Turbinate Hypertrophy - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Our nose consists of three pairs of turbinates that are superior (upper), middle, and inferior (lower). Lower turbinates are the largest among the three and most frequently get enlarged due to infections resulting in loss of smell and nasal blockage. The mucosa (tissue covering the nasal turbinates) usually swells and overgrows due to bacterial or viral infections like rhinitis and sinusitis. Overgrowth of the nasal turbinates also results in respiratory insufficiency (breathing problems).

What Are the Causes of Turbinate Hypertrophy?

• Allergic rhinitis (swelling of the tissue or mucous membrane of the nose due to allergic infections).

• Chronic sinusitis (long-standing swelling and infections of the nasal cavities).

• Hormonal changes.

• Medications (exposure to some intranasal medications cause nasal mucosa swelling).

• Common cold or flu.

What Is the Grading of Lower Nasal Turbinate Hypertrophy?

Inferior nasal turbinate overgrowth is divided into three grades:

• Grade 1: Mild overgrowth of the turbinates without any nasal obstruction.

• Grade 2: Mild to moderate overgrowth of the turbinates with slight nasal obstruction.

• Grade 3: Complete occlusion or blockage of the nasal cavities due to severe overgrowth of the nasal turbinates (tiny bony structures present in the nose) resulting in respiratory insufficiency (upper airway blockage).

What Are the Signs and Symptoms of Turbinates Hypertrophy?

Signs and symptoms associated with nasal turbinates hypertrophy are:

• Breathing problems.

• Upper airway blockage.

• Snoring.

• Loss of smell.

• Drying of the nasal tissue or mucosa.

• Nasal congestions.

• Noisy breathing or breathing from the mouth.

• Nasal drainage.

• Stuffy nose.

• Epistaxis (bleeding through the nose due to turbulent airflow).

How To Diagnose Turbinate Hypertrophy?

Nasal turbinates overgrowth can be diagnosed by:

• History and Clinical Examination: A complete history of the patient for the presence of any nasal discharge, nosebleeds, breathing problems, and loss of smell should be recorded. A Clinical examination of the nose is done by an ENT (ear, nose, and throat) specialist to check for nasal swelling, obstructing nasal cavities, and nasal discharge.

• Nasal Endoscopy: An endoscope (thin and flexible apparatus with an attached camera that is used to see the internal structures of the body) is used by the doctor to rule out any sinus (empty space within the skull bones connecting the nasal cavities) infections and careful examination of lower, middle and upper nasal turbinates for the presence of any swelling.

• Computed Tomography (CT) Scans: It is done to rule out the extent and size of the nasal turbinate swelling and helps in treatment planning accordingly.

What Is the Treatment of Turbinate Hypertrophy?

Treatment of nasal turbinate hypertrophy are:

Medicinal Therapy: For acute (swelling persisting from 10 to 15 days) turbinate overgrowth nasal decongestants like Oxymetazoline and Xylometazoline can be used for a minimum of three to four days under the prescription of a doctor to reduce the swelling. Overuse of nasal decongestants can further aggravate the swelling. Nasal decongestants do not help in long-standing (chronic cases) nasal turbinate swelling.

Nasal steroid sprays are also advised for the reduction or stopping of the growth of the nasal turbinates swelling.

Treatment of the Underlying Cause: Underlying allergic infections like allergic rhinitis and sinusitis should be treated by nasal antihistamine spray and nasal saline rinses as advised by the doctor.

Allergy Immunotherapy (AIT): It is also called allergen desensitization. This therapy is indicated to treat mild to moderate allergic rhinitis (swelling of the tissue or mucous membrane of the nose due to allergic infections).

Surgical Management: It is indicated when conservative management fails to treat the problem. Surgical management aims to reduce the size of the nasal turbinates swelling and to improve the free flow of air through the nose by removing the nasal obstruction. It is done under local or general anesthesia by an ENT specialist. Different surgical techniques used for reduction of the nasal turbinates are:

1. Conventional Turbinectomy: It is done by surgical removal of the lower (inferior) nasal turbinates partially or completely to remove the nasal obstruction and improve the airflow through the nose.

2. Laser Turbinectomy: It is a procedure done with the help of carbon dioxide or diode lasers (mostly used because of their precision in cutting). A diode laser with an infrared wavelength of 800 to 950 nanometers is used to vaporize the excessive tissue growth of the nasal turbinates by endoscopic approach (a procedure done under the guidance of the endoscope - a thin and flexible telescope-like apparatus with a camera). Laser turbinectomy creates a bloodless field for the surgeon to increase visibility and benefits the patient as well due to less blood loss while surgery.

3. Electrocautery Turbinectomy: In this technique, a probe tip-like instrument is used to apply the electric current to cauterize (burn the tissue) the turbinate tissues. It is performed cautiously to avoid damage to the surrounding tissues.

4. Cryotherapy turbinectomy: It is done by using cooling agents like nitrous oxide gas or liquid nitrogen. This procedure is used to induce necrosis of the turbinates tissue by freezing it.

Radiofrequency Turbinates Reduction: It is a procedure in which the needle is inserted into the swollen turbinates and radiation energy is induced in the tissues to cause controlled damage. It is done under local anesthesia. After the procedure, the patient is kept on antibiotics and advised nasal saline sprays. This procedure helps to reduce the swelling and improve the airflow through the nose.

Ultrasound Turbinoplasty: This is one of the newer techniques that is done by using an activated ultrasonic nasal probe that is inserted in the turbinate tissues and is moved backward-forward slowly to destroy the extra tissue growth.

What Are the Complications Related to Nasal Turbinates Surgery?

Some complications that can be expected after the surgery are:

• Pain.

• Swelling.

• Bleeding from the nose.

• Dryness of the nose.

• Recurrence of the nasal turbinate swelling.

Conclusion:

Turbinates hypertrophy is an overgrowth of the nasal tissue lining the turbinates (tiny bone structures in the nose) that can affect both children and adults. It affects the quality of life of the patient due to the symptoms like loss of smell, nosebleeds, difficulty in breathing, and continuous nasal discharge. Any symptoms noted should be reported to the doctor immediately for prompt diagnosis and treatment. Early diagnosis and management of turbinate hypertrophy are important to prevent further worsening of the condition leading to complications due to delayed management.