Turbinate Enlargement
Management of enlarged nasal turbinates that contribute to chronic nasal obstruction
What is turbinate enlargement?
Three ridges of bone covered in thick, spongy lining project from each side wall of the nose. They are called turbinates, and they are not spare tissue. They swirl incoming air, warm it to body temperature and add moisture to it before it reaches the lungs, and they filter particles out along the way.
The lining over them is unusual in containing venous spaces that can fill and empty, so the turbinates change size continuously. They swell in response to allergens, irritants, cold air, alcohol, hormonal shifts and some blood pressure medicines, and they alternate sides through the day as part of the normal nasal cycle.
The problem arises when that swelling stops reversing. After years of allergy or irritation, or after long overuse of decongestant sprays bought over the counter, the tissue thickens permanently and in some cases the bony core itself enlarges. At that point the nose is narrowed all the time, and treating the underlying allergy no longer opens it.
What you might notice
- A blocked nose for weeks
- Reduced sense of smell
- Loud snoring with pauses in the night
- Facial pressure and headache
How it is diagnosed
The doctor looks into the nose with a light and then an endoscope, assessing how much of the passage the turbinate occupies and what the lining looks like: pale and boggy suggests allergy, red and dry suggests irritation or spray overuse.
A decongestant spray is then applied and the nose re-examined after a few minutes. Tissue that shrinks well is still reversible and will respond to medication. Tissue that barely changes has become fixed, and that single observation does more than any scan to decide what is offered.
The septum is assessed at the same time, because a bend on one side and enlargement on the other commonly travel together. Allergy testing is arranged where the history points that way, and a CT is only needed if the sinuses are also in question.
Recovery
Medical treatment is a matter of consistency. A steroid spray needs several weeks of daily correct use before its effect can be judged, and stopping and restarting it is the usual reason people believe it failed. Where allergy is driving it, avoiding the trigger and treating it properly does more than anything aimed at the nose alone.
If tissue is treated in the clinic, there is no packing and no time off, though the nose feels more blocked for the first week or two while the treated area swells before it shrinks. The full effect appears over six to eight weeks.
After a surgical reduction the nose is congested and crusted for two to three weeks, and saline rinses several times a day are what carry it through. Desk work resumes in a few days and exercise at two to three weeks. Some people notice the nose feels drier for a while as the lining recovers its function.
If it is left untreated
This is not a dangerous condition and there is no clock on treating it. Many people manage with a spray for years and never need anything further.
When it is left entirely alone, the nose stays narrow, and the consequences are indirect. Persistent mouth breathing dries the throat and disturbs sleep, and in children long-term mouth breathing during the growing years affects how the face and jaw develop. Narrowed passages also impair sinus drainage, so sinus trouble becomes more frequent.
The one thing worth acting on early is overuse of a decongestant spray. Beyond about a week, these produce rebound swelling that is worse than the original problem, and the longer that cycle runs the harder the tissue is to recover. Stopping is uncomfortable for a fortnight and is the necessary first step.
Questions about turbinate enlargement
Can the turbinates simply be removed?
They should not be. Removing a turbinate entirely was done in the past and produced a difficult long-term problem, in which the nose is wide open yet feels permanently blocked and dry, because the tissue that senses airflow and conditions the air has gone. Modern practice is to reduce the tissue while preserving the lining and its function, whether by shrinking it from within or by trimming and reshaping it. Any surgeon discussing this with you should be talking about reduction.
Is my decongestant spray making things worse?
If you have been using one for more than about a week, very probably. These sprays work by constricting the blood vessels in the lining, and with continued use the tissue rebounds and swells more each time the effect wears off, so the spray is needed more often for less benefit. The tissue eventually thickens permanently. Stopping is uncomfortable for one to two weeks and a steroid spray started at the same time helps you through it, and it is the necessary first step before anything else is judged.
How long does the improvement last?
That depends on what is driving the swelling. Where allergy is well controlled afterwards, results are durable. Where the trigger continues, tissue can swell again over years, and shrinking the lining alone tends to last less well than a reduction that also addresses an enlarged bony core. Your doctor should tell you which of those they found at the examination, since it is the best guide to what to expect. Continuing a steroid spray and controlling the allergy are what keep the result.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
Day CareTalk to a care coordinator about turbinate enlargement
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one