Concha Bullosa - Causes, Symptoms, Diagnosis and Treatment

Introduction:

Concha is also called turbinates which are present in the nasal cavity. Three pairs of turbinates in the nose resemble shell-shaped bony structures that help control airflow. They also help moisturize and warm the inhaled air before reaching the lungs for respiration. Whenever one of the conchae gets filled with air, the condition is known as concha bullosa or pneumatization of turbinate (pneumatization means the presence of air-filled cavities).

What Are the Conchae?

Three pairs of conchae (singular-concha) are on both sides of the nasal septum. The nasal septum is the bone that separates the nostrils in half. The conchae are three nasal passages for airflow and are named based on their location in the nasal cavity, which is inferior (lowest), middle and superior (upper).

• Superior Concha - This is the highest conchae in the nose and is located near the brain and protects the part of the brain which helps with the smell.

• Middle Concha - The middle concha is between the superior and inferior conchae. It is as long as a little finger. It projects downwards towards the opening of various sinuses and protects them from the pressurized nasal airflow.

• Inferior Concha - The inferior concha is the largest among the three conchae and can be long as an index finger in humans. The inferior concha is responsible for various essential functions such as airflow direction, heating, humidification, and filtering the air inhaled through the nose.

Each of these nasal passages, separated by the conchae, opens into the sinus cavity, which are the air-filled spaces in the skull. There are four hollow air-filled cavities present in the facial bones named after the bones in which they are located, which include -

• Maxillary sinuses (located on each side of the nose near the cheekbones).

• Frontal sinuses (located above eyes near forehead).

• Ethmoid sinuses (located near the eyes on either side of the nose bridge).

• Sphenoid sinuses (present behind the eyes deep in the skull).

The primary function of the sinuses is to produce mucus, a type of fluid that is sticky and slippery and helps warm, moisten, and filter the air in the nasal cavity.

What Is Concha Bullosa?

Concha bullosa means the presence of air or pneumatization in the middle concha. It is a common disorder that generally does not cause serious complications except when it gets enlarged. The enlarged concha bullosa may cause blockage in the nasal cavity, preventing the sinuses from draining mucus properly. This can lead to the accumulation of mucus and cause a sinus infection.

The pneumatization of the middle and superior conchae is common. It is rare for the inferior concha and is known as the inferior concha bullosa. Concha bullosa may also be found along with deviated nasal septum, which is a condition in which the nasal septum is not entirely straight, making breathing harder.

What Are the Causes of Concha Bullosa?

The exact cause of concha bullosa is not known. According to various studies, it has been found that it is more likely to occur if a person has deviated nasal septum. This can cause issues in breathing, making it difficult to breathe from one nostril, and symptoms like loud snoring and sleep apnea may also be seen.

What Are the Symptoms of Concha Bullosa?

A small-size concha bullosa does not cause any symptoms and can even go unnoticed throughout the life of a person. However, large-size concha does cause some pain and discomfort. Some of the common symptoms of concha bullosa may include the following -

• Pain or feeling of pressure around the sinuses or the area around the eyes.

• Feeling like something is blocking the airway while breathing.

• Feeling like a person cannot get enough air in or out through the nose.

In case a person has deviated nasal septum, some of the following symptoms may also be seen such as -

• Noisy breathing.

• Loud snoring.

• Frequent nose bleeds.

However, the symptoms of concha bullosa may resemble the symptoms of a sinus infection. Still, it does not cause symptoms like mucus drainage or pain in the ear or jaw, which are commonly seen in sinus infections.

What Is the Diagnosis of Concha Bullosa?

Patients do not need to consult a doctor if they are not facing any difficulty in breathing. However, if the symptoms caused by concha bullosa are affecting the life of a person, they should seek medical help, and the doctor may advise the following tests to help diagnose this condition -

• CT (Computed Tomography) Scan - This is the most common test to diagnose concha bullosa. By this test, the doctor can see a cross-section of the nose and conchae structures and spot the air pockets. These pockets appear as black spots irrespective of the normal gray color of the concha. Usually, the concha bullosa appears as large circles or pockets extending to other parts of the nose.

• MRI (Magnetic Resonance Imaging) Scan - With this three-dimensional test view of the concha and other structures of the nose can be seen. Same as the CT scan, the MRI scan can also help in identifying the concha bullosa as a dark circle within the nasal cavity.

What Is the Treatment for Concha Bullosa?

Patients usually do not need any treatment if it is not causing any pain or discomfort. No medication or surgery is required if there are no related symptoms found. However, if the symptoms such as headache and breathing difficulty are there, some of the following procedures can be done to treat this condition -

• Crushing - In this procedure, the doctor will squeeze the concha bullosa by surgery until the trapped air is not released from them. This surgery can be performed under local or general anesthesia.

• Turbinoplasty - In this method, the surgeon will surgically reshape the bones and tissues around the concha bullosa to improve the airflow. This surgery is usually done under general anesthesia.

• Turbinate Reduction or Resection - In this surgery, the concha bullosa is removed using some special tools under general anesthesia.

• Septoplasty - This procedure is done in cases where concha bullosa develops due to deviated nasal septum. The deviated septum is straightened in this surgical procedure to make breathing easy.

Conclusion:

Concha bullosa is a common condition that usually does not cause serious complications and rarely requires any treatment. But if there is any pain or discomfort which is affecting the daily lifestyle of a patient, then they should go for the different surgical procedures available.