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Doc, my nose is all blocked up! Please help! Turbinates ....reduce!

Welcome back to TGIF Dr Euan blogpost!


Today's blogpost is on the topic of one reason why your nose may feel blocked: swollen turbinates.



Q: What is Inferior Turbinate Hypertrophy?


Turbinate hypertrophy, inferior turbinate hypertrophy, and nasal turbinate hypertrophy are all descriptions of a similar condition whereby the tissue on the lateral (outside) walls of the nose are too large, causing nasal obstruction, and difficulty in nasal breathing.


The inferior turbinate tissues are composed of rich groups of blood vessels, which can engorge and can become swollen due to a variety of factors including allergies, colds and upper respiratory infections, inflammation, exposure to certain irritants /medications, pregnancy, or idiopathically.


Endoscopic image of left and right swollen turbinates



Q: Why does the Turbinate swell up?


Turbinate hypertrophy can be acute or chronic. Some of the more common causes of this condition include:

  • chronic sinus inflammation

  • environmental irritants

  • seasonal allergies

  • Dust mite allergies, especially here in the Tropics and in urban environments

Each of these conditions can cause the soft tissue of the turbinates to enlarge and swell. Many people with turbinate hypertrophy also have a family history of allergic rhinitis.

Microscopic view of a dust mite. Allergic sensitivity to dust mites can cause the turbinates to swell.


Q: What are the usual symptoms?


Turbinate Hypertrophy can cause nasal blockage and result in the sensation of difficulty breathing through the nose. It can also cause snoring, difficulty sleeping, and nosebleeds (epistaxis) because of turbulent airflow. This may result from drying (dessication) of the mucous membranes lining the nose. Your sense of smell can also be affected.


Turbinate hypertrophy makes it harder for you to breathe through your nose. Some additional symptoms include:

  • altered sense of smell

  • dry mouth upon awakening, which happens when you sleep with your mouth open because you can’t breathe through your nose

  • forehead pressure

  • mild facial pain

  • prolonged nasal congestion

  • runny nose

  • snoring

The symptoms of turbinate hypertrophy are very similar to those of a cold that won’t seem to go away.


Q: What can I do to relieve my nasal blockage?


Your family doctor will usually recommend at-home treatments to see if the nasal turbinates can shrink. Reducing the amount of allergy-causing dust, pet dander, and mold can reduce allergy symptoms while other treatments can ideally help shrink the turbinates.

Reducing allergens in the home

One way to help treat symptoms of turbinate hypertrophy is to limit your exposure to environmental allergens. Here are some useful simple tips:

  • Make every effort to remove excess dust and pet dander from the home. This includes vacuuming carpets, pillows, drapes, and furniture to remove dust.

  • Place fabric-covered soft / plush toys in freezer bags and leave in the freezer for 24 hours. This can help to kill allergy-causing dust mites.

  • Protect your mattress from dust mites by placing a dust-proof cover over the mattress.

  • Refrain from smoking, especially indoors.

  • Remove mold and mildew with specially formulated cleaners, especially in basements, bathrooms, and kitchens.

  • Use a high-efficiency particulate air (HEPA) filter indoors. This filter can help to eliminate a significant amount of irritating dust in a room. The most effective place to use an air filter is in a bedroom, as it’s where you sleep. If you have indoor pets, keeping them out of your bedroom can help to reduce pet dander irritants.

You can read more about Dr Euan's advice about allergies here.

Medications and at-home treatments

In addition to reducing allergens in the home, there are medications and at-home treatments that can help turbinate hypertrophy. These include:

  • Taking ANTI-HISTAMINE medications to reduce seasonal allergies, such as cetirizine (Zyrtec) or loratadine (Claritin, Allegra).

  • Using nasal decongestant drops, such as pseudoephedrine or phenylephrine. However, these medications can affect blood pressure and should be avoided if you have blood pressure problems.

  • Temporarily using nasal decongestants to relieve nasal swelling. However, these should not be used on a regular basis because they can result in bleeding and ineffectiveness over time.


Q: What is RFIT?

Diagrams of the RFIT procedure courtesy of Smith and Nephew


Radio-frequency Inferior turbinate (RFIT) reduction is a procedure in which a needle-like instrument is inserted into the turbinate and energy is transmitted to the tissue to cause a very controlled coagulation effect, so by the time healing process occurs, the turbinates size will be reduced, allowing improved airflow through the nose.

It is an office-based procedure, performed under local anaesthesia, and it takes about 10 minutes. Usually there is no or minimal pain during the recovery process, no change on the physical aspect and no long-term side effects, such as loss of the sense of smell (olfactory perception).

The patient should be aware that he/she will have crusting inside the nose for approximately 2 to 3 weeks. We therefore recommend the frequent use of nasal saline irrigations and use of antibiotic ointment during this period of time. There is a slight chance that the turbinates can get bigger again overtime, making another Radio-frequency procedure necessary, in about 24 to 36 months.


Q: What is COBLATOR treatment? Is it safe?


Picture of the coblation wand courtesy of Smith and Nephew



Coblation of the inferior turbinates is a day-case / office based procedure, where by ultrasound energy is applied to the lining of the nasal airway to reduce swelling from conditions such as allergic rhinitis.

It is well tolerated in adults and children, and may often be combined with other ENT procedures such as adenoidectomy, grommets or tonsillectomy (under General Anaesthesia).

Post treatment, the nose may be a blocked with dry mucus for a few weeks afterwards. This is helped by gentle nasal saline spray, and softening ointment such as Nasalate, for my patients, I like to see them for regular nasal toilet to clear any crusts or debris, post coblation, to ensure maximal comfort and good nasal breathing.


Q: What if Coblator RFIT fails to resolve my nasal blockage?


If your symptoms do not respond to conservative treatments, a doctor may recommend surgery to reduce the size of the turbinates. There are three main surgical approaches to reducing turbinate hypertrophy:

  • Inferior turbinate bone resection (ITBR). This involves removing a portion of bone of the inferior turbinates to promote airflow in the nose.

  • Partial inferior turbinectomy (PIT). This procedure involves removing soft tissue of the inferior turbinate.

  • Submucosal diathermy (SMD). This procedure involves using a special needle called a diathermy needle to use heat energy to shrink the soft tissue inside the turbinates.

Many different approaches to turbinate surgery exist. Your ENT Specialist may make recommendations based on how severe / chronic your symptoms are. Turbinate surgery can be challenging because we should not completely remove the turbinates since they serve an important purpose: to warm and humidify the air we inspire. If all of your turbinates are resected, then you might experience a dry, stuffy nose on a permanent basis. We call this the “empty nose syndrome.”


Well, I hope this blog post has given you a little peek into all things TURBINATE!


If you suspect you may be suffering from Turbinate Hypertrophy and would like to seek treatment, please feel free to book an appointment at Euan's ENT here.


If you are keen to delve deeper, here is a list of relevant references


Till next time, Have a good and restful weekend! :-)


References:


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