffed up his nose. “I can’t live like this. This is miserable,” he told his parents. “I have no life now. I want my life back. I had a good life.”
在12月份，Brett和他的女朋友分手了。他曾经试着去挽回她，但是在濒死的感觉下努力实在是太折磨人了。为了渡过这种变化，他有时候穿过街道会跑去酒品店买一包口香糖，这个可以帮助他强迫用口呼吸。即便音乐是他的最爱，他不再演奏吉他了。他搬回了他孩时的房子，在那里他日夜不停得得把克里内克丝面巾纸塞到他的鼻子里面。“我不想要这样活着，这样子太悲惨了，”他告诉他的父母。“我现在没有生活的热情了，我想要让我以前的日子回来，过去我活得挺开心的。”
Brett was embarrassed by what he’d become. He lost all his empathy. He even envied people with cancer. Everyone has heard of cancer. Doctors take it seriously. He envied strangers blowing their snotty, functioning noses. His sinus cavity, meanwhile, felt like a hollowed-out pumpkin. In frantic attempts to explain the sensation, he’d grab his mom’s fingers and stick them up his own nose. She tried to comfort him. “Sweetie,” Carol would say. “You know we haven’t seen all the doctors there are to see. We need to do some more research. Sometimes shit happens, and we’ll get through it. It’ll be OK.”
Brett为他为他所成为的样子而羞愧。他失去了他全部的同理心。他甚至嫉妒那些得了癌症的人，因为每个人都听说过癌症，医生也会认真对待它。他嫉妒那些可以擤鼻涕的陌生人，他们有着功能完好的鼻子。然而他的鼻腔空着，就像一个被掏空的南瓜。他疯狂得尝试着去解释这种感受，他抓住了他妈妈的手指然后伸进他自己的鼻孔里面。 妈妈尝试着去去安慰他“亲爱的，”Carol说道“你知道的，我们还没有把在所有的医生都看遍呢。我们需要做一些调查。有的时候不幸的事情会发生，但是我们将会渡过它的，这一切都将会过去的。”
On Monday, February 16, 2015, four days shy of the one-year anniversary of his surgery, Brett drove his green Ford Focus down Interstate 71 in the snow toward Cincinnati. After crossing the Jeremiah Morrow Bridge — the tallest in Ohio — he parked near a closed rest stop, set his iPhone on the center console, rolled down his window, and got out of the car. Snow whipped around his face. It was severely cold, the windchill well below zero. His hands were white, his cheeks red. Low temperatures dried out his nose even more than usual, and the cold air hurt. Even though his mom had recently bought him a nice orange coat, he wore only a blue hoodie, black pants, and a winter hat.
在2015年2月16号，星期一, 还差4天就到了他的手术一周年纪念日了。Brett 开着他绿色的Ford Focus（车的牌子）在雪中沿着71号洲界公路去了辛辛那提。当穿过耶利米·莫罗桥的时候——俄亥俄州最高的地方，他把车子停在附近的休息站旁边，把爱疯放在控制台的中心，摇下他的窗户，然后向窗外望去。雪击打在他的脸上。温度在零度以下的温度使车外异常得冷。他的手被冻得发白，脸颊懂得发红。冷空气伤害着他的鼻腔，低温也使他的鼻腔甚至比以往更加干燥。即便他的妈妈给他买了一个非常棒的橘红色的大衣，他却仍然穿着一个蓝色的连帽夹克，黑裤子，（戴着）一个冬天的帽子。
The highway was under construction, and Brett walked north along a closed portion toward the bridge. A construction worker asked him where he was going, and Brett told him he was trying to get to the other side. The worker told him that he could drive him across and that he should come warm up in his truck. Brett shook his head and kept walking. Once he hit the bridge, Brett took off running, then stopped and looked over the edge. Climbing a parapet, he dangled his legs over the side, hung on briefly, then dropped 177 feet.
高速公路正在建设中，Brett(布雷特)向北沿着一个封闭的区域朝着桥走去。一个建筑工人问他要去哪里？Brett告诉他，他要去桥的另一端。工人告诉他，他可以带Brett过去，（只）需要先预热一下他的卡车。Brett摇了摇头然后继续行走着。当Brett到了桥了的时候，停下了，然后打量着桥边，爬上了栏杆，他把他的腿轻轻得悬挂在边缘，然后从177英尺的高度跳了下去。
Turbinate reductions are routinely performed around the world, and usually with great success. But some patients say this surgical procedure ruined their lives. In Michael Jackson’s wrongful death suit, one of his doctors testified that Jackson’s insomnia could have been a result of empty nose syndrome. Online ENS forums and Facebook support groups are filled with people who say they’ve been discarded by doctors who told them nothing is wrong — that it’s psychogenic, all in their heads. In China, one man who said he had empty nose syndrome became so enraged that he stabbed an otolaryngologist to death. Others direct violence toward themselves. When regular ENS commenters go silent online, the community wonders if they’re gone for good.
鼻甲缩减手术是一种在全球广泛推广的手术，通常有着不错的效果。但是也有些患者声称这种手术毁了他们的生活。在迈克尔杰克逊的非正常死亡诉讼中，他的一个医生检测认为：杰克逊的失眠症可能是由空鼻症引起的一个症状。在Facebook的群组和网络上到处都是这样的言论，这个群体认为自己被丢弃了，因为医生告知他们没有问题——这是心理疾病，出问题的是他们的脑子。在中国有一个认为自己得了空鼻症的男的变得非常暴躁，然后他把一个耳鼻喉科的医生用刀捅死了。其他人的暴力指向了自己（自虐，译者注）。当常规的空鼻症的言论在不被重视的时候，这个群体觉得死去对他们来说可能是一个好的归宿。
Even as some ENT doctors doubt the syndrome’s existence, a handful of otolaryngologists have made it their mission to figure out why some people develop it, how to prevent it, and whether underlying mental conditions should be considered when diagnosing and treating this invisible illness. Meanwhile, ENS patients continue to plead for help and relief.
即使在一部分耳鼻喉科大夫们在质疑这种综合症是否存在的时候，少数的耳鼻喉科专家了已经决定了去弄清楚，为什么有些人会出现这种症状，如何去预防它，当诊断和治疗这种不可见的疾病的时候，是否要考虑潜在的心理因素。与此同时，空鼻症的病人们也在不断得在苦寻帮助和缓解的方法。
During his ear, nose, and throat residency at the Cleveland Clinic, Dr. Steven Houser shadowed his attending physician during nasal surgeries and sometimes handled initial consultations with patients during clinic visits. One day toward the end of his residency in the late ’90s, Houser examined the chart of a middle-aged woman who was complaining of nasal blockage, congestion, and difficulty breathing. The attending doctor had operated on her turbinates years earlier. She’d had plenty of time to heal, so Houser assumed the patient must have hit her nose or maybe developed a polyp. But when he examined her, he was surprised to see that her nose wasn’t blocked at all. (“You could drive a truck through there,” Houser says.) Her septum was straight. There were no holes or other oddities, but her turbinates — those tubular, bony structures inside the nose — were significantly reduced from the surgery. The woman told Houser that for some reason, she could breathe easier when she had a cold.
