There are several different types of turbinates in the nose (inferior, middle and superior), but it is the inferior turbinates that most commonly affect airflow. When the bone or soft tissue become enlarged, they cause nasal obstruction. For most patients, the soft tissue part of the turbinates is the major problem, where the turbinates become enlarged (hypertrophic turbinates) leading to nasal congestion, blockage, and obstruction.
Inferior turbinate surgery is typically performed to improve nasal airflow and reduce nasal blockage and congestion. A turbinate reduction is the preferred surgical treatment to shrink the size of the turbinates and improve breathing. It is a minor, minimally-invasive, outpatient procedure.
The nasal septum is the structure that divides your nasal passages into right and left sides. It is made up of cartilage and bone, which are lined with a thin membrane called mucosa. The mucosa covers and protects the cartilage and bone, and helps to keep the inside of the nose moist.
The turbinates are also inside the nose near the septum. There is usually space between the septum and turbinates to allow air to pass through the nose. The turbinates are made of bone and soft tissue, and they help to warm and moisturize air as it flows through your nose.
A nasal obstruction is a very common problem that affects a patient’s ability to breathe through their nose. As a result, these patients tend to breathe through their mouth, leading to a sensation of a dry mouth. For some patients, these symptoms get worse at night and affect sleep.
A nasal obstruction can have many causes. For some patients, allergies lead to swelling of the nasal and sinus lining, which causes congestion and blockage. For other patients, the blockage may be due to a simple anatomical obstruction, such as enlarged adenoids, a polyp in the nasal passage, a deviated septum, enlarged turbinates or narrow nasal passages. Often patients with narrow nasal passages have problems with the nasal septum and turbinates.
During your consultation, your ENT (ear, nose, and throat) doctor will ask you about your symptoms and will perform a nasal examination using a lighted, 4mm nasal endoscope. The endoscope will help to visualize the nasal and sinus passages and will help to determine the potential source of your nasal congestion. For some patients, CT scans and allergy testing may also be ordered.
After your examination, your ENT doctor will discuss treatment options with you.
When enlarged turbinates are determined to be a significant causative factor of nasal obstruction, a turbinate reduction procedure may be recommended to correct the problem. There are several ways to shrink the size of the turbinates. If your turbinates are swollen, your doctor may prescribe medication (i.e., nasal corticosteroid sprays and nasal antihistamine sprays) to reduce the swelling. If enlarged inferior turbinates are causing your nasal obstruction, surgery may be the recommended treatment.
Two of the most commonly performed procedures include Radiofrequency Ablation (RFA) and Submucosal Reduction (SMR). Both are effective in minimizing the swelling of the turbinate mucosa and in diminishing the congested lining.
Radiofrequency Ablation (RFA) – During this procedure, a small probe is placed in the submucosal area of the turbinate (between the inner turbinate bone and the outer mucosal lining) and low-power radiofrequency energy is applied to decrease tissue volume.
Submucosal Reduction (SMR) – For the SMR procedure, a small incision is made in the front part (head) of the inferior turbinate. Dissection is performed creating a pocket in the submucosal lining for placement of a powered instrument called a micro-debrider. The micro-debrider uses suction to pull in the engorged submucosal tissue of the inferior turbinate, and the rotating blades cut it down or reduce it. Once the submucosal lining has been reduced, the healing process begins and scar tissue forms to prevent the lining from swelling as it had prior to surgery.
This procedure is effective in reducing congestion while maintaining the warming and humidification function of the turbinates.
For some patients, moving or “out-fracturing” the turbinate bone may be recommended to open up the nasal passage. This is an additional procedure that can be done alongside an RFA or SMR.
Out-Fracture Procedure – During an “out-fracture” procedure, the inferior turbinate Conchal bone is firmly moved or “out-fractured” from its normal midline position to a more lateral position along the nasal sidewalls. This allows for the central component of the nasal airway to open up allowing for improved passage of air.