Enlarged Nasal Turbinates

What Are the Turbinates?

The nasal turbinates are bony structures projecting from the lateral walls of the nasal cavity, covered by a richly vascular mucosal lining. There are three pairs — the superior, middle, and inferior turbinates — of which the inferior turbinates are the most clinically significant in terms of nasal airflow. The turbinates serve important physiological functions: they warm, humidify, and filter air as it passes through the nose, and they play a role in detecting airflow sensation. Any surgical approach to the turbinates must preserve these functions while improving airway patency.

Causes of Turbinate Enlargement

Inferior turbinate hypertrophy — enlargement of the inferior turbinates — is a common cause of nasal obstruction. Common causes include:

• Allergic rhinitis — the most common cause. Repeated allergen exposure causes progressive mucosal thickening and turbinate enlargement
• Chemical irritants — including cigarette smoke and environmental pollutants
• Rhinitis medicamentosa — rebound congestion from prolonged use of over-the-counter decongestant nasal sprays
• Chronic sinusitis — persistent sinus inflammation can drive turbinate hypertrophy
• Compensatory hypertrophy — when the septum deviates to one side, the inferior turbinate on the opposite (wider) side often enlarges to fill the available space
• Concha bullosa — an air cell forming within the middle turbinate, causing it to enlarge and block sinus drainage
• Congenital — some patients are born with larger turbinates, which may run in families

Non-Surgical Treatment

Many patients with turbinate hypertrophy can be managed effectively without surgery, at least initially. Non-surgical options include:

• Nasal steroid sprays — the most effective medical treatment for allergic turbinate enlargement
• Allergen avoidance and allergy management
• Discontinuation of decongestant sprays — with a supervised withdrawal period to manage rebound congestion
• Saline nasal rinses
• Treatment of any underlying chronic sinus infection

Surgical Treatment — Turbinoplasty

When non-surgical measures have not adequately controlled symptoms, or where the turbinate hypertrophy has a predominantly bony component that does not respond to topical treatment, surgical reduction of the inferior turbinates (turbinoplasty) may be recommended.

Several techniques have been used over the years with varying results — including radiofrequency ablation, cauterisation, and outright removal (turbinectomy). Dr Roth recommends the submucous resection of the inferior turbinate, which involves:

1. A small incision at the front of the inferior turbinate
2. Careful elevation of the mucosal lining on one side off the underlying bone
3. Removal of the protruding component of the turbinate bone that is obstructing the airway
4. The mucosal lining is then replaced and folded into a new, smaller turbinate structure

This approach preserves the mucosal lining and its important physiological functions — humidification, filtration, and airflow sensation — while creating a meaningful and durable improvement in the nasal airway. No external incisions are made, there is no change to the external shape of the nose, and there is no facial bruising.

The procedure is performed under general anaesthesia as a day surgical procedure. It is frequently performed alongside septoplasty and sinus surgery when these are also indicated.

Middle Turbinate — Concha Bullosa

Enlargement of the middle turbinate due to a concha bullosa (an air cell within the turbinate) is treated endoscopically. The obstructing component of the turbinate is removed using keyhole sinus techniques, while sufficient structural support of the turbinate is maintained.

Risks

Turbinoplasty is a common procedure with a low rate of serious complications. Risks include:

• Temporary bleeding — the turbinates have a rich blood supply and some oozing from the nose for a couple of days after surgery is expected
• Infection
• Temporary crusting during healing
• Dry nose — this is more likely with aggressive turbinate removal techniques. The submucous resection technique is specifically designed to minimise this risk by preserving the mucosal lining
• Insufficient improvement — in some patients with very complex or multifactorial nasal obstruction, turbinate surgery alone may not fully resolve symptoms if other contributing causes are not also addressed

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