在克利夫兰的耳鼻喉诊所，Steven Houser博士遮盖了他之前的主治医师鼻腔手术的记录，有时候会处理一些当初来他之前的诊所咨询的访客。在九十年代晚期，Houser（豪斯医生）实习期就要结束的一天，他检查了一个中年妇女的病历记录，这个妇女向抱怨她的鼻子堵塞、充血并且呼吸困难。主治医生在几年前已经给她的鼻甲进行了手术。由于手术时间已经很久，有足够的时间恢复，所以Houser认为这个女患者可能鼻子受过伤或者形成了鼻息肉导致堵塞。但是当Houser检查患者时候，他吃惊的发现女患者的鼻子根本没有堵塞物，（“你能开着卡车从那里通过” Houser说到），而且女患者鼻中隔非常直。没有破洞或者其他异物，但是，她的鼻甲-这些鼻子内部的管状骨结构-在手术后明显的减少。这个妇女告诉Houser医生，当她感冒的时候反而感到呼吸顺畅。
Dr. Steven Houser 史蒂夫豪斯大夫
Houser was baffled. How could this woman have trouble breathing when her nose was wide open? And why would a cold make her feel less blocked? He described the situation to his attending physician, who then went into the room without Houser. After the appointment, the attending physician hemmed and hawed and never provided a good explanation. He told Houser not to worry about it.
Houser很是困惑。为什么这个女人的鼻腔如此宽敞却有着呼吸困难的问题呢？为什么感冒会却让她感觉不堵塞呢？他吧这个情况反馈给了他的主治医师，他（主治）接下来在没有Houser的陪同下进行了就诊。在会诊结束后，主治医师支支吾吾得而且并没有提出一个合理的解释。但是他告诉Houser不要担心这个事情。
But Houser did worry. What could explain such a bizarre condition? He did some research, and after talking to Dr. Murray Grossan, an ENT doctor in Los Angeles, he learned about empty nose syndrome, a controversial condition coined by the Mayo Clinic’s Dr. Eugene Kern in 1994. Kern described “nasal cripples” who, after turbinate surgery, suffered from symptoms like nasal dryness, crusting, and a sense of obstruction despite a wide-open nasal airway. With the help of colleagues, Kern conducted a study of 242 patients who’d been diagnosed with a rare type of nasal infection and theorized that many of these patients actually suffered from empty nose syndrome.
但是Houser确实担心了。到底什么可以解释这种离奇的状态呢？他做了一些调查，当他在和一个在洛杉矶的耳鼻喉科医，Murray GRossan（默里葛罗桑）教授谈话后之后，他学到了空鼻症这个有争议的疾病，在1994由 梅奥诊所的 Eugene Kern（尤金科恩）医生创造并且提出的。Kern 描述为在鼻甲手术之后的“鼻损伤”，有着鼻腔干燥，结痂，和一种感官上的无阻碍的过度宽敞的鼻腔通道。在同行们的帮助下，Kern 调查了242 位受到一种罕见的鼻腔感染的病人后，推理出这些病人确实承受着空鼻症的折磨。
Not everyone in the ENT community was convinced by Kern. In a 2001 Los Angeles Times article, one physician referred to the supposed illness as “empty head syndrome.” But Houser took to the internet and began talking with people about their ENS symptoms. In one forum, he started a “Questions for Dr. Houser” thread. Some in the forum sound merely curious (“Is it good for us to swim?”). Some wonder about stem cell treatment to replace missing tissue (“Your first goal, if you want stem cells or another treatment,” Houser responds, “should be to get ENS recognized as a problem.”). Others can’t sleep and are getting desperate (“I am devastated. ... I can find things to do to make it through the day; can you help me make it through the night?”). Eventually there were so many questions — nearly 30 pages of threads — that Houser’s wife was getting mad at him for spending all night on the internet. He had to stop answering questions online, but he didn’t stop his investigation.
并不是所有的耳鼻喉团体都认同Kern. 在2001 年洛杉矶时间的文章中，一个内科医生认为这种疾病应该被叫做“空头症”。（但是）Houser开始在互联网上与人们讨论关于他们空鼻症的症状。在一个论坛上，他创建了一个“向Houser医生提问”主题。有的人在帖子中的话听起来很奇怪（“游泳会不会使我们好一点？”）。有些人惊讶于阴茎细胞治疗可以替代失去的组织{“如果你你的首要目标是想阴茎细胞或者其他的方式进行治疗，”Houser回复，“得到空鼻症患者的认可是一个问题。”} 有的人由于不能睡觉而变得绝望，（“我极度渴望（睡眠，译者注）。 。。。 我可以找到一些事情去做来度过白天；你可以帮助我使我熬过晚上吗？”）最终这些众多的问题——将近30页的帖子——使得Houser医生的妻子开始对他把整晚的时间花在电脑上面感到生气。他不得不对停止了在网络上的问答，但是他并没有停止他的调查。
（我已经有12个病人告诉我，我不仅仅拯救了他们的性命，而且让他们停止了自杀的尝试）
Once patients realized an ENT doc was not only interested in their condition but also wanted to help, they began traveling from Australia, Europe, China, and the Middle East to Houser’s clinic in Cleveland. For patients Houser diagnosed with ENS, he developed an AlloDerm implant to mimic the lost turbinate tissue. Insurance didn’t cover the $9,000 to $14,000 procedure, but it seemed to be working. One of Houser’s patients self-published a book about his ENS experience: Having Nasal Surgery? Don’t You Become an Empty Nose Victim! Houser wrote the foreword.
一旦病人们意识到一个耳鼻喉医生不是仅仅对他们的状况感兴趣，并且想要帮助他们（时，译者注），他们就开始从澳大利亚，欧洲，中国和中东来到Houser大夫位于克利夫兰的诊所。对被他诊断为空鼻症的病人，Houser研发出了一个内胚层去植入鼻甲组织来模拟失去的组织。花费9000-14000美元的手术并不被保险覆盖，但是它似乎起作用了。Houser的一个病人自己出版了一本关于他的空鼻症的经历：做了鼻腔手术吗？不要成为一个空鼻症的受害者！ Houser为这本书写了前言。
“I’ve had about a dozen patients tell me that I’ve saved their lives and kept them from committing suicide,” says Houser, who has operated on about 70 people. “That’s why I continue to do this, because, to be honest, these patients are very difficult.”
