Turbinate Reduction Surgery

Swelling of the nasal turbinates is one of the most important and common causes of nasal congestion.

The structures on the side walls inside the nose, three on each side in all healthy people, are called turbinates (conchae). They are sometimes confused with the lymphatic tissue in the space behind the nose (the adenoids, adenoid vegetation), but their location, structure and function are completely different.

The turbinates consist of a thin layer of bone, the soft tissue surrounding it, and a highly specialized mucosa covering it. They contain a very large number of blood vessels and nerves.

Breathing through the nose is very important, because the turbinates warm, humidify and filter germs and particles from the air passing through the nose.

The turbinates swell or shrink according to the temperature and humidity of the environment. In cold weather, the blood vessels fill with blood and swell, warming the cold air. In hot weather, blood withdraws from the vessels, the turbinates shrink, and the warm inhaled air is brought down to body temperature.

In addition, the mucosa covering the turbinates contains secretory cells that produce a fluid called mucus. These secretions trap and clear dust and germs from the inhaled air. When air comes into contact with the turbinates inside the nose, the air sacs of the lungs (alveoli) open automatically, and clean air reaches the lungs without any effort.

The nostrils take turns opening and closing every 2–3 hours, regulating the work of the lungs. Under normal conditions, both nostrils are not fully open at the same time. This is a normal physiological state, and a person with a normal nasal structure does not notice it. The lung on the side of the open nostril draws in more air and expands, while the other rests. In this way, thanks to the nose, the body rests itself during the day by working the lungs alternately.

Causes of turbinate enlargement

In people with allergies, inhaling an allergen (dust, pollen, mold, fungi, etc.) causes the turbinates to swell, most of all the inferior turbinate.

Air pollution and smoking cause the turbinates to swell.

Sinusitis, nasal inflammation and a deviated septum can also cause the turbinates to swell.

Symptoms of turbinate enlargement

The most obvious symptom is nasal congestion. Because not enough air can be taken in through the nose, the mouth opens involuntarily and the person breathes through the mouth. As a result, the ambient air dries out the mouth and upper airways. This becomes more pronounced during sleep. Because nasal breathing is inadequate, the lungs cannot take in enough air, so the body cannot get enough oxygen and cannot rest sufficiently. The person wakes up tired in the morning. Because of mouth breathing throughout the night, there is dry mouth and altered taste in the morning.

Diagnosis of turbinate enlargement

The information given by the patient, their work and living environment, and their history of allergies and smoking are important for diagnosis. The diagnosis is made with an endoscopic nasal examination. Allergy tests are also performed to determine whether there is an allergic condition.

Medical treatment of turbinate enlargement

Treatment depends on identifying the condition causing the turbinate enlargement. Correcting a deviated septum, quitting smoking, improving the living and working environment, and treating allergic rhinitis may bring improvement.

For allergies, preventive measures include avoiding dust, removing dust-producing carpets and woolen items from bedrooms, choosing cotton and hypoallergenic clothing rather than woolen clothes, and avoiding pets.

The mainstay of treatment is long-term use of corticosteroid nasal sprays. This can also cause side effects such as dryness and bleeding in the nose. Medication generally does not give much result, so most patients need surgery.

Surgical treatment of turbinate enlargement

There are many techniques. Whichever is used, preserving the mucosa covering the turbinates is extremely important. If the factors causing turbinate enlargement recur, the procedure may need to be repeated.

Mucosa-preserving procedures include outward fracture of the turbinates (lateralization), removal of the inner bone and, in particular, REDUCTION WITH RADIOFREQUENCY OR LASER.

It can be performed under general or local anesthesia. A small nasal pack for a few minutes to a few hours may be needed. The procedure takes about 5–10 minutes. If it is done under local anesthesia, the patient can return to work the same day. Nasal cleaning and moisturizing after surgery are very important.

Turbinate surgery is performed in almost every patient undergoing surgery to straighten the cartilage and bones of the nasal septum (septoplasty) and endoscopic sinus surgery.