The nasal passages prepare inhaled air for the lungs. Within these passages are structures called turbinates, or conchae, which are small, curved shelves of bone covered by a mucous membrane. There are typically three pairs of these structures on each side of the nose, and their primary function is to warm, humidify, and filter the air we breathe. This conditioning process protects the delicate tissues of the respiratory system from irritation.
Defining Concha Bullosa and Its Location
Concha bullosa (CB) is an anatomical variation where an air-filled space, known as pneumatization, forms within a nasal turbinate. While this condition can occur in any of the three turbinates, it is most frequently observed within the middle turbinate, also known as the middle concha.
A normal turbinate is a solid, shell-shaped structure. Concha bullosa causes the structure to bulge and take up more space inside the nasal cavity due to the air-filled enlargement. Experts consider concha bullosa a common anatomical difference, not a disease, as it is estimated to be present in up to 50% of the population. However, the size and specific location determine whether this variation becomes a clinical problem.
Symptoms and Functional Impact
Although many people with concha bullosa remain without symptoms, a large or strategically located air pocket can cause significant issues. The most frequent complaint is chronic nasal obstruction, often described as a persistent blockage or difficulty breathing through one side of the nose. This obstruction occurs because the enlarged turbinate physically narrows the nasal airway, impeding air flow.
The functional impact extends beyond simple breathing difficulties and often involves the sinuses. The middle turbinate is situated near the ostiomeatal complex, which is the narrow pathway responsible for draining the maxillary, frontal, and anterior ethmoid sinuses. When a concha bullosa becomes large, it can mechanically block this drainage pathway, preventing mucus from leaving the sinuses.
This impaired drainage creates an environment prone to infection, leading to recurrent or chronic sinusitis, which is characterized by inflammation and a buildup of pressure. Patients may experience facial pain and pressure that is concentrated around the cheeks and forehead, sometimes accompanied by persistent headaches. The size of the concha bullosa dictates the severity of these symptoms, with larger lesions being more likely to interfere with sinus function and breathing.
Diagnosis and Treatment Options
Confirming the presence of a concha bullosa requires specialized imaging, as it often cannot be definitively identified during a routine physical examination. A computed tomography (CT) scan of the sinuses is the standard diagnostic tool, providing detailed cross-sectional images of the bony structures. On a CT scan, the air-filled concha bullosa appears as a distinct black pocket within the turbinate, allowing clinicians to accurately measure its size and relationship to the sinus drainage pathways.
For patients who are not experiencing symptoms, no treatment is necessary, and the finding is simply noted as an anatomical variant. If the concha bullosa is causing mild symptoms, initial management usually involves medical therapies aimed at reducing any surrounding inflammation or managing related sinus issues. These non-surgical options can include the use of intranasal corticosteroid sprays to reduce mucosal swelling or saline nasal irrigation to clear excess mucus.
If medical management fails to relieve persistent symptoms, surgical intervention may be considered to reduce the size of the enlarged turbinate and restore normal function. The procedure is typically performed endoscopically, often as part of a functional endoscopic sinus surgery (FESS). The most common surgical approach is a partial resection, or turbinoplasty, where the air-filled lateral portion of the concha bullosa is carefully removed. This surgical reduction aims to open the nasal airway and unblock the sinus drainage ostia while preserving the remaining healthy turbinate tissue to maintain its functions of air conditioning.