“我已经有12个病人告诉我，我不仅仅拯救了他们的性命，而且让他们停止了自杀的尝试，”Houser这么说道，他给70个人做了手术。“这就是为什么我继续这样做，因为，说实话，这些人处境非常艰难。”
Since Kern’s report in 2001, very little had been written about empty nose until Houser published the findings of his experimental implants in 2007, and then another article — “The Diagnosis and Management of Empty Nose Syndrome” — in The Otolaryngologic Clinics of North America in 2009. In the same journal issue, Dr. Spencer Payne at the University of Virginia published a response paper titled 【“Empty Nose Syndrome: What Are We Really Talking About?”】
从2001年Kern的报告出来的时候开始，关于空鼻症的文章非常少， 直到在2007，Houser在他的位于北美的耳鼻喉诊所发布了他在的植入手术上面的发现，2009年发布了另一篇文章——“诊断和管理空鼻综合症”。 在同一期杂志上，弗吉尼亚大学的Spencer Payne（斯宾塞佩恩）医生发布了一个回复性论文标题为【“空鼻症：我们到底在说什么？”】
“The problem with empty nose syndrome is probably not that it does not exist,” Payne writes, “it is that we cannot adequately explain its existence by what we currently understand about the nose. Many otolaryngologists are unwilling to make a ‘leap of faith’ and, instead of acknowledging the existence of something they do not understand, are left skeptical of it in its entirety.”
“空鼻症的问题可能并不是不存在的，”Payne（佩恩）写道，“只是我们无法通过我们现有的关于鼻子的理解合理得解释他的存在（罢了）。很多耳鼻喉医生并不愿意去做一个‘信仰之跃’, 取代承认他们并不了解的存在的东西，他们不愿意去怀疑原有的认知。”
While the symptoms ENS patients complain of are unique, their plight is familiar. For years, people suffering from chronic fatigue syndrome were treated with skepticism from the medical community and often told their debilitating condition was psychogenic. “Maybe these people are just lazy” was the unspoken (or sometimes spoken) refrain. BuzzFeed previously reported on a 2010 CDC study that concluded chronic fatigue patients suffered disproportionately from “maladaptive personality features” like neuroticism, paranoia, and OCD. It wasn’t until 2015 that the National Academy of Sciences pronounced chronic fatigue syndrome to be a debilitating condition with concrete physical symptoms and not a psychological illness. In the same NAS study, most patients reported it taking more than a year to get a diagnosis; a third reported it took more than five years.
这些空鼻症患者们的抱怨并不是独有的，（还有人，译者注）和他们的困境是相似的。人们承受着持续很多年的慢性疲劳综合症，被医疗团队以怀疑的态度对待着。“也许这些人就是懒”，出于一种无言 {或者有时候口头上} 的避免，医生们告知他们的衰弱的情况是心理因素。BuzzFeed之前报道的一个在2010 CDC的研究，总结道慢性疲劳的病人不同程度得承受着“不适应的个人不良体征”像神经过敏症，妄想症，和强迫性官能症。直到在2015（美国）国家科学院声明慢性疲劳综合症是一种日渐衰退的状态并且不是心理疾病。在相同的美国国家科学院的研究中，大部分的病人得到一个诊断的时间大于一年；三分之一（的人）大于五年。
（“空鼻症的问题恐怕不是在它不存在，而是通过我们现在对鼻子的理解，我们无法科学的解释其存在。”）
Fibromyalgia patients face similar skepticism. Physicians also once believed irritable bowel syndrome was a psychological condition. Leaky gut syndrome is accepted within some corners of alternative medicine, but many doctors are skeptical of its existence. Morgellons — a more recent controversial condition involving painful, itchy lesions with mysterious “fibers” — is often regarded as a delusion, a form of psychosis.
纤维肌痛的病人面临着相似的怀疑。医生们也曾经一度认为大腸激躁症是一种心理疾病。肠漏综合症在因为（不同于现代西方医学的）另类医疗在某些方面被接受，但是很多医生怀疑其存在性。莫吉隆斯症—— 最近的一种更加有争议的疾病，（患者）的身体有着着疼痛，病态的痒，并带着神秘的“纤维物质”——经常被认为是错觉，一种精神疾病。
Regardless of the validity of these contentious conditions, the experience for people who believe they have them is similar. They go from doctor to doctor, craving a diagnosis, or at least a physician who will take their complaints seriously. In one study, chronic fatigue syndrome patients said that “lack of acknowledgment could be even worse than the symptoms.” 【Meanwhile, the actual symptoms — which are experientially real, even if the source is debated or unknown — persist. 】The longer the symptoms persist, the more likely they are to either exacerbate underlying psychological conditions (anxiety, depression, OCD) or create them.
不管这些有争议的情况的正确性，对于那些相信自己存在这种状况的朋友们来说，他们的经历是相似的。他们挨个得寻找大夫，渴望得到一个诊断，或至少得到一个医生可以认真对待他们的疾病。在一项研究中，慢性疲劳综合症的病人说：“缺乏承认的情况对我们来说，可能比自身的状况更加糟糕。”【与此同时，即便现有的资源对其的态度是未知的或者有争议的，真正的病症那些体验起来真实的，——持续存在着。】症状持续的时间越久, 越有可能会加剧患者的潜在的心理状况（焦虑，抑郁，强迫性官能症）或者制造这些问题。
To suffer is one thing. To suffer and be told by medical professionals that nothing is wrong? That’s enough to make some people want to end it all.
正在承受的（痛苦，译者注）是一个原因。承受着（痛苦，译者注）并且被医疗专家们告知你没有任何问题？ 光光这点足够让一些人想要结束这一切。
Inside your nose are two bony shelves divided by your septum, and these shelves contain three sets of turbinates. Each side of the nose contains a low, middle, and high turbinate. The low one, called an inferior turbinate, is the biggest — like a small cigar, about five or six centimeters long — and inside the inferior turbinate are blood vessels that can swell and shrink dramatically. (Imagine a penis and you’re not far off.) Turbinates help regulate airflow through the nose and also warm, filter, and humidify the air using a moist outer lining of tissue called mucosa.
