Conditions & Treatments: Symptoms, Causes and Risk Factors, Diagnosis, Treatment

Inferior Turbinate Reduction Surgery - What it is

The inferior turbinates are structures which protrude into the breathing passages of the nose. Well-sized turbinates provide necessary resistance and humidify the air we inhale. Turbinates can become enlarged as a result of allergies or infection and cause nasal obstruction.

Inferior turbinate reduction surgery aims to reduce the size of the inferior turbinates, either by using minimally invasive radiofrequency techniques, or surgical excision.

This procedure is typically performed:

If you suffer from nasal obstruction to increase your nasal airflow.
To facilitate the administration of nasal medication for treatment of allergic rhinitis.
To facilitate the use of Continuous Positive Airway Pressure (CPAP) in obstructive sleep apnea (OSA).

This procedure is not used to treat the symptoms of running nose or sneezing caused by allergic rhinitis.

What does it involve?

Inferior turbinate reduction can be performed by the following techniques/methods:

1. Radiofrequency or Coblation turbinate reduction are minimally invasive procedures. Radiofrequency delivers heat within the tissue of the turbinate while coblation combines radiofrequency energy with saline to create a plasma field. Both methods create a targeted area of coagulation and reduce tissue volume with minimal impact to surrounding tissues. If performed as a single procedure, the procedure will be performed as a day-surgery procedure and you will be awake throughout the procedure. After local anaesthesia is administered using a nasal spray and injection, a handheld needle probe is directed through the nostrils into the turbinates before radiofrequency energy is released several times along the length of the turbinate. This technique may have to be repeated 2 – 3 times in the future to achieve its desired outcome (another consent will be taken).

2. Inferior turbinoplasty or Turbinectomy is a surgical procedure which either partially or completely excises the inferior turbinate using instruments such as small knives, scissors, or powered instruments, guided by a telescope or nasal speculum through the nostril. This procedure is done under general anaesthesia. Nasal packs may be placed in each nostril for one to two days after the procedure to control bleeding, and you will have to breathe through your mouth during this time.

Common risks and complications:

Bleeding (1-10%)

After surgery, it is normal to have some blood-stained discharge from the nose and this usually resolves within two weeks. Occasionally, additional measures such as nasal packing or surgery may be needed to control excessive bleeding. Substantial bleeding requiring transfusion and further surgery is rare.

Persistent nasal obstruction

Persistent nasal obstruction due to deviation of the cartilage and bone separating the nose and ongoing poorly controlled allergic rhinitis may limit the outcome of surgery. Recurrence of nasal obstruction due to increase in turbinate tissue may occur after 6 months, particularly using radiofrequency or coblation techniques. It is presently not possible to reliably predict whether such a recurrence will occur and the patient will have to monitor his/her condition.

Crusting

Crusting in the nose may last for about two to six weeks after surgery due to hardening of nasal discharge and dried blood. Prolonged crusting is rare; however, it can occur and may last up to one year. Crusting is usually reduced by the use of humidification and saline nasal spray.

Scarring

If the procedure is done together with a septoplasty, scar tissue may form between the septum and turbinate. Further surgery may be needed.

Uncommon risks and complications:

Empty nose syndrome and dry nose

Over resection of the turbinate may result in dry nose and ‘empty nose syndrome’ in which there is persistent sensation of nasal obstruction after surgery despite adequate airflow. This is believed to be due to loss of airflow turbulence within the nasal cavity and reduced airflow sensation. This complication is rare.

Infection

Though infection is rare, it is a risk with any surgical procedure. If infection does occur, usually it can be treated with antibiotics. Rarely, drainage is required if an abscess develops.

Altered sense of smell

Nasal surgery may alter your sense of smell, and consequently, your appreciation of tastes. This is usually temporary due to postoperative swelling and nasal crusting and improves with healing. Rarely will there be a permanent severe loss of smell.

Injury to surrounding structures

The nasal septum, middle turbinates and tubal tonsils are nearby structures that may get injured during the course of the surgery. These injuries are usually mild and self-limiting.