Why Turbinates Are Important? - Empty Nose Syndrome

Turbinates and Their Important Health Related Jobs

Treatment of turbinate hypertrophy,Important Healt Related Jobs of Turbinates,Empty Nose Syndrome,Symptoms of Turbinate Hypertrophy,

Each nasal cavity contains 3 anatomical structures called "turbinates". These structures, which have outer parts as mucosa and inner parts as vascular structure rich tissue and bone, have different duties. These:

- By heating the air entering the nose

- Cleaning of air entering the nose

- Humidification of the air entering the nose

- Pressurization of the air entering the nose

- During sleep, the underlying turbinate grows in volume and the patient may need to change position in the sleep (nasal cycle)

- Increasing the percentage of oxygen absorption by adapting the air entering the nose to the lung end airways

Turbinate Hypertrophy

Turbinate Hypertrophy
 
In some cases, turbinates within your nose can grow and cause increased airway resistance in the nose, nasal obstruction, and a variety of other symptoms associated with it. This phenomenon, called Turbinate Hypertrophy, can occur temporarily or permanently due to the following reasons:

- allergic and nonallergic vasomotor rhinitis

- infections

- particulate rich air breathing

- use of decongestant spray for long-term and inappropriate dose in the nose

Symptoms of Turbinate Hypertrophy


In fact, the list can be extended. "Turbinate Hypertrophy" can cause a wide variety of symptoms, such as nasal congestion, dry mouth, reduced sleep quality, reduced daily performance. Depending on the nasal obstruction, the lungs are not suited to air expulsion, a reduction in the percentage of oxygen uptake occurs. 

Treatment of Turbinate Hypertrophy

  
Treatment of turbinate hypertrophy includes medical treatment and surgical treatment procedures. Medical treatment options are choiced in patients with allergy related symptoms or temporary turbinate hypertrophy.
 
Treatment of Turbinate Hypertrophy

For surgical treatment options are including total or partial inferior turbinectomy (PIT), lateral outfracture of inferior turbinates, submucosal resection with microdebrider, laser-assisted turbinate reduction, plasma surgery, cryosurgery,  infrared light, vidian neurectomy, chemical or electrical coagulation and radiofrequency volume turbinate reduction (RFVTR) (source: Radiofrequency volumetric inferior turbinate reduction: long-term clinical results).

Turbinate Hypertrophy

Only Volume-Reducing Applications Are Recommended!


Why Turbinates Are Important? - Turbinates and Their Important Healt Related Jobs - Turbinate Hypertrophy - Symptoms of Turbinate Hypertrophy - Treatment of Turbinate Hypertrophy - Only Volume-Reducing Applications Are Recommended! - Empty Nose Syndrome - Intranasal Hyperventilation - Hyperventilation Syndrome

Turinates are very important structures for normal nose functions. Currently minimal traumatic techniques such as radiofrequency turbinate reduction is the most commonly preffered by ent doctors. Radiofrequency inferior turbinate reduction is considered as a safe minimal invasive surgical procedure with only minimal mucosal damage on turbinate, minor patient's discomfort and low side effects for suitabke application (source: Outcomes of surgery for inferior turbinate hypertrophy).
 
Why Turbinates Are Important? - Turbinates and Their Important Healt Related Jobs - Turbinate Hypertrophy - Symptoms of Turbinate Hypertrophy - Treatment of Turbinate Hypertrophy - Only Volume-Reducing Applications Are Recommended! - Empty Nose Syndrome - Intranasal Hyperventilation - Hyperventilation Syndrome
Turbinates and Their Important Healt Related Jobs
As seen in the upper tomographic image above, when the inferior turbinates are removed surgically near the anterior, there is an abnormal increase in intranasal volume. For this reason, when we breathe into the nose, the incoming air moves very quickly, moving towards as the dirty, cold, unhumidified and unpressurized to lungs. Over time, nasal mucosa, nasal airway, nasal and lower respiratory tract dryness, infection and tissue changes are inevitable. Recently, "empty nose syndrome" and highlighted videotapes related to intranasal hyperventilation (hyperventilation syndrome) have been published in websites. In patients with turbinate hypertrophy, these tissues are considered to be an "organ", the "organ-protective interventions" are suitable to reduce the volume of the existing volume.
 
Complete surgical removal of the turbinates or excessive reduction of their volume can cause serious health problems that may affect the patient for life.

Video - Nasal Hyperventilation - Dry Nose After Turbinectomy With Septoplasty



Video description: The patient, who had turbinate resection and septoplasty operations in a different clinic, applied to our clinic because of the feeling of dryness, crusting in the nose and not getting enough air while breathing. His complaints increased gradually after the operation performed about 10 years ago. On physical examination of the patient, it was observed that both nasal cavities were wider than normal. It was observed that the inferior tubinate was resected close to the left side. Dry, bleeding and crusted areas were seen in the nasal mucosa. Turbinates are unique structures. These tissues and their mucosa should be protected as much as possible.

Examples of Patients with Empty Nose Syndrome

Case 1

Treatment of turbinate hypertrophy,Important Healt Related Jobs of Turbinates,Empty Nose Syndrome,Symptoms of Turbinate Hypertrophy,

Above are images of a patient with right and left nasal cavity endoscopy photographs. It can be seen that both inferior turbinates have been resected almost completely, the intranasal cavity is abnormally large, and the nasal mucosa is dry.

In particular, it can be seen that the left nasal cavity is larger and the nasopharynx is directly visible. The patient's complaints are summarized as follows:

- dryness in the nose
- nasal secretions that are sticky and difficult to remove
- feeling of cold air in the nose
- dryness in the nasal passages
- Feeling of not getting enough air from the nose during sleep
- painful areas inside the nose

Inferior metaus augmentation with cartilage implantation (or cartilage implanting to the inferior meatus for nasal hyperventilation) was planned for the patient. There is not enough turbinate tissue for turbinate augmentation with filling. The patient did not want Modified Young's Operation.

Case 2

Empty Nose Syndrome


Above is the left-side intranasal endoscopic examination photo of the patient who underwent septoplasty + turbinectomy 3 years ago in another clinic. In the examination of the patient, it can be understood that there are red and patchy lesions in the nasal septum and left inferior turbinate remnant due to nasal hyperventilation, the mucosa is dry, there is sticky secretion (secretion that can extend between the septum and the lateral wall), and the nasopharynx can be easily seen when viewed from the front.

The patient's complaints:

- feeling of dryness in the nose
- feeling of cold air in the nose
- Occasional pain in the nose
- feeling of insufficient air intake

When the patient narrowed the nose with a cotton pad impregnated with antibiotic ointment (cotton test), these complaints decreased.

Inferior meatal augmentation with left submucosal cartilage implantation was planned for the patient.

You can find detailed information about the empty nose >> https://www.ent-istanbul.com/search?q=empty+nose
 
 
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
E-Mail: muratenoz@gmail.com
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47


 


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