在你的鼻子里面有两个骨头的架子，中间被你的鼻中隔分开了，这些部分带有三组鼻甲。每边的鼻子都带有一个下，中，上鼻甲。低的那个，叫做下鼻甲，是最大的——像一根小雪茄，大概有5-6厘米长——在下鼻甲里面有着血管可以使鼻甲剧烈得收缩和膨胀。（想象一根阴茎，你没有想太远。）鼻甲使用一种湿润内层的组织粘膜帮助调节空气经过鼻子帮助温暖，过滤，湿润空气。
Allergies, sinus infections, and other conditions can cause the inferior turbinate to stay enlarged, which leads to nasal blockage. If that’s the case, and if antibiotics don’t work, it’s not unusual for an otolaryngologist to recommend reducing the inferior turbinate (and, in rare cases, the middle turbinate). There are a number of ways to do that, and there’s no consensus on which method is best. Some doctors break the bone and move the structure out of the way. Some remove about one centimeter from the head of the turbinate. Some remove the bottom third of the entire tube. Others leave the outer tube alone and remove the inside, like taking the tobacco out of a cigar. Some doctors shrink the turbinate using cauterization or radio frequency. Sometimes doctors remove the entire turbinate — a total turbinectomy — though that method has fallen out of favor in the U.S. Often these procedures are done in combination with a septoplasty to fix a deviated septum.
过敏，鼻腔感染，和其他的状况可以使下鼻甲保持膨胀，引起鼻塞。如果是这原因引起的，而且抗生素不起作用，耳鼻喉医生们建议消减下鼻甲并不是不寻常的{另外，在极少数案例中，会消除中鼻甲}。执行这种手术的方案有很多，然而关于哪种是最好的没有一致的观点。有些移除了鼻甲初段一厘米。有些移除整个鼻甲的三分之一。有的不动鼻甲的外面然后切除里面，就像抽卷烟和香烟一样。有的医生们用灼烧/腐蚀收缩鼻甲或者用射频消融。有的时候医生们会移除整个鼻甲——一个整个鼻甲切除术——尽管这种方法已经在美国失去了支持。这些手术通常会在一个鼻中隔成型手术中作为附属手术去完成。（我们患者们习惯把这种打包手术叫做鼻甲全家桶=。=）
Illustration by Bryan Christie
在手术之前
The CDC estimates that in 2006 (the most recent year of data), more than 900,000 people underwent nasal surgery. Though the CDC couldn’t provide data regarding turbinate surgeries specifically, the doctors I spoke to say a turbinate reduction is probably the most common procedure in rhinology, and they also say most of those patients walk away happy.
疾病控制中心在预测，在2006年（最近一年的数据）超多900，000 人做了鼻腔手术。尽管CDC不能提供具体的，关于鼻甲手术的数据，（但是，译者注）与我谈论医生们说鼻甲缩减术应该是在鼻科中最普遍的手术，而且他们说大部分的病人非常开心得离开了。
So imagine you’re an otolaryngologist operating on hundreds, maybe thousands, of patients. In follow-up appointments, almost all of them thank you for helping them to breathe normally for the first time in years. Only a handful are dissatisfied. One patient says he can’t breathe correctly. He feels like he’s suffocating. But everything looks great in his nose. The airway is completely open. The surgery did exactly what it was supposed to do.
所以想象一下你是一个耳鼻喉科的医生已经给上百或者上千的病人做过手术。在后续的就诊中，他们中的大部分人会因你帮助他们在这些年里第一次正常呼吸而感谢你。（然而，译者注）只有数个是不高兴的，但是他的鼻子里面看起来是如此得正常，通气道是全部敞开的。（他的，译者注）这个手术已经按照预期精确得完成其使命了。
And yet the patient keeps coming back, complaining more and more. He seems anxious, jittery, depressed. He’s not sleeping well. He’s having trouble performing everyday tasks. With each follow-up appointment, he becomes increasingly agitated. He says this routine surgery resulted in empty nose syndrome and ruined his life. You’ve heard of the condition, but you also know some doctors are skeptical of it. 【You certainly never spent time on the topic in medical school, where otolaryngology students concentrate on more common nasal problems, like sinusitis, deviated septum, and cancer. Not to mention the ears and throat.】
然后到现在为止，这些病人也在不断得回来，他们的抱怨也变得越来越多。他看起来开始焦虑，紧张不安，抑郁，而且睡得不好。他处理日常任务开始有困难了。在接下来的每一次跟踪会诊中，他的焦虑开始持续增长。他说这次日常手术导致了他得了空鼻症，并且毁了他的生活。你已经听说了这种疾病，但是你也知道有些医生对此是怀疑的。你肯定从来没有在医学院的课题中进修过，在那里耳鼻喉的学生们专注于更常见的鼻腔问题，像鼻窦炎，鼻中隔偏曲，和癌症。还没论及耳朵和喉咙。（你在这里应该是指就诊医生）
Lots of other patients have appointments lined up, and they all take time. This outlier is taking time away from those patients. 【 Eventually, you throw up your hands and discharge him from your practice.】
很多其他的病人在会诊中排着队，他们都在等待着。这个异常的病例会挤走其他病人的时间。【最终，你放弃了他并且不再会诊他。】
There’s only one explanation: This patient is crazy.
这只有一个解释：这个病人是疯了。
Doctors like Houser in Cleveland, Payne at UVA, Jayakar Nayak at Stanford University, Subinoy Das at the U.S. Institute for Advanced Sinus Care and Research in Columbus, and researchers at Ohio State University are studying empty nose syndrome and trying to figure out why some patients get it and others don’t. Houser, Nayak, and Das treat ENS patients with implants and/or injections, and many of these patients have seen improvement. (Carol Helling says Brett received injections from Das but saw only temporary improvement; Das declined to comment for this story.)
Payne(佩恩)在UVA(美国弗吉尼亚大学), 在斯坦福的Jayakar Nayak(人名)，在哥伦布的高级鼻窦的高级护理和研究机构的Subinoy Das，和在俄亥俄州立大学的研究者，像在克利夫兰的Houser大夫一样，他们都在研究空鼻症并且尝试去弄清楚，为什么有的人会得这种病有的人却不会。Houser, Nayak, 和Das（达斯）使用植入或者注射手术治疗空鼻症病人，他们中很多人的症状都得到了改善。（Carol Helling 说Brett接受了Das的注射但是只见到了暂时的改善; Das 拒绝对这个故事进行评价。）
Yet fundamental questions about ENS have yet to be answered. Are there environmental factors? Doctors in warm, humid climates like Singapore and Australia routinely perform total turbinectomies, and instances of ENS aren’t reported there as often, even though one study has shown that as many as 20% of patients who have their entire inferior turbinates removed could develop ENS.
到这里关于空鼻症的基本问题应该被回答了，空气环境因素重要吗？即便有一项报告说明20%的病人做了整个下鼻甲移除手术后会发展成为空鼻症，在温暖湿润气候的地方像新加坡，澳大利亚那里实行得常规所有鼻甲切除术中，医生们关于空鼻症的报告没有那么频繁。
And what accounts for the delayed diagnoses? Some patients begin experiencing symptoms months after the surgery; for others, symptoms don’t arise for years.
