The nasal turbinates are bony structures inside the nose that are covered by a mucous membrane lining, and have a rich blood supply. There are three nasal turbinates; an inferior, middle and superior turbinate. These structures are important because they act to humidify and heat the air we breathe and help to filter out dust particles and bacteria. They are also involved in our sense of smell (olfaction). The superior turbinates in particular, are covered by olfactory epithelium, which contain many tiny olfactory nerves and receptors which detect odours.
The turbinates swell and change size throughout the course of the day as part of their normal function (1). However, the turbinates can become enlarged and cause obstruction of the nasal cavity, this can interfere with breathing and cause feelings of congestion and nasal stuffiness. The enlargement can occur in both sides of the nose, or only in one side of the nose (2). If the obstruction becomes chronic this can lead to several other problems, such as sleep disturbances, dryness of the mouth and throat, nasal speech, fatigue, reduced lung volume and generally feeling lethargic and unwell (3).
There are a number of reasons as to why the turbinates can become enlarged, including:
Hayfever and allergies
Chronic sinus infections
Deviated nasal septum
Exposure to irritants including chemicals and cigarette smoke
Colds and other respiratory tract infections
Medications and hormones
Some of these factors only cause temporary enlargement of the turbinates, such as a cold, where they will return to their normal size once the cause is no longer present. In other cases, the enlargement is permanent. Initially, enlarged turbinates are treated with medications, such as nasal sprays and decongestant tablets. If these treatments fail to improve symptoms over an appropriate period, surgery may be indicated (3). In some individuals, long-term use of decongestant sprays can worsen the turbinate enlargement.
Surgery for enlarged turbinates is performed through the nostrils with no external incisions. Excessive tissue is removed to open up the nasal passages, this improves airflow through the nose and reduces feelings of congestion and stuffiness. The inferior turbinate is most commonly operated on. There are several different surgical procedures which can be performed on the enlarged turbinate, depending on the severity and the type of tissue which is enlarged (bone, soft tissue or both). However, surgical removal of the entire turbinate is not routinely recommended (turbinectomy) as there may be significant complications that can occur with this procedure. One such complication is ‘empty nose’ syndrome, where despite having the turbinate entirely or partially removed and the nasal passage widened, there is a persistent feeling of a blocked nose and feelings of dryness within the nose (1). Other complications following turbinate reduction surgery include bleeding, nasal dryness, crusting and atrophic rhinitis (3).
In addition, turbinate reduction surgery can help to improve breathing problems. Patients with sleep apnoea and nasal obstruction demonstrate some improvement after procedures such as turbinate reduction to alleviate obstruction of the nasal passages (4). There are numerous surgical techniques for reducing the turbinates, and each method has a different long-term outcome rate, and varying risks of complications (3). In the setting of chronic obstruction not relieved by medications and nasal sprays, surgery is indicated to improve breathing through the nose and to improve quality of life for the patient (5).
If you have questions about turbine reduction surgery or other solution a for how to improve breathing contact your local doctor who will arrange for you to see an ear nose throat specialist.
For more information about turbinate reduction or turbinoplasty surgery click here.
(1) Scheithauer, M. O. Surgery of the turbinates and “empty nose” syndrome. GMS Current topics in Otorhinolaryngology – Head and Neck Surgery, 2010; 9:1-28
(2) Farmer, S. E. J. & Eccles, R. Chronic inferior turbinate enlargement and the implications for surgical intervention. Rhinology, 2006;44(4): 234-238
(3) Willatt, D. The evidence for reducing inferior turbinates. Rhinology, 2009; 47(3):227-36
(4) Friedman, M., Tanyeri, H., Lim, J. W., Landsberg, R., Vaidyanathan, K., Caldarelli, D. Effect of improved nasal breathing on obstructive sleep apnoea. Otolaryngology – Head and Neck Surgery, 2000; 122(1):71-74
(5) Berger, G., Balum-azim, M., Ophir, D. The normal inferior turbinate: Histomorphometric analysis and clinical implications. The Laryngoscope, 2003; 113(7): 1192-1198