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.
What is a Nasal Obstruction?
A nasal obstruction is a very common problem that affects a patient’s ability to breath 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.
What Causes a Nasal Obstruction?
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.
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.
What are the Nasal Septum and Turbinates?
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.
The picture below shows the nasal septum and the inferior turbinate on the left side of the nose.
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.
The pictures below demonstrate how the inferior turbinates can block airflow when they are enlarged and touch the nasal septum.
How Are Enlarged Inferior Turbinates Diagnosed?
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 doctor will discuss treatment options with you.
What is the Treatment for Enlarged Inferior Turbinates?
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.
What Else an be Done to Open Up the Nasal Passage?
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.
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.
Are these In-Office Procedures?
The RFA procedure can be done as an in-office procedure under local anesthesia. The SMR and Out-Fracture procedures are normally done in an Ambulatory Surgery Center or in a hospital operating room under general anesthesia.
Is Nasal Packing Used for Turbinate Surgery?
Many surgeons perform turbinate surgery without nasal packing. If nasal packing is used, it is inserted to prevent excessive postoperative bleeding. Talk to your surgeon about his/her standard practice.
How Long Does Turbinate Surgery Take?
Generally, turbinate surgery takes 15-20 minutes, but that can vary from patient to patient. Of course, the time is extended when any other procedures are added on (i.e., sinus surgery, septoplasty, etc.).
How Long Do You Need to Take Off From Work?
Time off for recovery usually depends on the type of procedure performed as well as the type of anesthesia used. Recovery time for patients undergoing a RFA typically involves less time off of work–usually a day or two–because these procedures are performed under local anesthesia. For patients who have nasal and sinus procedures performed under general anesthesia, recovery time may be 3-4 days off of work. During this time, patients are advised to refrain from heavy lifting or vigorous activity for 1-2 weeks.
Does Turbinate Surgery Change the Nasal or Facial Appearance?
No, turbinate surgery does not affect the external appearance of the nose or face.
Are Stitches Required?
Neither sutures nor stitches are required for inferior turbinate surgery.
Is Turbinate Surgery Painful?
You can expect to have pain, fatigue, nasal stuffiness, and mild nasal drainage after your turbinate surgery. The stuffiness typically results from swelling after the procedure and typically starts to improve after the first week. Most patients find that post-operative pain is easily managed with low-dose narcotic medications, such as Tylenol with Codeine, for 1-2 days. After that, they switch to regular or extra-strength Tylenol and ibuprofen (taken together to control both pain and swelling) for another week or so.
Is There Bleeding After Turbinate Surgery?
There may be some post-operative bleeding after turbinate surgery, as the turbinates have a strong blood supply. For this reason, your doctor may advise you to use topical vasoconstrictor sprays such as Afrin or Oxymetazoline to control post-operative bleeding. If you experience any persistent or significant bleeding post-surgery, contact your doctor right away.
Can Other Procedures Be Performed at the Same Time?
Yes, other procedures can be performed at the same time as turbinate surgery. When other components contribute to nasal congestion, such as a deviated septum, sinus polyps, enlarged adenoids, or a sinus blockage, these components can be addressed at the same time as turbinate surgery Your doctor will discuss such options with you when he/she devises your treatment plan.
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