被延迟诊断的比例的病人有多少呢？有些病人在手术后几个月后就有了症状；然而有的人几年内都没有。
Courtesy Jayakar Nayak
Dr. Jayakar Nayak
No one knows for sure why some turbinate reductions result in ENS and others don’t, but there are currently two prevailing theories. Houser’s theory argues that for ENS to occur, turbinate tissue must be removed or damaged, and then the sensory nerves in that area must regenerate poorly. Some methods of turbinate surgery can damage the nerve-rich mucosal layer more than others.
没有人知道为什么鼻甲消减手术会引起空鼻症，而其他的人不会，但是有两个流行的理论。Houser 的理论认为，在鼻甲组织被移除或者损坏后，处在那里的神经传感器很再生得非常缓慢，空鼻症是因此发生的。有些鼻甲手术的方法，对富含神经的鼻粘膜层的伤害比其他的手术更大。
The other theory has to do with airflow — that the shape of a patient’s nose, and the way air flows through that nose, makes a patient more or less susceptible to ENS. Payne also thinks turbulence plays a role. “The more turbulent the airflow, the less you’re going to get a sense of good breathing,” he says. “It’s like if you stick your head out the window of a moving car, you can breathe in through your nose and feel the air moving through there, but I almost get anxious, because the air seems like it’s so poorly moving through the nose. I wouldn’t be surprised if in the empty nose patient, it’s not just a sense of decrease in receptors. It’s also an increase in the turbulence.”
有另一个理论对应着空气流动——病人的鼻子的形状和空气通过鼻子的方式，使病人或多或少容易受空鼻症的影响。Payne 也认为（气流的）动荡扮演一个角色。“气流越混乱，你得到呼吸正常的概率越低，”他说：“这就像假如你在一辆运行的汽车中，你把的头伸出窗外感受气流，你可以通过你的鼻子呼吸感受着气流在那儿的流动。但是我（会，译者注）变得焦虑，因为空气似乎很少进到我的鼻子里面。当这种现象发生在空鼻症患者的身上时，我并不感觉奇怪，这并不是仅仅一个鼻腔传感器的缺失。它也引起了鼻腔的气流混乱。
The physics of airflow through the nose is complex and still not fully understood, though a study is underway at Ohio State University to better understand it. OSU’s Dr. Alex Farag and engineer/researcher Kai Zhao are developing 3D models to perform virtual nasal surgeries on patients before an actual surgery. By taking measurements and running models, they hope to see how the surgery could affect nasal airflow, which could lead to more-informed surgeries and fewer complications.
经过鼻腔的气流物理学是复杂的，而且到现在也没有被全部弄清楚，通过一个在俄亥俄州立大学的进行中的研究可以更好得了解它。俄亥俄州立大学的Alex Farag医生和工程师/研究者Kai Zhao 发明了一个3D模型，可以在实际手术之前在病人身上进行模拟手术。在经过测量和运行模型后，他们希望可以看到手术是如何影响鼻腔气流的，这可以领导更加定向化的手术和更少的并发症。
It could also be that both the airflow and mucosal/sensory theories are simultaneously true. For now, Houser and Stanford’s Nayak use cotton pledgets in the nose to help diagnose patients who complain of ENS symptoms. When the piece of cotton is inserted correctly, a patient with ENS will often feel radical improvement.
也有可能气流论和 粘膜/传感器的理论都是正确的。到目前为止，Houser 和斯坦福的Nayak用医用脱脂棉塞入鼻腔来帮助那些受空鼻症困扰的人。当医用棉塞入正确的时候，空鼻症的病人通常会感受到彻底的改善。
And then there’s the psychological mystery. Nayak says the ENS patients he has treated not only breathe better, they’re happier. “Anxiety, depression — all of these are off the charts for the initial patient with true empty nose syndrome,” Nayak says. He and his team are still trying to understand why that simple tubular structure seems to be essential to a proper sense of well-being for some people.
有一些心理学上的疑问。Nayak 说他治疗后的病人不仅仅呼吸得好了，而且也高兴多了。“对当初来就医被确诊为空鼻症的患者，他们的焦虑，抑郁症——所有的这些问题的程度在图表的反馈上都降低了，”Nayak 说道。他和他的团队仍旧试图尝试去理解为什么这种简单的管状结构，对一些人的舒适度这么重要。
Houser can’t fully explain the relationship between mental health and ENS either. “I’ve wondered, which came first?” he says. “Were they that way, and therefore they’re more prone to nerves healing poorly after surgery and developing empty nose? Or is it the empty nose that made them so nervous and worried? I can say for sure that I’ve seen nervous, worried patients, and I implant them, and they do appear more at ease after they’re implanted. When I can get their breathing better, they’re less anxious.”
Houser并不能全面得解释精神问题和空鼻症的关系。“我在想哪个问题先来的？”他说。“如果按照他们所说的一样，因此他们更易于在手术恢复差的时候发展为空鼻症？又或者是空鼻症本身让他们如此紧张和担心呢？（但是，译者注）我可以保证我见过紧张，焦虑的（空鼻症）病人，我给他们移植管之后，但是他们的确变现得轻松多了。当我使他们可以更好得呼吸时，他们的焦虑会少些。
In a 2012 study in France, doctors treated a 37-year-old man with ENS symptoms who left his job and all social relationships. He spent most of his time alone in his bedroom with a humidifier. After doctors treated him with cognitive therapy and an antidepressant, many of his symptoms cleared up. “Treating ENS as a somatic symptom disorder might constitute a first-line safe alternative to surgical or even medical treatment,” the authors say.
在法兰西的一个2012年的调查，医生们治疗了一个37岁的男空鼻症患者，他放弃了他的工作和所有的社会关系。他把他所有的时间放在了一个带有加湿器的卧室里。在医生们对他进行了认知疗法和抗抑郁治疗后，他的许多症状消失了。“把空鼻症当做身体状态失调（来治疗），可能可以作为替代外科手术，甚至医疗治疗的第一安全方法，”作者们这么说。
“What we’ve seen in a lot of other chronic diseases is, each person’s perception of how bad they are is also dependent upon their general psychological health,” says UVA’s Payne. “People with poor coping mechanisms, with underlying depression or anxiety disorder — they are more likely to have symptoms that seem to take over their lives. That’s just not a normal response to chronic disease. And so you scratch your head, because as a physician, it’s the hardest thing trying to understand when are symptoms real, when are symptoms real but exacerbated by underlying psychological issues, and when are symptoms completely psychological.”
