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TURBINATE HYPERTROPHY

What are Turbinates and what is Turbinate Hypertrophy?

Turbinates are small structures located at the beginning of the nasal airway that are covered with mucous membranes. They serve to heat, humidify and filter air when it passes through your nasal cavity. For comfortable breathing, air needs to be warmed to the right temperature, moistened and filtered before it flows into the lungs.

 

If they become irritated or inflamed, nasal turbinates can swell up and enlarge, causing obstruction and blockages in the nasal airway passages. This is known as Turbinate Hypertrophy.

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.

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Endoscopic images showing enlarged nasal turbinates in the left and right nostrils

What causes Turbinate Hypertrophy?

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

  1. chronic sinus inflammation

  2. environmental irritants

  3. seasonal allergies

  4. 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.

What are the signs and symptoms of Turbinate Hypertrophy?

Turbinate hypertrophy can cause stuffiness and difficulty breathing through the nose, creating discomfort. Symptoms of turbinate hypertrophy are similar to a cold that won’t go away.

 

Some symptoms can include:

  • Prolonged nasal congestion

  • Runny or stuffy nose

  • Altered or reduced sense of smell

  • Snoring and difficulty sleeping, especially while lying down

  • Dry mouth from breathing through primarily your mouth while sleeping

  • Mild facial pain

  • Forehead pressure

  • Nosebleeds (epistaxis)

Blocked nasal passages may lead to primarily breathing through the mouth, especially in younger children. This can cause difficulty in eating, speaking, and sleeping at times.

What are the treatment options for Turbinate Hypertrophy?

As most people can still function in their daily lives, turbinate hypertrophy can be considered a “quality of life issue” with various treatment options. There are different approaches to turbinate reduction based on how severe or chronic your symptoms are that the doctor may recommend.

 

One way to help treat symptoms of turbinate hypertrophy is environmental control to limit your exposure to potential allergens such as dust mites, and cat or dog fur and dander.

 

Such methods can include:

  • Regular cleaning to remove excess dust and pet dander from the home. Vacuuming carpets, pillows, drapes, and furniture to remove dust.
     

  • Placing a dust-proof cover over the mattress of your bed to protect it from dust mites.
     

  • 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.

 

However, since we cannot control every environment that we interact with, such as the workplace or public facilities, there are also medications available to help reduce symptoms.

 

Applicable medications include:

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

  • Using Nasal Decongestant drops and sprays, such as pseudoephedrine (afrin) or phenylephrine. However, decongestant drops and sprays are also only for short-term use, e.g. less than a week. Continued use can cause “rebound congestion” as well as your body becoming dependent as a response. These medications can also affect blood pressure and should be avoided if you have blood pressure problems.
     

  • Using Intranasal Corticosteroid (INCS) Sprays to relieve nasal swelling. Nasal sprays need to be used on a regular basis and are more effective for treating allergic rhinitis.

 

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

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

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

  3. 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.
     

  4. Radio-frequency of Inferior Turbinates (RFIT) Coblator reduction. A similar process to SMD, however, it is carried out using plasma energy instead of heat, at a much lower temperature.

Radio-frequency of Inferior Turbinate (RFIT) Coblator Reduction

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

 

RFIT is done as day surgery in the clinic and is performed under local anaesthesia. The procedure itself is about 10 minutes, however, the entire duration, including the rest and observation period, is about an hour. Usually, there is no or minimal pain during the recovery process, no change in the physical aspect and no long-term side effects, such as loss of the sense of smell (olfactory perception).

The RFIT procedure is done using what’s known as a Coblator wand to shrink the turbinates. Coblation means “controlled ablation”, or the controlled removal of tissue. Coblation technology utilizes plasma energy at the tip of the wand to break down the molecules in the tissue.

There are two main benefits of using Coblation for RFIT:

  • Coblation is considered to operate at lower temperatures (40-70°C) than other radiofrequency-based technologies, minimizing the risk of thermal damage to the nose.

 

  • The thin plasma field generated allows for targeted and precise removal of soft tissue without affecting the surrounding tissue, making this a minimally invasive procedure.

Inferior Turbinate Bone Resection (ITBR) and Partial Inferior Turbinectomy (PIT)

These procedures involve removing the bone and/or soft tissue of the inferior turbinates to promote airflow in the nose. As these procedures are more invasive than radiofrequency of inferior turbinates/submucosal diathermy, they are done under general anaesthesia in the operating theatre. These procedures can be done as a day case and the patient can go home on the same day

Many different approaches to turbinate surgery exist. One option for surgery is to remove the turbinates entirely. However, turbinates do serve a 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, also known as empty nose syndrome (ENS).

 

People with this condition will have normal-appearing, clear nasal passages, but will still experience a feeling of discomfort. Empty nose syndrome (ENS) is most common in people who have had nasal surgery, such as a turbinectomy, the surgical procedure where the turbinate is removed.

 

Potential side effects and risks

  • Temporary Pain and Bleeding following the procedure

  • Temporary dryness of the nasal cavities, nasal wash and spray will be provided

  • Rare chance of Infection

 

Further treatment

In most cases, turbinate hypertrophy is due to allergy sensitivity. Available treatments include allergy testing to investigate what allergens may be causing your turbinate hypertrophy, and immunotherapy to decrease allergic reaction symptoms. Therefore, it may be effective to seek allergy treatment at the same time as RFIT.

If you would like to seek consultation for turbinate hypertrophy with Euan’s ENT Surgery & Clinic, please Contact Us to make an appointment.

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