Turbinoplasty

Inferior turbinates are like shelves in the side of the nose covered by mucous membrane. Their role is to increase the surface area within the nose and help to filter and humidify inspired air. Inflammation (rhinitis) can cause inferior turbinates to swell which narrows the nasal passage and may cause complete nasal obstruction. Symptoms include breathing difficulties, excessive nasal discharge (rhinorrhoea), sneezing, or nasal/eye itch.

Most common causes of nasal inflammation are viral infections and allergic response to airborne allergens. More information about allergic rhinitis you can find here.

Non-allergic non-infectious rhinitis is characterised by nasal symptoms that may be induced by exposure to irritants, tobacco smoke, temperature and humidity changes, hormonal disorders, pregnancy, use or abuse of certain drugs, most commonly nasal decongestants, and emotional stress. Itch and ocular symptoms are more common in allergic rhinitis, while other symptoms, like nasal stuffiness, runny nose and sneezing may affect patients with allergic and non-allergic rhinitis.

Treatment options of non-allergic rhinitis depend on the duration and severity of turbinate hypertrophy. Medical treatments include nasal corticosteroid sprays and tablets depending on the presence of allergies. Surgical treatments include turbinoplasty. This procedure is reserved for patients with persistent symptomatic rhinitis that has not responded to medical management, or for patients in whom medical management is contraindicated.

Diagnostic process usually includes:

  • Check possible stimuli, severity and duration of disease

  • Check drug use (systemic and topical), exposure at workplace, hormonal status (pregnancy, hypothyroidism,  acromegaly) and involvement of other organs (asthma, hormonal status)

  • Exclude other nasal diseases (nasal endoscopy)

  • Exclude allergy

  • Exclude sinus inflammation

 

Surgical treatments for rhinitis:

  • Coblation turbinoplasty

  • Endoscopic turbinate reduction

Coblation turbinoplasty

COBLATION™ plasma technology for turbinate reduction is a medical innovation used to treat nasal airway obstruction by both removing and shrinking soft tissue inside the turbinates. With COBLATION technology, your physician removes and shrinks excess soft tissue inside your nose with a specially designed device that is gently inserted just below the surface of your enlarged nasal turbinates. The procedure can typically be performed on an outpatient basis, or even in your doctor’s office. In such cases, patients typically return home shortly after the procedure.

For more information about coblation turbinoplasty, see leaflet here.

Endoscopic turbinate reduction

In certain cases where the nasal obstruction more severe and there is an element of both mucosal swelling and an enlargement of bony part of inferior turbinates, microdebrider assisted turbinoplasty may be indicated.

Microdebrider is a special instrument with a tiny, curved tip that helps the surgeon put the instrument where it’s needed to reduce the turbinates. Because this equipment is precise, there is less risk of removing too much tissue and causing unwanted complications. This can be also achieved by special forceps that delicately remove the excessive tissue.

Risks and complications

No surgery is 100% safe, because there is always the risk from anaesthesia and possible infection. Be sure to ask your doctor about potential complications from your procedure.

While turbinate surgery is generally safe, these are main risks:

  • Excessive Bleeding (circa 3 in 100)

  • Infection requiring antibiotics (circa 3 in 100)

  • Adhesions (<1 in 100)

  • Damage to the inside of your nose causing empty nose syndrome (rare)

 

What to expect after surgery

Absorbable foam or gel dressings may be placed in the nose to minimise bleeding. Rarely, nasal sponge packing may be placed to control bleeding.

Try to avoid blowing your nose for 24 hours as it triggers a bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. The nose may be congested or obstructed in the first few to several days following the procedure. This is relieved with saline rinses and nasal drops. Mild oozing of blood from the nose is expected in the first 48 hours.

Patients report mild nasal pain a few to several days following turbinate surgery. This is usually well controlled with over-the-counter ibuprofen or paracetamol.

Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation and you may get some blood-coloured watery fluid from your nose for the first two weeks or so.

No heavy lifting or straining for 2 weeks following the surgery. If your job requires manual labour, lifting or straining then you should be out of work for 2 weeks or limited to light duty until the 2-week mark. Walking and other light activities are encouraged after the first 24 hours. Try to stay away from dusty or smoky places.