Turbinate Hypertrophy and Treatment
Turbinates are bony structures covered with soft tissue on the sides of the inner nose that regulate airflow and protect the inner nasal anatomy. The major function of the turbinates is to control airflow. From the bottom to the top of the nose, there are three (sometimes four) levels of turbinate structures: the inferior, middle, superior and the supreme turbinate that is not present in every person.
The inferior turbinate plays the largest part in directing airflow, but it also moistens, heats, and filters air coming into the respiratory system. The middle turbinate primarily protects the sinuses and the olfactory bulb, which houses your smell receptors. The superior turbinate protects the sphenoid sinus on each side.
What can go wrong with the turbinates?
The primary issue people experience with their turbinates is turbinate hypertrophy (enlarged turbinates). Enlarged turbinates can be caused by allergies, chronic sinus inflammation, or environmental irritants. Turbinate hypertrophy can be situational or chronic. A common type of situational turbinate hypertrophy is the nasal cycle, in which the turbinates on one side of the nose will swell for four to six hours before returning to their normal size, at which point the turbinates on the other side will begin to swell.
Concha bullosa is a condition unique to the middle turbinates where the middle turbinate is filled with air and enlarged like a balloon. When this happens, the concha bullosa can block the flow of air to the maxillary sinus via a small passageway called the sinus ostium. If the sinus ostium is blocked and air does not reach the maxillary sinuses, they can accumulate fluid and become infected.
How are turbinate hypertrophy and a deviated nasal septum related?
A patient with a deviated nasal septum is more likely to have both turbinate hypertrophy and concha bullosa. Septal deviation causes turbinate hypertrophy because the structures within the nose tend to grow so that they fill open areas. If your septum is deviated to the left, that creates space for the right middle and inferior turbinate to grow larger.
How should I treat my enlarged turbinates?
Treatment options vary depending on the cause of your enlarged turbinates. Make sure you are certain of the cause before you begin treatment. If your enlarged turbinates are a result of allergies or environmental irritants, you can allergy-proof your home by following simple precautions to get rid of pollen, dust, and pet dander. Medications like nasal steroids should be tried but need to be continued and have varying efficacy. The best long-term treatment for chronically enlarged turbinates – especially if caused by a deviated septum, is turbinate reduction surgery. Turbinate reduction surgery is often performed at the same time as a septoplasty. Consult a board-certified ENT to determine the best course of treatment for you.
What Surgical Techniques Treat Turbinate Hypertrophy?
1. Outfracture: Fracturing the enlarged inferior turbinate laterally will crush the turbinate bone and open the nasal airway significantly but does not reduce the thickness of the turbinate mucosa.
2. Submucosal Resection: This involves opening the front end of the turbinate and removing the bone below the mucosa. This more significantly reduces the inferior turbinate and the mucosa will heal in the area where the bone was removed.
3. Cautery Reduction: This uses heat to shrink the mucosa or submucosal tissue. Mucosal shrinking will cause a fair amount of crusting during healing.
4. Radiofrequency (Coblation): A probe is inserted into the front of the turbinate into the submucosa. The radiofrequency waves are used to treat the submucosal tissue. Over time the turbinate will shrink as the submucosal area becomes smaller. Submucosal shrinking usually does not crust significantly and does less damage to the mucosa.
5. Turbinate excision: In this type of surgery, part or all of the turbinate is removed. This can be dangerous as the nose may not stop crusting and you may not feel air entering your nose termed “empty nose syndrome”. Dr. Bennett does not perform this technique.
6. A combination of any of the above may be used in certain situations to optimize breathing ability depending on your individual situation.
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