Enlarged turbinates or turbinate hypertrophy is a condition that occurs as the result of chronic inflammation of the mucosal membranes that cover the turbinates. When these membranes, which contain a large and sensitive supply of blood vessels, become chronically swollen they can produce prolonged nasal congestion.
What Are the Turbinates?
The turbinates are made of bone and soft tissue and are located inside the nose near the septum. (The nasal septum is the structure that divides your nasal passages into right and left sides.) The cartilage and bone are lined with a thin protecting membrane called mucosa that helps to keep the inside of the nose moist. Usually, there is space between the septum and turbinates to allow air to pass through the nose. The turbinates help to warm and moisturize that air as it flows through your nose.
There are three turbinates in each nostril (inferior, middle and superior), but it is the inferior turbinates that most commonly affect airflow. For most patients, the soft tissue part of the turbinates is the major problem, where the turbinates become enlarged leading to nasal congestion, blockage, and obstruction.
What is Nasal Obstruction?
Nasal obstruction is a blockage of the nose or nasal cavity that affects a patient’s ability to breathe through the nose. As a result, these patients tend to breathe through their mouth, leading to a sensation of a dry mouth. For some patients, these symptoms get worse at night and affect sleep.
What Causes Nasal Obstruction?
Nasal obstruction can have many causes. For some patients, allergies lead to swelling of the nasal and sinus lining, which causes congestion and blockage. For other patients, the blockage may be due to a simple anatomical obstruction, such as enlarged adenoids, a polyp in the nasal passage, a deviated septum, enlarged turbinates or narrow nasal passages. Often patients with narrow nasal passages have problems with the nasal septum and turbinates.
What are the Symptoms of Enlarged Turbinates?
Symptoms of enlarged turbinates may include:
- Persistent nasal congestion
- Difficulty breathing through the nose
- Recurring Sinus Infections (Sinusitis)
How is Turbinate Hypertrophy Diagnosed?
Generally, your ENT (ear, nose, and throat) doctor will ask you about your symptoms and will perform a nasal examination using a lighted, 4mm nasal endoscope. The endoscope will help to visualize the nasal and sinus passages and will help to determine the potential source of your nasal congestion. For some patients, CT scans and allergy testing may also be ordered.
What Treatment Options are Available for Enlarged Turbinates?
When enlarged inferior turbinates are determined to be a significant causative factor of nasal obstruction, turbinate reduction procedures may be recommended to shrink the size of the turbinates and improve breathing.
Two of the most commonly performed procedures include Radiofrequency Ablation (RFA) and Submucosal Reduction (SMR). Both are effective in minimizing the swelling of the turbinate mucosa and in diminishing the congested lining.
Radiofrequency Ablation (RFA)
During this procedure, a small probe is placed in the submucosal area of the turbinate (between the inner turbinate bone and the outer mucosal lining) and low-power radiofrequency energy is applied to decrease tissue volume.
Submucosal Reduction (SMR)
For the SMR procedure, a small incision is made in the front part (head) of the inferior turbinate. Dissection is performed creating a pocket in the submucosal lining for placement of a powered instrument called a micro-debrider. The micro-debrider uses suction to pull in the engorged submucosal tissue of the inferior turbinate, and the rotating blades cut it down or reduce it. Once the submucosal lining has been reduced, the healing process begins and scar tissue forms to prevent the lining from swelling as it had prior to surgery.
What Else Can be Done to Open Up the Nasal Passage?
For some patients, moving or “out-fracturing” the turbinate bone may be recommended to open up the nasal passage. This is an additional procedure that can be done alongside an RFA or SMR.
During an “out-fracture” procedure, the inferior turbinate Conchal bone is firmly moved or “out-fractured” from its normal midline position to a more lateral position along the nasal sidewalls. This allows for the central component of the nasal airway to open up allowing for improved passage of air.
Turbinate Reduction FAQs
Many surgeons perform turbinate surgery without nasal packing. If nasal packing is used, it is inserted to prevent excessive postoperative bleeding. Talk to your surgeon about his/her standard practice.
No, turbinate reduction surgery does not affect the external appearance of the nose or face.
Neither sutures nor stitches are required for inferior turbinate reduction surgery.
Patients can expect to have some discomfort after surgery including fatigue, nasal stuffiness, and mild nasal drainage. The stuffiness typically results from swelling after the procedure and typically starts to improve after the first week. Most patients find that any post-operative discomfort can easily be managed with regular or extra-strength Tylenol.
There may be some post-operative bleeding after turbinate surgery, as the turbinates have a strong blood supply. For this reason, your doctor may advise you to use topical vasoconstrictor sprays such as Afrin or Oxymetazoline to control post-operative bleeding. If you experience any persistent or significant bleeding post-surgery, contact your doctor right away.
Yes, other procedures can be performed at the same time as a turbinate reduction. When other components contribute to nasal congestion, such as a deviated septum, sinus polyps, enlarged adenoids, or a sinus blockage, these components can be addressed at the same time as turbinate surgery Your doctor will discuss such options with you when developing your treatment plan.
Time off for recovery usually depends on the type of procedure performed as well as the type of anesthesia used. Recovery time for patients undergoing an RFA typically involves less time off of work–usually a day or two–because these procedures are performed under local anesthesia. For patients who have nasal and sinus procedures performed under general anesthesia, they may need to take 3-4 days off of work. During this time, patients are advised to refrain from heavy lifting or vigorous activity for 1-2 weeks.
Generally, turbinate reduction surgery takes 15-20 minutes, but that can vary from patient to patient. Of course, the time is extended when any other procedures are added on (e.g., sinus surgery, septoplasty, etc.).
All of the procedures for turbinate reduction (RFA, SMR, and Out-Fracture) can be done as an in-office procedure under local anesthesia.