Hypertrophy of the Nasal Turbinates
Nasal turbinates are bony prominences arising from the internal sidewalls of your nose. There is one of each turbinate in either side of the nose, separated by the septum: the inferior turbinates, or the closest to the palate of the mouth, the middle turbinates, and the superior turbinates, which are closest to the top of the head. Turbinates help to warm and humidify the air we inhale, and to regulate breathing through each nasal passage. They also protect the olfactory bulb (smell sense) and buffer the sinuses from direct pressurized nasal airflow. Most of our inhaled airflow is passed through the space under the inferior and middle turbinates.
Sometimes, enlargement (hypertrophy) of the lowest lying turbinates may contribute to nasal obstruction. The inferior turbinates are the largest and the closest to the nostrils, and they are also responsible for the majority of preparing and directing inhaled airflow. Thus, when they become inflamed or enlarged, patients often report difficulty breathing and decreased airflow.
Hypertrophy of the inferior nasal turbinates can be classified as either mucosal or bony. In other words, the enlargement of the nasal turbinates can either be caused by swelling of the soft mucus lining of the turbinates, or caused by excess size of the bony structure of the turbinates themselves. Reasons for mucosal turbinate hypertrophy include both allergic and nonallergic (vasomotor) causes. Allergic causes can be classified as indoor such as allergy to dust and is typically present year-round and outdoor allergens such as pollen which will often present with seasonal fluctuation. Non-allergic or vasomotor rhinitis (mucosal swelling) is a condition in which the lining tissue is excessively sensitive to stimuli such as change in light, temperature or pressure, or exposure to irritants such as smoke, perfume, cleaning solvents, etc. In patients having only mucosal swelling, or enlargement of the soft, fleshy lining of the turbinates, the hypertrophy is generally seen bilaterally (on both sides) and the sense of obstruction will typically respond well to topical decongestants or other antihistamine oral medications. Surgery in these cases is often reserved only for those who have already failed a course of medical treatment.
When decongestion and medications to decrease inflammation of the mucosa do not do enough to improve breathing, bony turbinate hypertrophy along with deviation of the septum and nasal valve compromise are considered as possible sources of the patient’s discomfort. Rather than the inflammation of the lining, the actual structure of the nose itself may need to be changed to improve breathing quality.
This obstruction arising from bony turbinate enlargement is generally constant and is often compensatory. Drs. Solieman and Litner find that these patients generally present with a significantly deviated septum away from side of the enlarged turbinate; thus both sides of the nasal airway can be compromised in this situation, one side by the enlarged turbinate and the other side by the deviated septum. The turbinate mucosa and underlying bone enlarge into the more open nasal passage in pursuit of regulating nasal airway resistance on both sides.
Deviated Septum & Enlarged Turbinate Correction
Correction of the deviated septum and reduction of the enlarged turbinate are performed together to relieve obstructive complaints. Straightening only the septum without modifying the hypertrophic turbinate will result in obstruction secondary to the large turbinate on the side where obstruction was not previously perceived. Conversely, only reduction of the enlarged turbinate without straightening the septum will still result in obstruction of the side affected by the deviation. By trimming the excess bony turbinate and straightening the septum to its proper location, Drs. Solieman and Litner routinely help their patients significantly improve their nasal airflow!