Turbinate Hypertrophy

Nasal turbinates are a normal part of the architecture of the nasal cavity. These outgrowths from the sidewall bone share the same mucous membrane covering that is common to all the surfaces in the nasal cavity. This mucous membrane lining serves a number of important functions, including adding moisture to the air that comes in through the nose. It also helps to clear out any foreign matter that may be inhaled and ensures a normal flow of nasal mucous. Finally, this membrane helps to regulate the flow of air during respiration.

The nasal turbinate structures form three distinct areas. Each side of the nose contains the superior turbinates, the middle turbinates, and the inferior turbinates. Medical problems most often result from enlargement of the middle and inferior turbinates since this is the area through which passes about half the air that comes in through the nose. These problems usually take the form of nasal obstruction.

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Treating the Inferior Turbinate

When the inferior turbinates become enlarged, this is usually the result of an inflammatory condition. Less often, it may occur naturally during development. The first step in treating this inflammation is to try a non-surgical procedure. Nasal sprays that deliver a steroid to the affected area may help the swelling to subside.

When medication does not bring relief, more assertive procedures may be called for. The purpose of these procedures is to remove the tissue that is causing the obstruction.

One effective choice is called submucous resection. This is an endoscopy procedure that allows the physician to remove very precise areas of bone. Any tissue in the area that is obstructive can also be removed at the same time. The result is that the inferior turbinate is reduced in size while the precision of the procedure leaves the rest of the nasal lining undamaged.

There are other options, such as coblation. This is a more radical procedure and involves removing part or all the turbinate. Not only has this option been shown to be less effective, but it can also have much more severe side effects than submucous resection. For example, coblation may cause bleeding during surgery that requires packing. Another undesirable consequence of coblation is called “empty nose syndrome.” This is the unpleasant sensation that the nose is “stuffed up,” even though the passages are clear. Empty nose syndrome occurs when the lining along the path of airflow has been removed or damaged. This leaves the patient unable to detect the passage of air through the nose. This condition is difficult to treat and is unlikely to occur with submucous resection.

Treating the Middle Turbinate

Problems with the middle turbinate are usually the result of a congenital malformation. This is called a concha bullosa, which is an air-filled enlargement in the turbinate. This enlargement can vary in size, but if it becomes large enough to block the nose, it can cause sinusitis. Sinusitis occurs when the concha bullosa blocks the drainage of mucous, resulting in inflammation. This condition can be effectively treated with an endoscopic procedure to ablate the enlargement.

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