Enlarged turbinates
Persistent nasal blockage from swelling of the turbinates inside the nose, often together with allergy, chronic rhinitis or a deviated septum.
The turbinates are three pairs of scroll-shaped tissues on the side wall of each nostril. The largest pair, the inferior turbinates, sit just inside the entrance to the nose and do most of the work, warming, humidifying and filtering the air as you breathe in. When the lining stays chronically swollen, the airway narrows and the nose feels blocked, sometimes day and night.
Common symptoms
- Persistent nasal blockage, often worse lying down or on alternating sides through the day
- Mouth-breathing and a dry throat in the morning
- Snoring and disturbed sleep
- A nose that responds only briefly, or not at all, to over-the-counter sprays
- Sometimes a reduced sense of smell
Common causes
- Allergic rhinitis (hayfever, house dust mite, animal dander)
- Non-allergic rhinitis, including the chronic vasomotor type
- Chronic rhinosinusitis
- A deviated septum, where the turbinates on the wider side compensate by enlarging
- Long-term use of decongestant nasal sprays (rhinitis medicamentosa)
- Hormonal causes such as pregnancy or thyroid disease, where the swelling is medical rather than structural
Assessment
Examination is straightforward, usually with a small endoscope at the same visit. The aim is to work out which causes are at play, because the right treatment depends on the mix. Allergy testing, a CT scan of the sinuses or a sleep history are sometimes added, depending on the picture.
Treatment
Most people improve with medical treatment first: a daily nasal steroid spray, saline rinses, and treatment of any underlying allergy. If a decongestant spray has been overused, stopping it is part of the plan. Where the turbinates remain structurally enlarged after a fair trial of medical treatment, a small day-case operation to reduce them can open the airway durably while keeping their useful function intact. Where a deviated septum is contributing, septoplasty and turbinate surgery are usually done together.
See also: septoplasty and turbinate surgery, and the patient information sheet on turbinate reduction.
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This page is general information and not a substitute for individual medical advice.