Nasal Turbinate Surgery
The nasal turbinates are paired bony and mucosal structures that project from the lateral walls of the nasal cavity on each side. The inferior turbinates — the largest and lowest pair — play an important role in warming, filtering, and humidifying inspired air as it passes through the nose. When the inferior turbinates are persistently enlarged, they can significantly reduce the cross-sectional area of the nasal airway, contributing to nasal obstruction, mouth breathing, disrupted sleep, and in some cases snoring. Turbinate surgery aims to reduce this obstruction while preserving the important physiological functions of the turbinate tissue.
Turbinate surgery is most commonly performed as part of a septoplasty (correction of a deviated septum) or a rhinoplasty, though it may occasionally be performed in isolation where turbinate enlargement is the primary or sole cause of nasal obstruction. The appropriate surgical approach depends on the degree of enlargement, the likely underlying cause, and individual patient anatomy.
Why Do Turbinates Enlarge?
The inferior turbinates are covered in a highly vascular mucous membrane that can swell and shrink in response to a range of factors. The most common causes of persistent inferior turbinate enlargement include:
- Allergic rhinitis — chronic mucosal inflammation driven by allergy causes persistent turbinate swelling that does not fully resolve between exposures
- Non-allergic (vasomotor) rhinitis — turbinate swelling driven by environmental triggers (temperature change, humidity, irritants) without an identifiable allergic cause
- Compensatory hypertrophy — when the septum is deviated to one side, the inferior turbinate on the opposite side often undergoes compensatory enlargement to fill the wider airway; correcting the septal deviation without addressing the hypertrophied turbinate may leave the patient with persistent obstruction on that side
- Chronic rhinosinusitis — persistent mucosal inflammation from sinus disease can contribute to turbinate swelling
- Medication overuse (rhinitis medicamentosa) — overuse of decongestant nasal sprays causes rebound swelling of the turbinate mucosa
Non-Surgical Management First
Before turbinate surgery is considered, non-surgical management should be trialled. Nasal corticosteroid sprays (such as fluticasone or mometasone) are the primary medical treatment for turbinate hypertrophy from allergic or non-allergic rhinitis, and can achieve meaningful reduction in turbinate size with consistent use. Allergen avoidance, saline nasal irrigation, and antihistamines may also be helpful. Surgery is appropriate where medical management has failed or is not suitable, or where the hypertrophy has a structural component (bony enlargement) that will not respond to topical treatment.
Surgical Techniques for Turbinate Reduction
A range of surgical approaches have been used for turbinate reduction over the years, with varying degrees of effectiveness and different risk profiles. Understanding the options helps patients ask informed questions at consultation.
Total Inferior Turbinectomy (Historical)
The earliest techniques involved complete removal of the inferior turbinate with scissors or a snare. This reliably created a larger airway but in some patients led to a troublesome long-term complication — atrophic rhinitis or “empty nose syndrome” — characterised by paradoxical nasal obstruction (the airway is wide but the patient feels they cannot breathe), excessive dryness, crusting, and in some cases a foul odour. The mechanism is complex but relates partly to the loss of turbinate function in regulating airflow sensation and humidification. Total turbinectomy is no longer the preferred approach for most surgeons.
Radiofrequency Ablation and Coblation
These outpatient office-based techniques use radiofrequency energy to cause controlled submucosal fibrosis and shrinkage of the turbinate soft tissue without removing tissue. They are minimally invasive and can be performed under local anaesthesia, avoiding hospital admission. The improvement in airway size is generally modest, and some patients do not notice a significant or durable change. They are most appropriate for patients with mild-to-moderate mucosal hypertrophy where the enlargement is predominantly soft tissue (mucosa and submucosa) rather than bony.
Submucous Resection of the Inferior Turbinate (Turbinoplasty)
The submucous resection technique — a form of turbinoplasty — involves a small incision at the anterior end of the inferior turbinate, careful elevation of the mucosa away from the underlying bone on one side, removal of the hypertrophied bone and submucosal tissue that is encroaching on the airway, and replacement of the mucosal flap to cover the reduced turbinate. This approach reduces the turbinate volume and the degree of airway obstruction while preserving the overlying mucosa and its physiological functions.
Dr Roth’s preferred approach for significant turbinate hypertrophy — particularly where a bony component is present — is submucous resection, as described by Professor Peter Wormald of Adelaide. This technique has been used widely by otolaryngologists for a number of years and preserves the important functions of the turbinate while creating a more patent airway. Surgery is performed endoscopically under general anaesthesia in hospital.
What to Expect After Turbinate Surgery
Turbinate surgery is typically performed endoscopically (through the nostrils) under general anaesthesia, with no external incisions or facial bruising. It is commonly combined with septoplasty or rhinoplasty where indicated.
Risks of Turbinate Surgery
- Bleeding — the most common complication. Usually self-limiting but occasionally requires packing or further intervention
- Infection — uncommon; managed with antibiotics
- Temporary crusting — resolves with regular saline irrigation
- Over-reduction — excessive removal of turbinate tissue can produce the paradoxical nasal symptoms described above; this is avoided by the conservative, mucosal-preserving submucous approach
- Recurrence — turbinate enlargement can recur, particularly where the underlying cause (allergy, chronic rhinitis) is not controlled
- Inadequate improvement — in some patients the degree of improvement in nasal breathing is modest or not as expected
Enlarged Nasal Turbinates → | Septoplasty → | Rhinoplasty → | Arrange a Consultation →
Dr Roth’s Clinical Perspective
I almost never perform turbinate surgery in isolation — it is virtually always combined with septoplasty, because compensatory turbinate hypertrophy and a deviated septum are usually part of the same obstructive anatomy. The more important consideration is that turbinate surgery works best when allergy is optimally managed. I discuss nasal steroid spray compliance and allergy testing at every turbinate surgery consultation, because a patient who continues to have poorly controlled allergic rhinitis after surgery will have recurrent turbinate swelling regardless of what was done surgically.
— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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