What are the turbinates?
The turbinates are shelf-like structures on the side walls of the nasal cavity: a thin bony core covered by a thick, vascular lining. They are not a disease but a normal part of the nose, warming, humidifying and filtering the air we breathe. The inferior turbinates are the largest and direct most of the airflow, which is why any swelling in them is felt immediately as a blocked nose.
The lining of the turbinates swells and shrinks naturally through the day, and the two sides alternate every few hours in what is called the nasal cycle. The problem begins when the swelling becomes permanent and no longer responds to medication; this is turbinate hypertrophy.
Why do they enlarge?
The most common cause is allergic rhinitis: house-dust mite, pollen or animal dander keep the lining constantly irritated. Cigarette smoke, polluted air, hormonal changes (pregnancy, thyroid disease), some blood-pressure medicines and long-term use of decongestant nasal sprays (rhinitis medicamentosa) also enlarge the turbinates. With a deviated septum, the turbinate on the wider side grows over the years to fill the space, which is why the turbinates must be assessed in every septum operation.
In long-standing cases not only the lining but also the underlying bone thickens. The distinction matters: mucosal enlargement responds well to medication and radiofrequency, whereas bony enlargement needs surgical reduction.
What are the symptoms?
The main symptom is nasal obstruction, usually on both sides and worse at night; when lying on one side, the lower nostril blocks. Mouth breathing, snoring, a dry mouth in the morning, post-nasal drip, reduced sense of smell, recurrent sinusitis and a nasal-sounding voice are typical. When allergy is the cause, sneezing, itching and watery discharge accompany the blockage.
A blocked nose that opens for a few hours after a decongestant spray and then returns worse is the classic sign of turbinate-related obstruction and of rhinitis medicamentosa; these sprays should only be used for short periods.
How is it diagnosed?
The inside of the nose is examined with an endoscope, which shows the size of the turbinates, the colour of the lining, any septal deviation and any polyps at the same time. After a decongestant is applied, the surgeon checks how much the turbinate shrinks: good shrinkage means the problem is mucosal, little shrinkage means bone is the main component. Allergy tests and a CT scan of the sinuses are ordered when needed; CT is particularly useful when surgery is being planned, because it shows the septum, turbinates and sinuses together.
Treatment: medication first
The first step is to treat the underlying cause. In allergic rhinitis, regular intranasal corticosteroid sprays (whose effect builds up with regular use), antihistamines, saline rinses and allergen avoidance are enough for most patients. Smoking should be stopped and decongestant sprays discontinued. If obstruction persists despite an adequate period of regular treatment, surgical reduction is discussed.
Turbinate reduction techniques
The aim is not to remove the turbinate but to reduce its volume while preserving its function; complete removal dries the nose and can lead to the distressing condition known as empty nose syndrome. The most widely used method is radiofrequency turbinate reduction: under local anaesthesia a thin probe is placed beneath the lining and controlled heat shrinks the tissue. The procedure takes 10–15 minutes, needs no packing and allows a return to work the same day; the effect becomes evident within 3–6 weeks. It preserves the lining of the nose and can be repeated if necessary.
When bony enlargement predominates or radiofrequency is insufficient, submucosal reduction with a microdebrider or a turbinoplasty in which part of the bone is removed is performed. These procedures are usually combined with septoplasty or rhinoplasty in the same session under general anaesthesia, with no external incision. Crusting and slight bleeding are expected in the first days; regular saline rinses and moisturising ointments speed up healing. For a lasting result, treatment of the underlying allergy must continue.
This article is for general information purposes only; please consult your physician for diagnosis and treatment.
- Han JK, et al. Clinical Consensus Statement: Septoplasty with or without Inferior Turbinate Reduction. Otolaryngol Head Neck Surg 2015. PubMed