What are the inferior turbinates?
The inferior turbinates are normal structures that protrude into the nasal cavity from the side wall of the nose. They can become enlarged for a variety of reasons including allergies, sinusitis or irritation from various chemicals including cigarette smoke.
What are the indications for inferior turbinate reduction?
The most common reason for surgery is a blocked nose. This can cause problems breathing through the nose when awake, or at night resulting in disturbed sleep, snoring, and / or sleep apnoea. It is also commonly performed as part of a larger procedure to treat sinusitis or nasal deformity.
How is the surgery performed?
Inferior turbinate reduction is usually performed using a camera and endoscope through the nostrils – there are no external incisions or bruising. The technique used is to remove the turbinate bone while preserving as much of the turbinate mucosa as possible – removing the bone means that the result is usually permanent.
In small children when the nose is too small to perform this surgery, coblation or other devices are used to reduce the turbinates without removing the bone. This is usually effective but the problem can recur over time. If so, by the time the problem recurs they are usually big enough to do the more permanent procedure.
What to expect after surgery
Pain is not usually severe, paracetamol and / or ibuprofen are usually sufficient for pain relief.
The breathing is usually fairly clear straight away, but then becomes more blocked due to swelling inside the nose and starts improving again after a week or so.
There will be some bleeding from the nose over the first few days, with risk of bleeding for about 2 weeks after surgery.
Nasal and sinus douching is important after surgery to clear blood clot and mucus from the nose. If blood clot is left in the nose, it can promote scarring and adhesion formation, which can cause a poor surgical result.
Most children will cope well with this, but if not, a simple saline spray used several times per day is used.
Nasal douching or spray is usually continued for around 6 weeks after the operation as it can take this long for the normal mucus clearance mechanisms to start functioning properly.
If there are still significant allergy symptoms (sneezing, itchy eyes and nose, clear runny nose), nasal steroid sprays such as Nasonex can be restarted a week after surgery.
Risks of surgery
- Some bleeding is normal postoperatively but occasionally heavy bleeding may require treatment with packing in the nose or returning to the operating theatre.
- Occasionally, adhesions can form between the septum and the turbinate. If this occurs and is causing symptoms they may need to be divided in the clinic or with further surgery.
- If there is underlying allergy, this will still be present and may still need treatment.