Turbinate hypertrophy is a common medical condition defined by the chronic enlargement of the turbinates, which are structures located inside the nasal passages. Also called nasal conchae, these structures are covered in a specialized mucous membrane and are normally responsible for managing airflow. When the tissue surrounding the bony core of a turbinate swells over a long period, the condition is considered chronic hypertrophy. This enlargement restricts the nasal airway, leading to persistent symptoms like chronic congestion and difficulty breathing through the nose.
The Role of Turbinates in Nasal Breathing
The nasal cavity contains three pairs of turbinates on each side: the superior, middle, and inferior turbinates. These long, curved shelves of bone and tissue are positioned along the lateral walls of the nose. Their primary function is to prepare inhaled air before it travels down to the lungs. This preparation involves three processes: warming the air to body temperature, humidifying it to prevent drying of the respiratory lining, and filtering out dust and other small particles.
The turbinates contain a rich network of blood vessels that can expand and contract to regulate the amount of air passing through the nasal cavity. The inferior turbinates are the largest of the three and are responsible for the majority of airflow regulation, humidification, and warming. Because of their size and position at the main entry point for inhaled air, the inferior turbinates are the most frequently affected structures in cases of hypertrophy. When they swell, the nasal passages narrow dramatically, compromising their ability to perform their air-conditioning duties.
Common Triggers for Turbinate Enlargement
Chronic inflammation of the nasal lining is the underlying mechanism that drives turbinate hypertrophy. Allergic rhinitis, commonly known as allergies, is a frequent trigger and can be seasonal or perennial. Exposure to environmental irritants like tobacco smoke, strong chemical odors, or dust can also cause persistent, non-allergic rhinitis, leading to long-term swelling of the turbinate tissue.
Chronic sinus infections (rhinosinusitis) maintain inflammation within the nasal and sinus cavities that contributes directly to turbinate enlargement. Certain systemic conditions, such as hormonal changes related to pregnancy, can also cause the blood vessels within the turbinates to expand and remain swollen. A physical deviation of the nasal septum (the wall dividing the nostrils) can result in compensatory hypertrophy. In this scenario, the turbinate opposite the deviation enlarges to regulate uneven airflow, often leading to two obstructed nasal passages.
Diagnosing the Condition and Conservative Management
Patients with turbinate hypertrophy experience chronic nasal obstruction that does not resolve with standard cold or flu remedies. This persistent blockage often leads to secondary symptoms such as mouth breathing, especially during sleep, which can cause excessive snoring. Other complaints include a reduced sense of smell, facial pressure or mild pain, and nasal stuffiness that may alternate between the two sides of the nose.
Diagnosis begins with a physical examination, where a physician may use a nasal speculum or an endoscope to visualize the turbinates directly. This visual assessment helps confirm the enlargement and differentiate it from other causes of nasal obstruction. A computed tomography (CT) scan may be ordered to assess the underlying bone structure, evaluate the sinuses, and confirm the obstruction is not caused by a deviated septum. Airflow can also be objectively measured using a rhinomanometry test, which provides quantifiable data about the severity of the nasal blockage.
The initial approach to managing turbinate hypertrophy is conservative, focusing on reducing the underlying inflammation. Intranasal corticosteroid sprays are often the first-line medical treatment because they directly target inflammation in the mucosal lining. Antihistamines are prescribed when allergies are a confirmed contributing factor to the swelling. Nasal saline irrigation or rinses also provide therapeutic benefit by washing away irritants, allergens, and excess mucus from the nasal cavity.
Patients may use oral decongestants for short-term relief, but their use is discouraged for chronic management due to potential side effects like elevated blood pressure. Topical decongestant sprays should be used for no more than three to five days, as prolonged use can cause a rebound swelling condition called rhinitis medicamentosa, which worsens the original hypertrophy. If allergy testing confirms a specific sensitivity, immunotherapy, such as allergy shots, may be recommended to address the root cause of the chronic inflammation.
Surgical Interventions for Lasting Relief
Surgical intervention is reserved for patients whose symptoms persist despite a dedicated trial of conservative medical management. The goal of any turbinate surgery is to reduce the size of the enlarged tissue enough to restore proper nasal breathing while preserving the mucosal surface and its function. Removing too much turbinate tissue can lead to a debilitating condition characterized by chronic dryness and a paradoxical feeling of congestion, which doctors call empty nose syndrome.
A variety of minimally invasive techniques are available to achieve this reduction. Radiofrequency ablation involves inserting a thin probe into the turbinate tissue to deliver controlled heat energy, which creates scar tissue that shrinks the turbinate over several weeks. Cryotherapy uses a similar probe to freeze and destroy the submucosal tissue, leading to a reduction in volume. These methods are often preferred because they are mucosal-sparing, meaning they minimize damage to the surface lining.
More aggressive techniques are used when the underlying bone structure of the turbinate is also enlarged, not just the soft tissue. A partial turbinotomy or turbinectomy involves surgically removing a portion of the turbinate bone and mucosa. Microdebrider-assisted turbinoplasty uses a small, rotating surgical tool to precisely shave and remove excess tissue from beneath the mucosal surface. This allows for significant volume reduction while maintaining the integrity of the surface lining necessary for warming and humidifying inhaled air.