Turbinates are scroll-like, shell-shaped networks of bones, vessels, and tissues within the nasal passageways.
There are three turbinates on the sides of both nasal cavities (nostrils). They are called superior, middle, and inferior turbinates. Turbinates are made of bone and are covered by a soft tissue known as “mucosa.” They help regulate airflow and temperature of the air entering the nose and moisture levels inhaled through the nose.
Turbinates can become swollen, enlarged, or displaced, causing nose block and breathing difficulty. Turbinate reduction or turbinoplasty is indicated in such cases if medical therapy fails. Following turbinate reduction, most people can return to work in about a week and go to their usual pre-operative routine in about 3 weeks. Complete recovery can take 1-2 months.
Why is turbinate reduction done?
Turbinates can become swollen, enlarged, or displaced due to various reasons. Problems associated with turbinates may go away on their own or with medical treatment. In some cases, if medical treatment fails, surgical turbinate reduction is indicated.
Some common causes of turbinate enlargement include:
- Recurrent infections
- Weather changes
- Hormonal changes
- Anatomical (structural) issues with the nose
What happens during the procedure?
The procedure is performed by an ear, nose, and throat (ENT) surgeon under general or local anesthesia. Several techniques are used to reduce the size of turbinates. They are all performed inside the nose, and some are less invasive than others.
Cauterization, coblation, and radiofrequency turbinate reduction: Turbinates are shrunk without removing any underlying bone or tissue. A specialized needle-like device is inserted into turbinates. Turbinates are heated through the needle using a heat source or energy waves. This causes scar tissue to form, shrinking the turbinate. The procedure takes around 12-20 minutes and can be performed under local anesthesia. Patients can go home after the surgery and return to their normal activities. Pain and swelling associated with the procedure may be present, but this resolves in a few days.
Surgical turbinate removal: This procedure is more invasive but performed inside the nose, without any external visible cuts. It is usually performed under general anesthesia. It may be combined with nasal septum or sinus surgery. In some cases, only parts of the turbinates are surgically removed. During surgical reduction, the surgeon cuts into turbinates to remove some of the bone underneath to reduce their size. Some of the tissue around turbinates may be shaved away as well.
After surgery: Most patients can go home the same day or day after the surgery. The nose may be packed and dressed for up to 48 hours. Patients may experience swelling, bruising, crusting, and blood-stained nasal discharge after the surgery, which usually resolves in a week. Painkillers, antibiotics, and nasal and oral decongestants may be prescribed. Most patients can return to work in about a week and go to their usual pre-operative routine in about 3 weeks. Complete recovery can take 1-2 months if septal and/or sinus surgery are also performed.
What are the risks of turbinate reduction?
Turbinate reduction surgery is routinely performed. Complications are rare and usually temporary. Some possible risks associated with the procedure include:
- Nasal discharge
- Crusting in the nose
- Dryness in the nose
- Recurrence of the problem (turbinate tissue may regrow after the surgery) requiring further treatment
Empty nose syndrome: This is an extremely rare complication that can sometimes occur after the surgery in the nose if too much bone and tissue are removed. The nasal cavity becomes wide open and roomy. It is characterized by a dry nose, nasal discharge, crusting, nose bleeds, headache, and a feeling that the nose is blocked, despite the nasal cavity being wide. There is no definitive cure for this condition. Treatment mainly involves providing symptomatic relief.