Turbinate reduction

What are the turbinates?

The turbinates (tur-bin-ates) 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. In a healthy nose they humidify, warm, and filter the air as you breathe in.

When the lining swells up and stays swollen, the airway through the nose narrows and breathing becomes a struggle. Turbinate reduction shrinks the swollen tissue to open the airway, while preserving the lining so the turbinates can keep doing their job.

Why turbinates cause problems

The most common reason is chronic inflammation of the nasal lining. The usual triggers are:

• Allergic rhinitis, including hay fever and year-round house dust mite allergy
• Non-allergic rhinitis, where the lining reacts to irritants, temperature change, hormones, or strong smells
• A deviated septum. The turbinate on the wider side often enlarges to fill the extra space
• Decongestant spray overuse (rhinitis medicamentosa). Long-term use of sprays such as Otrivine and Sudafed keeps the turbinates artificially shut down between doses, then rebound-swollen between them

The symptoms are persistent nasal blockage, mouth breathing (often worse at night), snoring, post-nasal drip, and reduced sense of smell.

What we try first

Surgery is for cases where medical treatment has not given enough relief. Before considering the operation we will:

• Confirm that the turbinates are the main source of obstruction, usually with a nasal endoscopy in clinic
• Treat any underlying allergy or rhinitis fully (intranasal steroid spray, saline rinses, daily antihistamine)
• Address the septum if it is significantly deviated, sometimes at the same operation
• Stop any decongestant spray that may be perpetuating the swelling

Most patients see meaningful improvement from medical treatment alone. Surgery is offered when twelve weeks of consistent treatment have not given you the airway you want.

How the operation works

The technique I use depends on your anatomy and the cause of your symptoms. Three approaches are common, often combined.

Submucous diathermy or radiofrequency

A fine probe is passed through the lining of the turbinate to heat and shrink the swollen tissue underneath. The surface lining is left intact. Quick, well tolerated, and the default for moderate enlargement. Day case, around 20 minutes.

Microdebrider-assisted reduction

A small powered shaver removes a controlled amount of swollen tissue from beneath the lining. More tissue is removed than with diathermy. Useful when diathermy alone has not given a durable result, or when the turbinate is grossly enlarged.

Outfracture

The bony part of the turbinate is gently moved sideways to widen the airway. Often added to one of the techniques above when the bone is contributing to the obstruction.

Turbinate reduction is often combined with septoplasty, sinus surgery, or other nasal procedures in a single operation.

On the day of surgery

• General anaesthetic, day case in almost all cases
• 30 to 60 minutes in theatre, depending on what is combined
• No external scars. Everything is done through the nostrils
• Home the same afternoon. Do not drive home; arrange a lift
• Have someone with you for the first 24 hours after a general anaesthetic
• I will see you in the recovery area before you leave, and you will go home with a written discharge note covering aftercare and emergency contact details

Recovery

The nose usually feels more blocked than usual for the first one to two weeks after the operation, because of swelling and crusting. This is normal and not a sign that the operation has failed. Things to do:

• Saline rinses twice a day from day one. Essential. They clear crusts, prevent infection, and speed healing. A NeilMed Sinus Rinse bottle or similar works well
• Avoid blowing your nose hard for two weeks. Dab, do not blow
• Avoid hot baths and strenuous exercise for one week, then build back gradually
• Sleep with the head of the bed slightly elevated for the first few nights to reduce swelling
• Take simple painkillers if needed (paracetamol). Avoid ibuprofen and aspirin for two weeks before and after the operation, as they thin the blood and increase the risk of bleeding

Most patients return to office work within three to five days and to manual work within seven to ten days. The full benefit of the operation is usually clear by six weeks, with continued small improvements out to three months.

Risks

Turbinate reduction is a low-risk operation. The risks I take through with every patient are:

• Bleeding. A small amount of bloody discharge is normal for the first 48 hours. Significant bleeding is uncommon (around 2% of cases) and usually settles with simple pressure. Avoid aspirin and ibuprofen for two weeks before and after, and do not blow your nose hard.
• Infection. Uncommon. Saline rinses reduce the risk. Contact me if you develop fever, increasing pain, or visible pus.
• Crusting and dryness. The lining takes a few weeks to settle and can feel dry or crusty in that time. Saline rinses help; the feeling resolves as the lining heals.
• Under-treatment. Some patients need a second reduction after months or years if the tissue swells back up. This is more likely if the underlying rhinitis is not well controlled.
• Empty nose syndrome. Rare, and the reason I deliberately under-treat rather than over-treat. A paradoxical feeling of nasal obstruction despite a wide airway, caused by removing too much turbinate. Conservative reduction makes this very unlikely.
• Adhesions or synechiae. Thin strands of scar between the turbinate and the septum. Easily divided in clinic in the rare cases they cause symptoms.
• Change in sense of smell. Very rare with conservative reduction. Saline rinses post-op protect the olfactory lining.

When to seek help

If you experience any of the risks listed above, or any new symptom that concerns you, contact me on 020 7435 8171 (office), 020 7435 8171 (urgent), or office@noseandsinus.md.

Follow-up

I will see you at two to four weeks for a brief check, with a nasal endoscopy to make sure the lining is healing cleanly and to clear any residual crusts. Most of the swelling has settled by six weeks, with full healing by two to three months. If the underlying rhinitis is well controlled, the result is durable for years.

Get in touch

If you have any questions before or after the operation, please contact the practice. We are happy to discuss whether turbinate reduction is the right next step for you, or to adjust the plan if your symptoms change.

Book a consultation

This page is general information given to you by Mr Gane and is not a substitute for individual medical advice. If your symptoms change, or if you would like help deciding between treatment options, please get in touch.

If you need urgent help relating to your care, see urgent and emergency contact.