Enlarged Turbinates

Many people have nasal obstruction, which could be temporary (ie. a cold) or more persistent (ie. a deviated septum). Blockage of air flow through the nose is associated with sinusitis, allergies, snoring and other medical conditions.

There are several reasons for not being able to breathe well through the nose including a deviation of the nasal septum (the wall between the right and left parts of the inside of the nose), polyps or a growth in the nose, anatomical obstruction of the nose from birth(like choanal atresia – a blockage of the connection between the back of the nose and the throat by bony or soft tissue) and enlargement of the nasal turbinates.

What are the nasal turbinates?
The nasal turbinates run the length of the inside of the nose serving to regulate the airflow and provide humidity, warmth and filtration to the air we breathe. This coins the function of the nose as the air conditioner of the body. From the outside, the turbinates look like bumps on the side of the nose and are commonly mistaken by both patients and doctors alike as polyps or growths.

The turbinates achieve appropriate conditioning of the air coming through the nose by cycling through an enlargement and shrinkage process called the nasal cycle. Every half hour to 3 hours approximately, one side of the nose will undergo enlargement of its turbinate’s and will thus provide more humidity only to shrink and allow the opposite side to do the same while it shrinks back to its normal size. We have three turbinates on either side, a lower or inferior, middle and upper or superior turbinate. The lower turbinate seems to usually be the larger of the three.

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 half an hour to three hours before returning to their normal size, at which point the turbinates on the other side will begin to swell. The nasal cycle is normal and happens in everyone. At any given point one side of the nose breathes slightly better than the other.

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 blocks the flow of air to the sinuses via a small passageway called the sinus ostium. If the sinus ostium is blocked and air does not reach the sinuses, they can accumulate fluid and become infected. Since the middle turbinate is located higher in the nose a concha bullosa can also block air from getting to the top of the nose where the nerve endings responsible for smell are located thus reducing the ability to smell and taste.

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 turbinate to grow larger. As a result although the septum is deviated to one side, the obstruction may be on the other side where the turbinate became enlarged.

What can be done for enlarged turbinates?
Treatment options vary depending on the cause of enlarged turbinates. The ear nose and throat doctor will need  make certain the cause of enlargement is understood before beginning treatment. If the enlarged turbinates are a result of allergies or environmental irritants, allergy-proofing the home by following simple precautions to get rid of pollen, dust, and pet dander can be undertaken. Various prescription nasal sprays, antihistamines and allergy injection therapy may be helpful in reducing the size of the turbinates. However, medical treatment is not always successful. The best long-term treatment for chronically enlarged turbinate’s that do not respond to medical treatment – especially if caused by a deviated septum – is turbinate reduction surgery, which is often performed at the same time as a septoplasty.

How is turbinate surgery performed?
Reduction of enlarged turbinates means either shrinking the tissue with a source of energy (heat, radiofrequency, plasma) or actually removing part of the turbinate. The procedure may be performed under local or general anesthesia, either as an in-office or ambulatory surgery procedure.