“我们看到的就像很多其他心理疾病一样，每个人的对于他们的好坏程度的判断也是取决于他们的总体的心理健康，”UVA的Payne说道。“那些有着不良应对机制的人，那些潜在的抑郁或者焦虑的人 —— 他们更有可能产生那些毁掉他们生活得症状。这对心理疾病来说并不是一个简单的回答。因为作为一个医生，当你在搜刮你大脑的时候，尝试着要去理解这个是最困难的，到底什么时候症状是真的，什么时候这些症状是真的但是被潜在的心理问题恶化的时候，什么时候全部的症状完全是心理上的。”
One ENS patient I spoke with, 52-year-old Sheila O’Shea, has become an informal counselor for suicidal ENS sufferers and sometimes fields late-night phone calls from them. She finds the emphasis on depression and mental health issues associated with ENS patronizing and insulting. “We’re sane people going through an insane situation," she says. "Have you ever been stuck underwater, and you couldn’t make it to the surface fast enough? That panic you have? We have that all day long.”
我跟一个空鼻症的病人交谈过，52岁的Sheila O’Shea，已经成为一个资深的心理咨询家为那些想要想要自杀的空鼻症患者服务，有的时候他们会夜里打电话过来。她认为把在抑郁和心理健康问题，联系到空鼻症上面是傲慢而又污蔑人的。“我们是神智健全的人却在经历一个非常疯狂的处境，”她说。“你有经历过不能尽快回到水面的时候在水下不能动吗？你有经历过那种痛苦吗？我们整天都承受着这样的痛苦。”
She, like Brett, insists the accompanying mental condition is different from depression. “It’s as if you’re looking at the world through a big piece of Plexiglas. You can see everything and hear everything, but every experience is flat,” she says. “Depression messes with perception. Here, nothing is wrong with our perception. I’m not depressed.”
她就像Brett一样，坚持着伴随他们的心理状况是不同于焦虑的。“就像你在透过一个巨大的树脂玻璃看着这个世界。你可以看见和听见所有的东西，但是一切的经历却是单调的，”她说。“抑郁症会混乱感知能力。这里，我们的感知能力没有任何问题，所以我没有抑郁症。”
Brett Helling’s older brother, Paul, once gave him a mounted deer head he’d fished out of the trash. As a joke, Brett put the deer head in his car and drove around town with it for months. The first time Sean Gardner saw it, they were drinking beers on a Saturday afternoon in a friend’s living room. “Suddenly, this deer is banging its antlers against the window,” Sean says. “We’re all freaking out, like, ‘Oh my God!’ I run over to the side and I see Brett with this big smile. And he’s like, ‘Yeah, you just got deer-burned.’ That became his new thing.”
但是 Brett Helling 的兄长，Paul, 有一次给了他一个装饰好的鹿头，他从垃圾里面捡来的。 作为一个玩笑，Brett把鹿头放在他的车里并且开着它在镇里开了数个月。第一次Sean Gardner 见到它的时候，是在一个周六的下午，他们在一个朋友的起居室喝着啤酒。“突然，这只鹿用它的鹿角猛击着窗户，”Sean 说道。“我们都吓坏了，就像，‘我的上帝！’我马上跑到一遍，然后我看到了Brett带着他的大大的笑脸。表情就像, ‘哈哈，你刚刚被鹿吓到了。’这渐渐变成了他的新事。”
“He deer-burned me in the kitchen once,” Mollie Gardner says, http://laughing.In the day or two following Brett’s death, Sean and Mollie wondered aloud, hopefully, if the whole ordeal was just another deer burn — the ultimate fake-out. But they knew that was wishful thinking. Once friends and family began arriving from out of town, Carol gave Sean and a few other friends one of several typed-in-advance notes Brett had left in his car near the bridge. There was also a handwritten note for the police.
“他又一次在厨房把我吓到了一次，”Mollie Gardner 说着，笑着。在Brett死后的一两天内，Sean 和Mollie 非常怀念他，他们希望着这整个悲剧只是另一个鹿头恶作剧 —— 无尽的恶作剧。但是他们知道这仅仅是的愿想罢了。当朋友们和家人从外镇来到他自杀的地方的时候，Carol 给Sean和一部分其他的朋友一份Brett提前打印好的遗书，Brett把它留在了停在桥旁边的车里面。那里也有一份手写的遗书，是留给警察的。
“Suffering from empty nose syndrome (aka: sinus surgery gone wrong) and cannot suffocate any longer,” he’d scribbled with a Sharpie. “Please recognize this for what it really is and not just pass it off as ‘depression.’ ... ENT doctors need to stop taking away perfectly good lives like mine was. This disease is very real, is untreatable, yet 100% preventable. Awareness is needed to make ENS a household name so people will stop being talked/pushed into very dangerous ‘routine’ surgery. We will continue to lose good, happy, productive, and healthy people to this disease otherwise. It took everything from me. I am not the last. www.emptynosesyndrome.org.
“我承受着空鼻症的痛苦（aka:鼻窦手术出错）并且再也不能忍受窒息感了，”他用变形的字体潦草得写下。“请认识到这个病是真实的，不要仅仅把它诊断为‘抑郁症’来忽略它。…… 这个疾病是真实的，是无法医治的，也是100%的可以预防的。意识到把空鼻症作为一个日常的民资，这样子人们才会停止被讨论/推动进一个非常危险的‘常规’手术中。我们不然我们将会持续得将善良的，高兴的，有生产力的，和健康的人丢到这个疾病里面。他把我的一切都夺走了，然而我并不是最后一个。
“P.S. Mom, I’m sorry! I held on as long as I could for you.”
“附言：妈妈，我非常抱歉！我已经为你坚持得尽可能得久了。“
The other notes went into more detail. One was a nearly 30-page script that Brett instructed Sean and three other friends to read at a memorial held at Natalie’s. The script had stage directions and specific instructions from Brett about who should read each section and even how long to pause so that certain jokes would land. It’s long-winded and rambling — angry at times (“I was ultimately killed by Empty Nose Syndrome and a salesman in a long, white jacket”) and darkly funny at others (“I felt like I was splashing around in the ocean and when Hasselhoff finally pulled up to rescue me, he just slapped some sunscreen on me and drove away on his little Jet-ski”). Brett had a way with words, but it was emotionally torturous for Sean and others to read those words on a stage in front of everyone.
