The nasal passages contain structures called turbinates. These structures play a significant role in the respiratory system. When turbinates swell or become enlarged, a condition known as turbinate hypertrophy, they can obstruct the nasal cavity. This enlargement often leads to breathing difficulties and other uncomfortable symptoms.
Turbinate Basics
Inside each nostril, there are three pairs of turbinates: the superior (upper), middle, and inferior (lower) turbinates. These are shell-shaped bone, tissue, and blood vessels, covered by a mucous membrane. The inferior turbinates are the largest and most frequently implicated in breathing issues due to their size and position within the nasal cavity.
Turbinates condition the air inhaled through the nose before it reaches the lungs. As air passes over these structures, it is warmed to body temperature and humidified, preventing irritation to the delicate lung tissues. The mucous membrane also traps dust, pollen, and other airborne particles, acting as a natural filter, cleansing the air.
Why Turbinates Enlarge
Turbinates can swell due to inflammation and increased blood flow to the nasal lining. Chronic allergies are a common trigger, as exposure to allergens prompts the immune system to release histamines, leading to inflammation and enlargement. Recurrent sinus infections or chronic sinusitis can also impact the turbinates, particularly the middle turbinate, resulting in persistent swelling and mucus buildup.
Non-allergic rhinitis is another cause, due to irritants such as smoke, pollution, strong perfumes, or changes in temperature or humidity. Hormonal changes, such as during pregnancy or hypothyroidism, can increase blood flow to the nasal lining, contributing to turbinate swelling. Prolonged overuse of certain over-the-counter nasal decongestant sprays can lead to a condition called rhinitis medicamentosa, where turbinates swell significantly when its use is stopped.
Recognizing Enlarged Turbinate Symptoms
Enlarged turbinates lead to nasal obstruction. This is often more pronounced at night or when lying down, as gravity can increase congestion. Individuals may experience chronic nasal congestion.
Snoring or noisy breathing during sleep is a frequent symptom, as obstructed airflow forces mouth breathing, leading to a dry mouth upon waking. A reduced sense of smell can also occur due to impaired airflow. Facial pressure or mild pain, particularly in the forehead, may also occur. These symptoms can disrupt daily life, affecting sleep quality and comfort.
Managing Enlarged Turbinates
Diagnosis of enlarged turbinates typically begins with a physical examination by an ENT specialist, which may include a nasal endoscopy. This involves inserting a small, lighted telescope into the nasal passages to visualize the turbinates and assess their size and condition. In some cases, imaging tests like a computed tomography (CT) scan may be performed to further evaluate the nasal cavity and rule out other structural issues, such as a deviated septum, which can present with similar symptoms.
Non-surgical approaches are often the first line of treatment to reduce turbinate swelling and improve airflow. Nasal steroid sprays, such as fluticasone or mometasone, are commonly prescribed to reduce inflammation directly in the nasal lining. Antihistamines can help control allergic reactions that contribute to swelling, while saline rinses clear irritants and mucus from the nasal passages. Decongestants may offer temporary relief but should be used cautiously and for only a few days to avoid rebound congestion.
If medical treatments do not provide sufficient relief, surgical interventions may be considered. Turbinate reduction, also known as turbinoplasty, aims to decrease the overall volume of the turbinates to enhance nasal airflow. Procedures vary but can involve techniques like submucous resection, where tissue and sometimes bone are removed from beneath the mucous membrane, or outfracturing, which repositions the turbinate laterally. These procedures are often performed as outpatient surgeries, sometimes in conjunction with septoplasty if a deviated septum is also present. The primary goal of treatment, whether medical or surgical, is to reduce the size of the turbinates and restore comfortable nasal breathing.