Turbinate hypertrophy: enlarged nasal turbinates, symptoms and treatment

Inside the nose, three pairs of ridges, the turbinates, project from the side walls. ENT UK describes the inferior turbinates as ridges of bone covered with soft tissue and the nasal lining, one on the right and one on the left, which help to make the air we breathe warm and moist. When one becomes swollen it can partly block the nasal passage.

ENT UK explains that inferior turbinates can swell with exercise, cold air or lying on one side. Everyone has fluctuating swelling of the turbinates, called the nasal cycle, and this is normal. Hypertrophy describes the abnormal situation where swelling is persistent or severe enough to cause a blocked nose that does not settle.

According to ENT UK, abnormal swelling of the turbinates can occur due to allergies, hormone changes, nerve stimulation, and diseases that cause inflammation, and sometimes for unknown reasons. In practice that overlaps with the causes of rhinitis: NHS Wales lists colds, changes in weather, smoke and fumes, hormonal changes and some medicines as causes of a blocked or runny nose.

A Scottish NHS GP guideline adds that long-term overuse of over-the-counter nasal decongestants causes rhinitis medicamentosa, with rebound nasal congestion when they are stopped, which can look like turbinate swelling. Reviewing medicines and decongestant use is therefore part of the assessment.

The main symptom is a blocked nose, often worse on one side and often changing from side to side. NHS Wales lists a blocked or runny nose, sneezing, itching and a reduced sense of smell as symptoms of rhinitis, which may accompany swollen turbinates. ENT UK says a blocked nose may affect quality of life but that enlarged turbinates will not cause you any harm.

A blocked nose can affect sleep, breathing through the nose when exercising, and the sense of smell. If blockage occurs on one side only, or comes with bleeding, facial pain, or discharge that smells, it is worth seeing a GP in case something else is responsible.

ENT UK says enlarged inferior turbinates can be diagnosed by a doctor after a review of your symptoms and a nasal examination. A nasal endoscopy, a thin camera inside the nose, may help with the diagnosis and make sure there are no other causes of a blocked nose.

The Scottish GP guideline suggests that referral to ENT on a routine basis should be considered where there is diagnostic doubt after failed initial therapy, and notes that most patients with rhinitis have significant improvement with medical management and that surgical interventions are rarely utilised.

ENT UK lists medication that can help reduce the size of the turbinates and improve a blocked nose: saltwater washes or douching, antihistamine tablets, and steroid sprays or drops applied directly into the nose. If surgery is later recommended, it advises continuing to use medication inside the nose as the alternative that will help shrink the turbinates to give more room to breathe.

NHS Wales warns that nasal decongestant sprays bought without a prescription should not be used for more than a week because longer use can make the problem worse. It describes a homemade saltwater rinse that can be used up to three times a day.

ENT UK says that if medicines do not improve a blocked nose, an operation to reduce the size of the inferior turbinates may be helpful. Surgery can be done under local or general anaesthetic, is done inside the nose with no scars or bruises outside, takes around 30 minutes and can be combined with other nose or sinus operations.

There are several techniques, and what you are offered depends on your surgeon and centre. ENT UK says most methods have similar outcomes, and each has its own risks and benefits.

ENT UK says most patients recover well. Listed risks include bleeding (a nosebleed is very common after most nasal surgery), persistent symptoms that may need further medical treatment, infection (rare), adhesions or scar tissue bridging to the septum, and, rarely, empty nose syndrome after a lot of tissue is removed, with symptoms including a sensation of blockage, dryness, pain and poor sleep. General anaesthetic carries its own risks.

After surgery you can expect pain, fatigue, nasal stuffiness and mild discharge. Blood-stained watery fluid may come from the nose for about two weeks, the nose may be blocked like a heavy cold 10 to 14 days after the operation, and you should not blow your nose for about a week. Most turbinate surgery is day-case, and you need at least 2 days at home, or a week off if your work involves heavy lifting. NHS operations are free at the point of use, and private ENT surgery follows the same principles.