ABOUT THE CONDITION
What are the inferior turbinates?
The inferior turbinates are made up of ridges of bone covered with soft tissue and the nasal lining. There is one on the right and one on the left side of the side walls on the inside of the nose.
The turbinates play an important role in making the air we breathe warm and moist.
Figure 1. The left nasal turbinate is swollen and blocking the left nasal passage.
What causes enlarged inferior turbinates?
Inferior turbinates can become swollen with exercise, cold air or lying on one side. Everyone has fluctuating swelling of the nasal turbinates. This is called the nasal cycle. This is normal.
Abnormal swelling of the turbinates, however, can occur due to:
- allergies
- hormone changes
- nerve stimulation
- diseases that cause inflammation
- sometimes for unknown reasons
How are abnormal enlarged inferior turbinates diagnosed?
Enlarged inferior turbinates can be diagnosed by your doctor after a review of your symptoms and a nasal examination. A nasal endoscopy (thin camera inside your nose) may help with the diagnosis and make sure there are no other causes of a blocked nose.
How are enlarged inferior turbinates treated?
Medication to help reduce the size of the turbinates may improve your symptoms of blocked nose. This can include:
- saltwater washes or douching
- antihistamine tablets
- steroids sprays or drops applied directly into the nose
If these do not improve your symptoms of a blocked nose, then an operation to reduce the size of the inferior turbinates may be helpful.
ABOUT THE PROCEDURE
What is the benefit of having an operation?
Your surgeon has recommended an operation because you have had a lot of medication through the nose or by mouth, but you are still having a lot of symptoms.
What will happen if I do not have the operation?
A blocked nose may affect your quality of life. But enlarged turbinates will not cause you any harm. It is your choice if you want an operation to try and improve your blocked nose if it has been recommended by your surgeon.
What are the alternatives to surgery?
You should continue to use medication inside the nose. These will help shrink the inferior turbinates to give you more room to breathe through the nose.
What does surgery involve?
Surgery can be performed under local anaesthetic (the nose is “numbed”) or general anaesthetic (you are asleep). The surgery is done inside your nose with no scars or bruises on the outside. Turbinate surgery takes around 30 minutes. One or both sides can be done alone or combined with another operation on your nose or sinuses.
There are different ways to operate on the turbinates. Examples of the techniques include:
- electrocautery (application of heat)
- coblation (a plasma field to ablate tissue)
- laser (synchronized light waves)
- radiofrequency reduction (radio-waves to reduce the tissue)
- microdebrider resection (small blades to suction and cut away tissue)
- partial or/ total resection
Some of these methods shrink the turbinates without removing bone or tissue. Some keep the lining intact whilst removing the tissue inside the turbinate. Others involve removing a portion of the turbinate.
Each has its own risks and benefits. What you will be offered will depend on your surgeon and centre, but most methods have similar outcomes.
In some instances, packing or dressings may be placed in your nose during the healing process.
|
Figure 2(a). Before the operation.
A swollen left inferior turbinate causing nasal blockage.
|
|
Figure 2(b). After the operation.
The left inferior turbinate is smaller in size. The left nasal passage looks wider.
|
ABOUT THE RISKS
Are there any complications to this operation?
Most patients who have this operation recover well.
The complications and risks of any surgery are grouped into the following categories.
Your surgeon will be able to tell you their own complication rate.
Bleeding
A nosebleed is very common after most nasal surgery. Occasionally due to significant bleeding, the operation may need to be stopped or nasal dressing or packing put in the nose to stop it (uncommon).
If you are taking blood-thinning medication, please discuss this with your surgeon before the operation.
Persistent symptoms
Most people’s symptoms of blocked nose get better after this operation. However, some people may need further medical treatment even after surgery (common). Rarely, you may notice no improvement or worsening of your symptoms of blocked nose.
Infection
The nose is not a sterile environment, but infections are fortunately rare. You should see your doctor if your nose is getting more blocked, sore and there may be a bad smell.
Adhesions
These are scar tissue bridging from the healing turbinate tissue and the nasal septum. Although relatively uncommon, these can contribute to nasal blockage if they occur.
Your surgeon may place plastic splints inside one / both sides of the nose to prevent these, which may require removal some days later.
Empty Nose Syndrome
This may occur when a lot of tissue is removed from the nasal cavity. Possible symptoms include sensation of a blocked nose, difficulty in breathing, dryness, pain or burning, loss of smell, poor sleep quality and/or psychological effects. This complication is rare.
Complications of general anaesthetic.
The operation is usually performed under a general anaesthetic. Complications can include blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism), heart attack, chest infection, stroke, and death. The pre-assessment team and anaesthetist will tell you what happens during a general anaesthetic and any risks that are relevant to you. The linked document explains the common events and risks of a general anaesthetic.
AFTER THE SURGERY
What happens after my operation?
After the operation, you can expect to have some pain, fatigue, nasal stuffiness, and mild nasal discharge. The pain can usually be controlled with simple painkillers.
- You may get some blood-stained watery fluid from your nose for two weeks or so. This is normal.
- Your nose will be blocked like a heavy cold 10-14 days after the operation You may be asked to use saltwater washes after your surgery.
Your surgeon will go through some post-operative care to allow your nose to heal properly.
- Do not blow your nose after the procedure for about a week, or it might start to bleed.
- If you are going to sneeze, sneeze with your mouth open to protect your nose.
How long will I be in hospital?
Most turbinate surgery is done as a day-case procedure which means you can go home on the same day of your operation. If your surgery has been combined with other procedures, you may go home the next day.
If for any reason, there is a complication following surgery, then you might need to stay in hospital for longer.
How long will I be off work?
You will need to rest at home for at least 2 days. If you do heavy lifting or carrying at work, you should take one week off.
Will I have a follow-up appointment?
Your surgical team will advise you on this.
Disclaimer: This publication is designed for the information of patients. Whilst every effort has been made to ensure accuracy, the information contained may not be comprehensive and patients should not act upon it without seeking professional advice.