Nasal turbinates are normal outgrowths of the nasal sidewall bone that are covered in nasal cavity mucous membrane. This lining has several functions, including humidification of the air we breathe, regulation of airflow, clearance of foreign particles, and normal mucus flow. The nasal cavity generally contains 3 sets of turbinates on each side – the superior, middle, and inferior turbinates. Approximately 50% of nasal airflow passes between the middle and inferior turbinates. Therefore, abnormal enlargement of these two structures can be a culprit cause of nasal obstruction.
Enlargement of the inferior turbinate typically occurs in response to inflammation or may be developmental. Medicines such as nasal steroid sprays can help treat the inflammation. In cases that do not improve with medication, procedures may be necessary to remove tissue from the turbinates. Dr. Bhandarkar performs a procedure called “submucous resection” to reduce the size of the inferior turbinate. In this procedure, an endoscope is utilized to assist with precise removal of bone and expanded tissue from the inside of the turbinate, therefore maximally preserving the functional lining of the nose.
Other turbinate treatments such as coblation are available, but have been shown to be less effective than submucous resection. Excision of part or all of the inferior turbinate is not recommended and may have a number of consequences. Severe bleeding requiring packing may be encountered during surgery. Packing is rarely required for submucous resection. Also, “empty nose syndrome” may develop with over aggressive removal, where though the nasal airway is wide open, the loss of lining that normally senses airflow leaves patients feeling like their nose is obstructed. This is an extremely difficult, frustrating condition to treat, and the best treatment is avoidance.
The middle turbinate may be enlarged due to a concha bullosa, or air-filled turbinate. This is a congenital anatomic variant, meaning you are born with it. Nevertheless, a concha bullosa (pictured) can be quite large and occupy a significant amount of space in the nose. Because of its location intimately associated with sinus drainage pathways, sinusitis may be a consequence of or be worsened by a concha bullosa. Endoscopic surgery is an effective way to precisely remove the concha bullosa (video).