Turbinate Hypertrophy - Definition, Symptoms, Causes and Treatment

Enlarged (Hypertrophied) Turbinates

Turbinate Hypertrophy Definition

Inside our nose, there are unique, perfectly designed cylindrical or oval-round shaped structures called "turbinates" in changing the air flow entering the nose, flow velocities and flow directions. There are 3 turbinates (inferior, middle and superior tubinate) in each nasal cavity. Especially the lowest inferior tubinates are the most functional ones. Turbinates are the first to encounter external air when we draw air into our nose, and turbinates take part in making this air suitable for the lungs, that is, "warm, humid, pressurized and clean air". Turbinates can grow due to contact with allergens, chronic infections, contaminated air contact, hormonal or genetic reasons, and this condition is called "Turbinate Hypertrophy - Enlarged Turbinate - Hypertrophied Turbinate". When the turbinate volume increases abnormally, it may cause an abnormal increase in intranasal airway resistance and nasal congestion.

Recently, it has been emphasized that this unique structure should be accepted as an "organ", only the existing structure should be reduced in size and surgical partial or complete excision should not be performed in the treatment of hypertophic turbinate. Surgical removal of the turbinates or making them abnormally small may result in a dysfunctional nose (empty nose syndrome) and nasal hyperventilation. You can browse the links on this subject >>Surgery of the turbinates and “empty nose” syndrome (nih.gov) / Overreduction of Turbinate - Nasal Hyperventilation (ent-istanbul.com)

Turbinate Hypertrophy Symptoms

Enlarged inferior turbinates leads to increase of nasal airway resistance and nasal congestion.

Symptoms of turbinate hypertrophy include:

- Congested or blocked nasal breathing
- Breathing trouble at night and snoring
- Sleeping with the mouth open
- Dry mouth
- Reduction in exercise capacity
- An increase in gum disease
- Difficulty wearing a nasal CPAP mask

Causes of Turbinate Hypertrophy

Enlargement of turbinates can occur due to the following reasons:

- Allergic rhinitis (inflammation associated with allergies)
- Chronic sinusitis
- Second-hand smoking
- Chemical irritants.
- Vasomotor rhinitis
- Drugs (Overuse of topical and oral decongestants / Rhinitis medicamentosa)
- Hormones
- Septal deviation (that creates air space in the nasal cavity, turbinate which in the bigger air space side become to grow larger).

Nasal septum deviation and compensatory turbinate hypertrophy

Causes of Turbinate Hypertrophy,Enlarged Turbinates,Radiofrequency turbinate reduction,Coblation Turbinate Reduction,Hypertrophied Turbinates

The 2 photographs above show the right inferior turbinate hypertrophy (red and yellow arrows) and the nasal septum deviation to the left. Generally, in patients with nasal septum deviation, turbinate hypertrophy occurs in the passage with a large air passage in the nose, in order to slow down the current air flow and to humidify, purify, pressurize and heat the air entering the nose. Especially in patients with severe nasal septum, when highly asymmetrical air volumes occur in the nasal air volumes, inferior turbinate hypertrophy may be more pronounced on the side with large volume. Perhaps with the contrary idea, more air entering the large or wide nasal cavity, more allergens or microorganisms entering, more nasal mucosa drying can cause this situation. You can look detailed links >> Compensatory hypertrophy of the contralateral inferior turbinate in patients with unilateral nasal septal deviation. A computed tomography study - PubMed (nih.gov) / Histopathology of the Inferior Turbinate With Compensatory Hypertrophy in Patients With Deviated Nasal Septum - Berger - 2000 - The Laryngoscope - Wiley Online Library

Diagnosis of Turbinate Hypertrophy

Turbinate hypertrophy diagnosis can be made by ent doctor with a thorough evaluation of symptoms and nasal examination. Computed tomography is usually not necessary for diagnosis. However, in the presence of septal deviation, chronic sinusitis, nasal polyps and intrasal mass lesion the paranasal computed tomography may be required.

Medical Treatment Options For Turbinate Hypertrophy

The following drugs and measures are appropriate in the turbinate hypertrophy:

- Nasal irrigation with hypertonic saline (very salty water)
- Allergen avoidance and proper treatment of allergic rhinitis
- Avoidance of cigarette smoke (second-hand smoking) and chemical irritants
- Topical nasal steroid sprays
- Topical nasal decongestant sprays (for only a few days)
- Oral decongestant (for only a few days)

Turbinate Surgery (Turbinate Resection)

There are many methods for reducing of the concha. Concha surgery is one of them. Turbinate surgery can be performed with conjunction of septoplasty. Generraly partial resection of the concha performed via submucosal way. Microdebrider resection can be also used for it. It is important that the turbinate not be removed completely because its removal can cause to deterioration of nasal air physiology and it can result in a very dry and crusty nose. In the absence of nasal turbinate, the air that is breathed may not be to adequately humidified, filtered and warmed. Some methods include turbinate bone resection.

Currently, modern minimal invasive technologic methods more favorable than surgical removal of turbinates in turbinate hypertrophy treatment such as cauterization, coblation, radiofrequency reduction. These minimal invasive methods can be applied under local anesthesia in office conditions.

Radiofrequency Turbinate Reduction

Radiofrequency turbinate reduction (RFTR) is a non-surgical, minimally invasive technique that can reduce tissue volume of the turbinates. In this method, Radiofrequency energy dissipation and damage to the surrounding tissue is minimal. Radiofrequency turbinate reduction technique is well tolerated and effective and it has a low complication rate and has been shown to reduce nasal obstruction secondary to inferior turbinate hypertrophy according to the a systematic literature review (Source: Radiofrequency thermal ablation for patients with nasal ...). RFTA, provides immediate reduction in nasal congestion.

An Important Information About Turbinate!

Turbinates are tissues inside our nose that purify the air, warm the humidifier and make it pressurized. It should be regarded as a unique "organ". Abnormal reduction or surgical removal of these tissues may cause permanent health problems (such as empty nose syndrome). You can find detailed information on this topic >> Why Turbinates Are Important? - Empty Nose Syndrome

Radiofrequency Turbinate Reduction Videos:

Radiofrequency Turbinate Reduction Video - 1:

Radiofrequency Turbinate Reduction Video - 2:

Coblation Turbinate Reduction

Coblation® turbinate reduction procedures use a Coblation-channeling® technique designed to simultaneously remove and shrink submucosal turbinate tissue while leaving the mucosal lining virtually undisturbed (Source: ArthroCare ENT: Turbinate Reduction - A minimally invasive ...). This method is more expensive than the radiofrequency reduction.

Coblation Turbinate Reduction

Turbinate tissue can re-grow after turbinate surgery and turbinate reduction in patients especially those living in environments where the particles are allergenic. The procedures may need to be repeated.