Turbinate hypertrophy (concha hypertrophy)

The turbinates: each of the two nasal cavities contains three turbinates. The size of the inferior, middle and superior turbinates increases from top to bottom. In other words, the superior turbinate is the smallest and the inferior turbinate is the largest.

The turbinates, which are rich in blood vessels, mainly function to warm, cool, humidify and filter the inhaled air. The size of the turbinates is not constant and changes depending on many factors such as air temperature, humidity, physiological processes in the body and hormonal changes. Normally, during the day the size of the turbinates in the right and left nasal cavities changes every few hours; for example, when the turbinates on the right side enlarge, those on the left shrink, and then the exact opposite happens.

Enlargement is observed mostly in the inferior turbinates. If septal deviation is present alongside turbinate hypertrophy, nasal obstruction becomes even more pronounced. The most common cause of turbinate hypertrophy is allergy. Other causes include chronic sinusitis, smoking, inhalation of chemical gases, air pollution, and the long-term use of nasal decongestant sprays and drops.

Treatment: In turbinate hypertrophy, drug treatment is started first of all.

• Rinsing the nose with hypertonic solutions relieves obstruction for a short time.
• Cortisone nasal sprays are beneficial when used long-term, especially in patients with allergies.
• Decongestant medicines reduce nasal obstruction when used for a short time. However, long-term use is not advisable. Their use is contraindicated in people with high blood pressure, in patients with heart and kidney disease, in those with prostate enlargement, and in patients with high intraocular pressure. Nasal decongestant sprays give short-term benefit. After long-term use, the turbinates enlarge even more and nasal obstruction increases.

Turbinate surgery: In this case the enlarged turbinate is reduced. The reduction can be performed by several different methods:

• Surgical reduction
• Reduction with a microdebrider
• Cauterisation
• Laser
• Radiofrequency — the most commonly used method. Without damaging the surface that provides the turbinate's function, its inner part, rich in blood vessels, is reduced. The needle of the radiofrequency device is inserted into the turbinate, and the energy delivered at radio-wave frequency causes the turbinate to shrink.

The decision on which of these methods to use depends on the doctor's choice and on the condition of the turbinate.

After turbinate surgery, tampons or silicone splints may be placed inside the nose for one or two days to reduce bleeding. During the first week after turbinate surgery, nasal obstruction may increase because of intranasal swelling, crusting, and increased and thickened secretion. The result of the treatment appears within 6–8 weeks. Therefore, relief of nasal obstruction should not be expected in the early period.