Enlarged Turbinates

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 supply of blood vessels that are very sensitive, 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.  It is made up of cartilage and bone, which are lined with a thin membrane called mucosa. The mucosa covers and protects the cartilage and bone, and 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 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.  When the bone or soft tissue become enlarged, they cause nasal obstruction. 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.

Inferior turbinate surgery is typically performed to improve nasal airflow and reduce nasal blockage and congestion. A turbinate reduction is the preferred surgical treatment to shrink the size of the turbinates and improve breathing. It is a minor, minimally-invasive, outpatient procedure.

What is a Nasal Obstruction?

A 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 a Nasal Obstruction?

A 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?

Symptoms of a turbinate hypertrophy may include

  • Persistent nasal congestion
  • Difficulty breathing through the nose
  • Snoring
  • Nosebleeds
  • Recurring Sinus Infections (Sinusitis)

How is Turbinate Hypertrophy Diagnosed?

During your consultation, 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.

After your examination, your doctor will discuss treatment options with you.

What is the Treatment for Turbinate Hypertrophy?

When enlarged turbinates are determined to be a significant causative factor of nasal obstruction, a turbinate reduction procedure may be recommended to correct the problem. There are several ways to shrink the size of the turbinates. If your turbinates are swollen, your doctor may prescribe medication (i.e., nasal corticosteroid sprays and nasal antihistamine sprays) to reduce the swelling.  If enlarged inferior turbinates are causing your nasal obstruction, surgery may be the recommended treatment.

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.

This procedure is effective in reducing congestion while maintaining the warming and humidification function of the turbinates.

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.

Out-Fracture Procedure

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

A septoplasty procedure is generally recommended for adults 16 years and older. It is generally recommended that a person has completed puberty before a septoplasty is recommended.

Category: Deviated Septum

If a septoplasty is the only procedure performed, there should be little to no bruising after surgery.

Category: Deviated Septum

The procedure takes, on average, 1 to 1 ½ hours, depending on the deviation.

Category: Deviated Septum

Many surgeons perform septoplasty without packing or septal splints. If nasal packing is used, it is inserted to prevent excessive postoperative bleeding. Talk to your surgeon about his/her standard practice.

Category: Deviated Septum

This procedure can be done using a local or a general anesthetic and is usually done on an outpatient basis.

You can expect to have mild pain, fatigue, nasal stuffiness, and mild nasal drainage after your surgery. The stuffiness typically results from swelling after the procedure and typically starts to improve after the first week. Most patients find that post-operative pain is easily managed with low-dose narcotic medications, such as Tylenol with Codeine or Tramadol, for 1-2 days. After that, they switch to regular or extra-strength Tylenol and ibuprofen (taken together to control both pain and swelling) for another week or so.

Category: Deviated Septum

Sutures may be used to sew the skin incision site and mucosal flaps together at the end of surgery. Frequently, if an incision is made into the mucosa, sutures are not placed. If sutures are placed, they are typically dissolvable and do not require removal.

Category: Deviated Septum

After surgery, you may have drainage of some mucus and blood from your nose. This is a normal part of the healing process.

Many patients typically take several days to a week off from work for recovery. During this time, patients are advised to refrain from heavy lifting or vigorous activity for 1-2 weeks.

Category: Deviated Septum

After surgery, there are no restrictions on eating or bathing. Actually, you may eat whatever you feel like eating.

Category: Deviated Septum

If a deviated septum is the sole cause for your chronic sinusitis, you can expect improved nasal breathing and airflow, decreased blockage and congestion, diminished dry mouth, and a more complete, restful sleep. Overall, you will experience relief from your symptoms and improved quality of life.

Category: Deviated Septum

A septoplasty can be frequently combined with turbinate reductions, and/or balloon sinuplasty and functional endoscopic sinus surgery. These procedures should not leave any bruising or facial swelling. A septoplasty can also be performed in conjunction with a rhinoplasty (nose job), and if this happens bruising and swelling are more common. The ENT surgeon will work in conjunction with a plastic surgeon to perform those procedures.

Category: Deviated Septum

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If you are having an issue with nasal congestion

Contact ENT of Parker at (303) 840-9690 to schedule a consultation.