更多的细节在他的其他的遗书里面显现出来了。有一个是接近30页的手迹，Brett指示Sean和其他三个朋友去读，是他之前存留于娜塔莉那里的。
这个手迹里面有着舞台剧的指示和其他的细节的指示，甚至包括谁来念哪一部分和甚至有该停顿多久来等待特定的笑话。是有长喘气的和杂乱无章的——数次生气的抱怨（“我已经被空鼻症和一个穿着白色长夹克的生意人杀了无数次”）和一些对其他人开的黑暗笑话（“我感受到我被扔在海上时Hasselhoff最终把我拉了起来拯救了我，他只是将一些阳光拍在我身上然后开着他的小水上摩托车走了”）。Brett对描述有着一套，但是这在情感上的折磨着Sean和在舞台上读着这些话的，以及舞台前的每一个人。
“The idea of selfishly trying to end my suffering seems less and less selfish the worse things get,” Brett wrote. “I beg for your blessing in letting me go… I’m worn out, worn down and nothing feels right anymore. Our bodies are simply not equipped to deal with what I have been dealing with for so long, and I’m really sorry but I gotta get the fuck outta here, you guys.”】
“结束自己痛苦的念头（即自杀，译者注）曾让我觉得自己很自私，但随着情况越来越糟糕，这样的想法越来越淡了。” 我已筋疲力竭，逐渐垮掉，所有的一切都不再美好。人类（原文为我们，译者注）的身体实在无法应对我一直以来承受的痛苦。我很抱歉，但我不得不离开这里了。永别了，大家。
Courtesy Helling Family
The poster from Helling Yeah!, a benefit that Brett's friends threw to remember him. 这个海报是来自“Helling Yeah!”，一个Brett的朋友们用来纪念他的募捐活动。
The memorial was so packed that Sean and others had to keep moving tables out of the way to make space for the crowd. He was thankful for the task. It gave him something to do other than sit and stare at that deer head and wonder whether his friend could have been saved.
纪念仪式是如此得繁忙，以至于Sean和其他人不得不一直把桌子移走，把空间腾出来给人群空间。他非常感激自己有这个任务。这给他一些事情去忙，而不是坐在那里注视着鹿头，思考着他的朋友是否可以被拯救。
Brett may get one of his dying wishes in 2016. Though ENS is still little-known to the general public, more ENT doctors are recognizing it and wrestling with it. In August, one of Nayak’s patients, Peter Esquinasi, wrote a letter to the American Rhinologic Society, relaying his ENS experiences and demanding a response. “Just because many people survive these types of surgeries does not mean it is the best thing for them,” he wrote. “Yours is an organization which sadly must answer this question: Do ENTs do extra surgeries for extra money? Or are they grossly misinformed? Either one is bad, but you must look in the mirror and choose one.”
Brett可能在2016年完成了一个他的死前的愿望。尽管空鼻症仍然没有被大众所熟知，（但是）更多的耳鼻喉医生开始承认和研究它。在八月份，一个Nayak医生的病人，Peter Esquinasi，写了一篇新给美国鼻科研会（ARS），转述了他的空鼻症的经历，希望得到一个回复。“不是很多人从这几种手术中幸存不代表这个是对他们最好的，”他写道。“不幸的是，即使你们是同一个一个组织，你们也必须回答这个问题：耳鼻喉医生们有没有做额外的手术去赚更多的钱？或者他们故意引导着？每一个选项都是不好的，但是你们不得不照着镜子去从中选一个。”
The ARS executive committee responded in a letter. “We want you to know that the American Rhinologic Society is pursuing an ongoing educational effort relating to ENS,” it stated. “Your letter is of particular importance to us in the context of our educational mission.”
美国鼻科科研会行政部门委员会在信中这么回复着。“我们想让你知道美国鼻科科研会正在继续着一项跟空鼻症的教育相关的努力，”回信这么陈述道。“你的信件对整体的教育任务是非常重要的。”
Dr. David Poetker, who’s on the ARS board of directors, said in an email that the ARS has no particular stance on ENS. “It is a complex issue that is not very well understood,” Poetker says. “Unfortunately, there is not a lot of money for research for nasal issues in general. We continue to do the best research we can with the limited resources available.”
David Poetker医师 是一个美国鼻科科研会的一个董事，在一封邮件中说道 美国鼻科科研会对空鼻症没有特别的态度。“这是一个非常复杂的问题，并不是很好理解，”Poetker说道。“不幸的是，从整体上说我们并没有很多的钱去研究鼻腔的问题。我们会继续用有限的资源去做最好的调查。”
In January, Dr. Das in Columbus noted a sea change in an open letter to ENS patients he posted on the emptynosesyndrome.org forum. ENS, he said, is the thing keeping some of his colleagues up at night. “There continues to be greater recognition that ENS is a problem,” Das writes. “Many panels within the American Rhinologic Society are discussing ENS as a real problem and leading discussions on the best way to solve this problem.” Das’s letter also expresses hope about the injection therapies he’s tried on 180 patients from 25 countries; 82% of them reported an improvement in their symptoms.
一月份的时候，在 emptynosesyndrome.org的论坛上，哥伦布的Das医师在一封对空鼻症患者的公开信中，指出了一个巨大的变化。他说空鼻症开始让他的一些同行通宵研究。“那里有持续着更多的认知，（去认识到）空鼻症是一个问题，”Das 写道。“很多美国鼻科科研会的事务委员把空鼻症当做一个真实的问题并且带领着讨论，用什么方式才能更好得解决这个问题。” Das的信中也展示了关于注射疗法的希望，他在25个国家中的180个病人中进行的注射疗法中，82%的人报告说他们的症状有改善。
And it’s no small thing that a press release for Ohio State’s nasal surgery study mentions empty nose syndrome by name, even though Carol Helling says Ohio State doctors told Brett he didn’t have it.
俄亥俄州立大学的鼻腔手术研究中提及了空鼻症的名字，（Das的公开信）这对他们来说减轻了很多的压力，即使Carol Helling（Brett的母亲）说俄亥俄州的医生们告诉Brett他并没有空鼻症。
In some ways, Brett’s case was typical. His symptoms overlapped with many others who say they have ENS. The problem is, there’s still no firm definition of empty nose syndrome, which means there’s also no firm way of diagnosing it. And misdiagnosis is an issue. Houser and Nayak say they’ve seen patients who were convinced they had ENS but had a different nasal problem entirely.
在某些程度来说，Brett的案例是具有代表性的。他的病情综合了很多其他自认为自己是空鼻症的人的症状。（但）问题是，关于空鼻症没有严格的定义，这也就意味着没有确切的方法去诊断它。与此同时，误诊也是一个问题，Houser 和Nayak医生说他们见过很多认为自己是空鼻症的病人，但是他们在整体上(却是)其他的鼻腔问题。
（在某些程度来说，Brett的案例是具有代表性的。他的病情综合了很多其他自认为自己是空鼻症的人的症状。）
“My research group is trying to lay the groundwork for better defining ENS, and pulling it out of the ‘mysterious, not sure it exists’ bucket, into the ‘definite diagnosis with defined parameters’ category,” Nayak says. Recently, Nayak and his Stanford researchers analyzed CT scans of patients diagnosed with ENS and compared them to patients who underwent turbinate reduction surgery but had no ENS symptoms — a comparison that had never been done before. “We detected a statistically significant central location in the nasal airway that swells in the CT scans of ENS patients, but not in any control patients,” Nayak says of the soon-to-be-published study. Nayak’s group also came up with six questions he says will more accurately diagnose ENS. He and his team will present their findings at a national meeting of otolaryngologists in Chicago in May.
