Enlarged Nasal Turbinates
What are the turbinates?
The turbinates are structures located on the nasal sidewall that function to humidify and filter air. They jut out into the nasal airway and can block the nose if they become diseased or enlarged.
What are the symptoms of enlarged turbinates?
Enlarged turbinates cause nasal blockage or stuffiness. They can also secrete large amounts of mucus. They can also be the cause of snoring in some people.
What causes turbinates to enlarge?
Common causes of turbinate enlargement are:
- Allergic rhinitis (hayfever) – most commonly house dust mite, pollens, grasses or mould
- Chemical irritants including cigarette smoke
- Long-term use of over-the-counter decongestant sprays
- A persistent (chronic) sinus infection
- A bent septum which allows the inferior turbinate to grow into the space left in the wider airway.
- Abnormal growth of the middle turbinate which grows with a large hollow air cell within it (a concha bullosa)
- Congenital – some people just develop very large turbinates (typically the bony component) and this can run in families.
How is inferior turbinate enlargement treated?
Many techniques are used to treat enlarged turbinates and most do shrink the size to some degree. It is very important not to remove too much turbinate tissue because this can leave the nose dry and patients can develop troublesome crusting within the nose. If the procedure is too conservative and the turbinate is not sufficiently reduced in size the patient may not notice much of a difference in their breathing.
In most patients Dr Roth recommends a type of inferior turbinate reduction called a submucous resection of the turbinate. Here the mucosa overlying the turbinates is carefully and precisely lifted. The horizontal component of the turbinate bone is then removed and the mucosa is carefully preserved and curled into a smaller new turbinate structure. This provides an excellent airway but maintains the ability of the turbinates the humidify and filter air. No skin incisions are made and the shape of the nose remains unchanged. There is no bruising of the face externally.
How is middle turbinate enlargement treated?
Enlargement of the middle turbinate can partly block the nasal airway and drainage from the sinuses into the nose. This is usually caused by development of an abnormal air cell within the turbinate called a “concha bullosa”.
Dr Roth treats an enlarged middle turbinate with keyhole endoscopic sinus techniques. This involves leaving sufficient support for the turbinate but removing the component blocking the airway.
Are there alternatives to surgery?
There are a number of things that can be done to treat enlarged turbinates that may prevent surgery being necessary. These include the following:
- Avoidance of triggers – allergies, cigarette smoke.
- Long-term and regular use of a steroid nasal spray.
- Avoidance of over-the-counter decongestant sprays
- Treat any infected sinuses appropriately
- Allergy assessment and treatment – this may include antihistamine tablets or sprays, steroid sprays, saline sprays or immunotherapy.
Nasal turbinate treatment
The nasal turbinates can cause problems with breathing, snoring and in some cases sinus problems. Over the years many procedures have been trialled on turbinates with different degrees of success in alleviating patient symptoms.
What techniques have been used to treat enlarged turbinates?
The earliest techniques involved simply removing the inferior turbinates with a pair of long scissors. They did not grow back. In some patients this lead to a dramatic improvement in their breathing with no long term problems. In a small group of patients, significant dryness and sensitivity developed in the nose. This was sometimes associated with the development of crusting of dry mucus.
Other popular techniques involved cauterising (burning) or inserting a radiofrequency probe into the turbinates. These techniques were popular in the United States as they could be performed in the outpatient office and avoid expensive hospital fees. A “coblation” turbinoplasty falls into the category as well. A modest improvement could be obtained but many patients felt that the results were short lived or did not notice any improvement at all.
The word “turbinectomy” means to completely remove (or cut off) the turbinate. The word “turbinoplasty” means to reshape the turbinate. Note that there are actually four turbinates in each side of the nose – the supreme, superior, middle and inferior. This article relates to the inferior turbinates. Other problems can also occur in the other turbinates.
PJ Wormald, a world renowned otolaryngologist (ENT Specialist) in Adelaide published the technique of the submucous resection of the inferior turbinates nearly a decade ago. This has now been used by otolaryngologists for some time and the results have stood the test of time.
The submucous resection of turbinates technique (also known as an inferior turbinoplasty)
In this technique a small incision is made at the front end of the inferior turbinate. The mucosa on one side is carefully lifted free of the bone and removed. The component of the turbinate bone that is protruding out into the nasal airway and causing problems is removed. The mucosa is then laid back down and curled into a new, small turbinate.
This technique preserves all the good functions of the turbinate – humidification of air, production of mucus, sensation of airflow. At the same time it creates an improvement in breathing (and snoring in some cases).
The main risk of surgery is temporary bleeding. The turbinates have a rich blood supply so there can be some oozing from the nose for a couple of days after the surgery. There is also a small risk of infection and temporary crusting.
The surgery is done endoscopically (key-hole) under general anaesthetic in a hospital. There are no external scars and no facial bruising. The patient satisfaction rate is very high with this procedure. Most patients report a significant improvement in breathing, sleep quality and their overall quality of life.
Dr Roth often performs a submucous resection of the turbinates as part of the treatment of snoring, sinus problems, breathing problems or during a rhinoplasty. You can read more about nasal surgery including rhinoplasty here.
Please contact our office for an appointment to discuss whether you are a candidate for turbinate surgery and to look at what types of benefits you may obtain from it.