Turbinate reduction: surgery for a persistently blocked nose

The turbinates are ridges inside the nose that warm and moisten air. When the lower pair (inferior turbinates) stays swollen, perhaps from allergy or long-standing irritation, the nose feels blocked on both sides. ENT UK says surgery is meant for people whose blockage persists despite saltwater washes and steroid sprays.

Continuing medical management is the main alternative. If the bend in the septum rather than the turbinates is the cause, septoplasty may be more relevant, and the two are sometimes done together.

Your surgeon will examine the nose with a small camera, and may check for allergy or other causes of blockage. Pre-assessment covers anaesthetic fitness, and you will be told about fasting if general anaesthetic is planned.

Plan some days of rest, and for longer if combined with septoplasty. Stock saline rinses ahead of time.

It also helps to be clear about what you are hoping for. If allergy, rather than the shape of the nose, is driving the swelling, the benefit from reducing the turbinates may fade, and the underlying allergy still needs treating. Ask what your surgeon would expect to change in your case, and how long they would normally wait before judging the result.

ENT UK describes surgery as done inside the nose with no external scarring, under local or general anaesthetic, in about 30 minutes. Several techniques exist: applying heat or plasma, laser, radiofrequency reduction or removing part of the turbinate. They vary in how much tissue they preserve, and ENT UK says the outcomes are generally similar.

Day case discharge is typical.

ENT UK describes nosebleeds as very common and persistent symptoms despite surgery as common. Less often there is infection, scar tissue, and a rare condition called empty nose syndrome, in which the nose feels paradoxically blocked despite wide open airways. General anaesthetic has its own risks.

The Royal Cornwall leaflet notes crusting resolving over one to two months after combined septoplasty and turbinate surgery.

Avoid blowing the nose for about a week and expect blood-tinged discharge for around two weeks, per ENT UK. Saline rinses reduce crusting. ENT UK suggests at least two days of rest and a week if you lift heavy items. The Royal Cornwall leaflet, which covers septoplasty with turbinate reduction, says two weeks off work and no strenuous sport for three weeks.

• Increasing blockage, soreness or a foul smell: possible infection.

• Bright red bleeding or large clots that do not stop with pressure: seek urgent help.

• Fever or severe pain.

• Are my turbinates or my septum the main problem?

• Which technique do you use and why?

• What is the chance my symptoms will persist?

• How long will crusting last and how do I manage it?

NHS commissioners often expect proof that sprays and rinses have been tried properly, and some areas restrict surgery. Privately, scheduling is quicker, but the same clinical test applies: is surgery likely to help? Ask your surgeon how often the symptoms return after their technique.