“我的研究团队一直为尝试着，为更好得定义空鼻症而打基础，（将）它从‘神秘，不确定存在’的盒子中拉出来，放到‘可以用确切得参量确切得诊断’范畴内，”Nayak说道。最近，Nayak和他的斯坦福的研究者们 把那些诊断为空鼻症的病人和那些做了鼻甲消融手术，却没有空鼻症症状的病人的CT扫描做了对比——他们以前从没有做过这样子的对比过。“从数据上非常明确得显示，空鼻症患者在鼻腔的中心位置有着非常明显的肿胀，但是术后没得空鼻症的人却没有，”Nayak在他的即将发布的研究中说道。Nayak的团队也得出了可以帮助更加准确得诊断空鼻症的六个问题。在五月份，他和他的团队们将会把他们的研究发表于，位于芝加哥的耳鼻喉科医师的国际会议上。
Doctors’ responses to the presentations could determine how ENT doctors approach ENS moving forward. Will Nayak’s research — along with the work from Ohio State, Das, Houser, and others — finally put the skepticism to rest, or will doubt persist? If the data resonate, will doctors alter their surgical methods? And will those changes spill over to the cosmetic surgery community, where doctors performing nose jobs are probably even less familiar with ENS?
医生们在报告中的回馈可能会决定耳鼻喉医生们在接触空鼻症的时候该如何展开工作。Nayak的研究将会和俄亥俄州立大学，Das, Houser, 和其他的人的研究一起——最终将会使怀疑论止歇，（Nayak的研究）又或将会质疑坚持论呢？ 如果数据和之前的研究产生共鸣，会不会给医生们的手术方式敲响警钟？又或是这些改变会从整形手术社区中流出，使得那些从事鼻子工作的大夫对空鼻症更加不理解？
Turbinate reductions aren’t likely to go away, despite outcries of malpractice from ENS patients. Every otolaryngologist I spoke to, including those who acknowledge the dangers of ENS, continues to perform surgeries on turbinates. A friend of Brett’s recently wrote to his congressman to propose a bill that would require doctors to warn patients about the risks of ENS before turbinate surgeries, but even Houser says that goes too far. “The rate of ENS development is so small, and if turbinates are treated properly, ENS should essentially never occur,” Houser says. “The focus should be on educating doctors of proper techniques.”
鼻甲消减手术不太可能会消失，除了被医疗不当的空鼻症患者们的高声呐喊外。每一个与我谈论过的耳鼻喉医生，包括那些认同空鼻症的危害的，也在继续着在鼻甲上面进行手术。一个Brett的朋友最近给他的国会议员的信中写道，他建议提出一个法案去要求医生们在进行鼻甲消减手术之前要向患者们警示手术有空鼻症的风险。但是即使是Houser医生也说这点走得太远了。“发展成为空鼻症的概率很小，假如我们对待鼻甲的处理正确，空鼻症应该永远不会发生，”Houser 说。“我们应该把精力放在对教育医生们进行合理的手术上面。”
Houser also often requires patients to undergo mental health assessments before he considers surgery, and Payne says he’s similarly vigilant. “There are some people I’ve refused to do surgery because they were people who I felt were setups for an empty nose scenario,” Payne says.
Houser 也经常要求病人们在考虑手术之前，去接受心理健康上面的帮助，Payne（也）表述了相同的顾虑。“我拒绝给一些人手术，因为我觉得这些人有着发展为空鼻症的基础，”Payne 说道
In January, Brett Helling’s friends celebrated his life with a two-day concert dubbed “Helling Yeah!” at Natalie’s. (The promotional poster featured a giant deer head.) At first, the organizers wanted proceeds from the event to benefit ENS awareness, as well as suicide prevention. But there’s no vetted, surefire way to contribute to ENS awareness yet. Despite the strides in research, it’s still nebulous, still opaque.
在一月份的时候，在Natalie（地名），Brett Helling 的朋友们在为他的生活做了一个两天的音乐会，并且命名为“Helling Yeah!”。（推广海报是具有特征的巨大的鹿头。）（见上图）起初，组织者们想要用这个活动为宣传空鼻症（进行）募捐，就像预防自杀一样。但是目前并没有诊断，无误的有助于空鼻症的认识的方法。除了正在研究中的进展，前路仍旧是模糊不清的，仍然是晦暗无光的。
Just a couple of weeks before the benefit concert, a frightened new visitor to the Empty Nose Syndrome Facebook page posted a desperate plea.
就在义卖音乐会之前的数周，一个恐惧的来访者在空鼻症的脸书主页上面发布了一个令人绝望的声音。
“Please help! I had surgery December 7, 2015,” she wrote. “I feel the nasal passages as huge tunnels, the cold air burns the nose and throat. … I’m going crazy, no sleep 8 days. What do I do? I don’t want to die.” •
“请帮帮我！我在2015年的12月7号做了手术，”她写道。“我觉得鼻腔的通道就像巨大的隧道，寒冷的空气灼烧着鼻子和喉咙。 。。。我已经变得疯狂了，我已经有8天没有睡觉了。我该怎么办？我并不想死啊。”
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原文地址
文章中还有很多的链接，有兴趣的人可以去看看。
水平不足，第一篇翻译的文章，有点像谷歌机翻，请多多见谅。另外感谢网友：呼吸OK, 竹敲响月，刹那间，的帮助。翻译者 be simple, 欢迎关注微信公众号：空鼻综合症 ID: enscare
另外欢迎加入 空鼻症公益基金救助群 QQ群：563104416
借用竹敲响月的一句话：虽然翻译的像机器 但是还是为大部分人提供了阅读便利。 心里还是有点安慰的。。。
我都不想承认这篇文章是我翻译的了（捂脸狂哭），暂时就这水平了。因为空鼻症四年除了一本合和版圣经，其他的书一本都没看完过，看一会会就头晕得厉害，所以语境什么的都丢了。。。。。给我多点时间改进应该会好点。（PS:第一段是请人帮我改的，emoji哭.jpa）
另外，有如果有朋友愿意帮我改进一下得话或者整体重新翻译一下，我将感激不尽，谢谢大家~
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另外，肯定有朋友想吐槽，为什么图片这么大？因为是作者把图片就搞得这么大，单单把一个鹿头缩小我就已经很愧疚了。
两年前我在这里发的匿名消息，至今感慨万千，如果我没有想尽办法恢复这么多，恐怕连这个问题，这些发言都提不出来了吧。
空鼻症是西医不懂科学闹的笑话。原因我就不在此免费讲解，医学专家普遍缺乏科学素养，应大力向百姓宣传，医学不是自然科学。欢迎大家回答此问: https://www.zhihu.com/question/57361030?from=profile_question_card