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Registration Form 1. E-mail Address: *   2. First Name * 3. Last Name * 4. Gender * Female Male 5. Age * 6. Occupation 7. Street * 8. City * 9. State * 10. Zip Code * 11. Country * 12. Telephone # 13. Do you suffer from ENS (or Secondary Atrophic Rhinitis)? * Yes No 14. How long have you been suffering from ENS (or Secondary Atrophic Rhinitis)? 15. Please check all the symptoms that frequently effect you since having turbinate surgery Breathing Symptoms Shortness of breath (a suffocation feeling) Difficulty in excerising due to shortness of breath Tightness in the chest Abnormal heart rate when exercising Voice problems Paradoxical nasal congestion Unable to control breathing Sleep Symptoms Waking up and not feeling well rested Unable to sleep through the night Nightmares and night terrors Sleepwalking Feeling tired during the day Nasal Symptoms Nasal dryness Nasal pain Dryness in throat (and/or palette and/or tongue) Post nasal drip Chronic sinus problems that have started since having surgery Headaches Facial pain Ear pressure, and/or fluids in ear. Psychological Symptoms Depression Anxiety Anger Feelings of impending doom Hopelessness Feeling overwhelmed Mentally and physically fatigued Emotionless Inability to concentrate on basic things Avoidance of social situations 16. If certain symptoms are not listed, add them below 17. What kind of operation/s did you have, and please specify the amount of turbinates, or other nasal structures, which were removed from your nose: * 18. Have you had any reconstructive surgeries since you have developed ENS (or Atrophic Rhinitis)?: Yes No 19. If yes, Please explain: 20. Have you received any non-invasive therapy for ENS (or secondary atrophic rhinitis)? Yes No 21. If yes, Please explain: 22. Do you have a website? 23. Would you like to volunteer and help promote the goals of this website? * Yes No 24. Click on the topics you would like to help us with Anything Advertising Financial administration Legal issues Medical counceling(Only if you are a physician) Psychological Counseling (Only if you are a licensed therapist) Media coverage Arranging sponsorships Internet and website General administration * Required

Our Mission - What is empty nose syndrome and how it relates to nose surgery and sinus surgery - ENS Articles with info about symptoms such as nasal dryness, sinus infections, sinusitis and nasal pain- Testimonials by people that have had turbinate surgery - Donations - News relating to solutions for empty nose syndrome that include inferior turbinate regeneration involving stem cells and tissue engineering of functional nasal or sinus tissue- Visit the Discussion Forum to discuss ways to cope with empty nose syndrome symptoms and ideas to find medical solutions - The Nose Tutorial includes detailed pictures of the inferior turbinates, middle turbinates, olfactory bulb, and the septum - turbinates tutorial - Respiratory System -empty nose syndrome Survival Tips include ways to keep the nose moist and ways to diminish symptoms such as sinusitis, nasal pain, and breathing difficulties - Links - contact - Be Proactive and promote awareness of empty nose syndrome - Become a Member - Otolaryngology