Turbinate Hypertrophy

 
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Think of the inferior turbinate as a sausage filled with blood vessels.  They naturally change in size.  The size of the turbinates is unconsciously controlled so that they swell on one side at a time and shrink on the other side.  Some people are annoyed by the stuffiness which shifts from side to side several times a day.  Others notice that their nose gets stopped up when they lie down.  That occurs  because lying down allows more blood to collect in the turbinates.

Unfortunately, the size of the inferior turbinates can be too much to allow normal airflow through the nose. People cannot breathe properly when exercising, sleeping or even at rest. This is particularly noticeable for people who also have a deviated septum.

Turbinates are also the tissue that shrinks when we use topical decongestants, such as Afrin or NeoSynephrine, or an oral decongestant, such as Sudafed. Overuse of topical decongestants results in even more swelling of the turbinates after the medication has worn off.

The most common cause of turbinate hypertrophy is the inflammation associated with seasonal and environmental allergies (link). Other causes include chronic sinusitis, second-hand smoke and chemical irritants.

Medical treatment options :

  • Oral decongestant (link) requires taking a pill once or twice a day, causes insomnia in some people, anxiousness in others and must be avoided by people with high blood pressure, heart or kidney disease.
  • Hypertonic saline (very salty water) irrigation or spray is an even safer, but somewhat more time-consuming and short-acting treatment. (link)
  • For people with allergies, an antihistamine (link) can be effective in restoring normal breathing.  All of these medicines may bring on sleepiness and cannot be combined with alcohol.  Caution needs to be used if driving.
  • Topical nasal steroid sprays (link) are a safer way to shrink the nasal membranes, but has some occasional side effects, such as nasal bleeding or unpleasant taste.
  • Avoid all topical nasal decongestants, such as Afrin or Neo-Synephrine.  They will provide a dramatic improvement, but it is a temporary solution.  It shrinks the nasal membranes, but has the unpleasant side effect of causing the membranes to become even larger and the nasal blockage worse.  Also decongestants can make one feel jittery and should not be used by people with certain medical problems, such as high blood pressure, heart, thyroid or kidney disease.

Turbinate Surgery


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 In this procedure, a portion of one or both inferior turbinates is reduced in size. The most common technique requires only a small incision inside the nose and a tool which removes some of the blood vessels, shrinks the turbinates, but leaves the mucosal surface intact. An alternative procedure is cauterization (coblation) of the inferior turbinates.

 Usually the surgery is performed in an outpatient surgery center. The surgery is often performed under general anesthesia or with the patient made sleepy and forgetful by some IV medication.

 

What to Expect
  • Nasal packing for one night.  At the end of the operation a small, soft packing is placed inside the nose to reduce the amount of bleeding.  The packing is somewhat uncomfortable because of pressure and complete blockage of the nose.  It is best to keep one’s head upright and elevated by sitting in a chair or with several pillows under the head.  The packing is removed usually in the doctor’s office the next day.
     
  • Recovery within one week.  The nose will have some crusting and blood clots for about one week, but then will return to normal.  And breathing through the nose should be much better.
     

Risks

  • There is a concentration of blood vessels in the nose.  It is normal to have blood oozing from the nose for the first day.  Occasionally, patients need attention after a surgical procedure to control heavy or persistent bleeding.
  • Nasal crusting may occur if there is an area of mucosal scarring or removal of too much of the inferior turbinates.
  • Nasal congestion may persist even after surgery.  It is difficult for the surgeon to know the exact amount of tissue to remove.  It is better to leave too much of the inferior turbinate tissue in place where it can be treated again, rather than removing too much and not being able to replace it.

“Septoplasty and turbinoplasty (turbinate reduction) I was expecting to be recovering for a longer period of time, but I recovered in about 1 week and was able to eat pasta and soft food the following day. Surgery was probably the easy part.” Rafael Espaillat



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