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Q. I am suffering from breathing problem. Please advice me on turbinate reduction.

Answered by
Dr. Shyam Kalyan N
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Aug 10, 2019

Hello doctor,

I am a 25-year-old female. I have been struggling with breathing through my nose my whole life. When I was a child, I did not know if others breathed like me or not. I would expand the skin on my cheekbones sideways to open my nasal airways and breathe better for a second. I started investigating the problem maybe four years ago. My health center performed a regular X-ray and reported that I do not have a deviated septum (which I suspected I had).

They mentioned I had a slightly enlarged turbinate (do not remember which side). It was too vague, so I tried to ignore the problem for four years. (during these years I have had way too many sore throats and postnasal drip, and I have been tired and exhausted all the time). Now, I am a teacher, and my breathing problem is affecting the quality of my life more than ever.1. I get tired of doing exercise very quickly, so I quit cardio.2. I cannot indulge in mouth-kissing with my husband for more than a few seconds.3. I eat quickly and swallow my food.4. I am fatigued, and I am unable to focus on anything. I feel like I am stupid and simple (while I used to be very creative).

I feel tired from inhaling, it feels too tight or clogged in my nasal airways when I inhale. It makes my chest tired because I do not feel like I get enough air in my lungs, sometimes I am so tired that I cry. The exhaling is fine, and it seems to my doctors and me that the air that comes out is more than the air that goes in. My doctor is a bit surprised that I have breathing problems because he used a piece of metal under my nostrils to measure the air that comes out of my nose, and to him, it seemed very normal.

Also, it is essential to know that my nose is dry all the time. It is like I do not have mucus unless I eat spicy food or I catch the flu. Other times it just goes straight to my throat. I rarely blow my nose. I have never done any surgery in my life and never had an accident in which my nose was involved. I feel better when I use breathe right nasal strips. I use them during the day at work, and I do not feel embarrassed anymore because I am suffering. When I use Otrivin nasal spray, I got introduced to it by a doctor that I begged for relief. And I became addicted to it for more than two months. I used it almost every day. Then I was reading about it and found out that it is dangerous and addictive and might harm my nose even further so I quit it. Now I only use it once in a while when I have a long day ahead, and I need to be focused or physically active. My recent investigations and doctors.

During the last couple of years, I have been to many doctors to arrive at the best diagnosis. At last, one doctor told me that I have a deviated septum and I need surgery to fix it. He also gave me two injections because he said I had an enlarged childhood adenoid, and the injections should shrink it. He did not do a CT scan. I went to two other specialists, and one agreed I had deviated septum and the other thought maybe I need plastic surgery to widen my nostrils. All these three doctors gave me similar medications like antihistamine pills, nasal sprays like Nasonex, both of which I am taking for about a year because of the prescriptions of several doctors.

My last doctor had a different opinion. He said that I do not have a deviated septum and proved it with a CT scan. He said I have slightly enlarged turbinates on both sides. He is the one who put a metal under my nostrils to measure the air. He believes that I do not have a severe condition, but I insisted that I do not have a normal life because I cannot breathe. He also gave me antihistamine for one month, Avamys fluticasone furoate nasal spray for two months, saline solution for two months.

He told me to wait for 2 to 3 months and see if I improve or prefer to have turbinate reduction surgery. I told him that if I choose the surgery, I would like to go with tonsillectomy with it because of my recurrent sore throats.

I searched about the turbinate reduction, and empty nose syndrome scared me a lot as I do not want to worsen my breathing. So I am hesitant. Now I am still thinking, and I thought I would consult other specialists. I will attach samples of CT scan as well. I want to breathe and inhale like ordinary people because I feel it is killing me slowly.

Dr. Shyam Kalyan N

Allergy Specialist Otolaryngology (E.N.T)
#

Hello,

Welcome to icliniq.com.

I need to have a look at the CT to assess how much of a space you have inside the nasal cavities, whether the enlarged turbinates are causing airway compromise, whether there is any adenoid remnant in the nasopharynx, whether there is any polyp or mucosal thickening inside the sinuses. Continue with Avamys, antihistamine and the saline douches. Are you allergic to anything? Have you undergone a skin prick testing to determine what you are allergic to?


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Thank you doctor,

I have attached the file.

Dr. Shyam Kalyan N

Allergy Specialist Otolaryngology (E.N.T)
#

Hello,

Welcome back to icliniq.com.

I went through all the cuts of the scans exhaustively. What I find is that the right maxillary sinus is minimally congested or inflammed. The septum is very mildly deviated. But both the inferior turbinates and the right middle turbinate are enlarged and compromising the space. As a consequence you are experiencing persistent congestion and nasal blockage and that gets relieved with otrivin because it is a soft tissue problem unlike a septal deviation which is bony and unresponsive to vasoconstrictors like Otrivin.

The main reason for the obstruction is the enlarged turbinates and a turbinate reduction surgery will be beneficial in you if other factors like allergy and environment are controlled. Empty nose syndrome occurs only when excess of turbinates are removed. Since we do most of our surgeries endoscopically the risk of ENS is very low. Additionally we can use mucosa sparing techniques to address the enlarged turbinates.


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