Inferior Turbinate Hypertrophy

What Exactly Is Turbinate Hypertrophy?

Turbinates are bone-like structures inside the nose that are covered by a mucous membrane. These act as radiators by adding warm moist heat to the air that passes as we breathe. The turbinates are very susceptible to allergy and dust irritation and will often swell in response to irritants or infections.

There are three pairs of turbinates in each side of the nasal cavity:

  • inferior turbinates (largest)
  • middle turbinates
  • superior turbinates (smallest)

Causes of hypertrophied turbinates

The mucous membrane that covers the turbinates can contract or expand in response to changes in blood flow. Blood flow can be altered by lying down, eating certain foods, or by allergies, medications, hormones, and infections. 

Restricted breathing and a feeling of congestion are symptoms when turbinates become enlarged. Inferior turbinates are often a source of breathing difficulties. Inferior turbinate hypertrophy is when inferior turbinates become enlarged.

Some patients have congenital enlargement of the middle turbinates that then obstructs/restricts the major sinus outflow tract. This condition is caused by an air-filled turbinate called Concha Bullosa (CB).

Special Considerations:

Septal Deviation – In patients with a septal deviation, it is not uncommon for both sides of the nose to become blocked. A common scenario is when one side of the nose is blocked from permanent inferior turbinate hypertrophy and the other from a deviated septum.

Allergies – Allergies can cause swelling, often leading to permanent turbinate hypertrophy.

Colds and Infections – Turbinates will enlarge and then return to their normal size when a patient is congested due to a cold or infection. In some cases like chronic sinusitis, the turbinate hypertrophy may remain permanent.

Take Our Sinus Quiz

Our quiz measures symptoms, along with frequency and duration, and is used as a tool for diagnosis and treatment.

Diagnosis of turbinate hypertrophy can usually be determined during your first appointment. After reviewing your medical history and performing an exam, we may use a small telescope (endoscope) to examine the inside of your nose. Having a CT scan can confirm a congenital enlargement of the middle turbinates called a Concha Bullosa.
Nasal steroids, decongestants, and antihistamines can be used to manage inferior turbinate hypertrophy. These options may help decrease swelling and improve breathing. It may be necessary to perform a simple surgery to reduce the size of your inferior turbinates, should these options not improve your symptoms.
Our physicians typically use a fine radio-frequency wand, small suction device, or laser to remove tissue inside the inferior turbinate. This procedure may improve the nasal airway, allowing patients to breathe easier. This surgery is occasionally performed as a stand-alone procedure but is often combined with a septoplasty to treat nasal obstruction adequately.

In the case of middle turbinate enlargement (Concha Bullosa), it may be necessary to use an instrument called a microshaver to trim back the portion of the turbinate narrowing the sinus outflow tract.