Everything You Need To Know About Enlarged Nasal Turbinates and How To Treat Nasal Congestion Safely

The Inferior Turbinates are responsible for the majority of nasal obstruction symptoms during respiratory illnesses, nasal allergy flareups, pregnancy, decongestant abuse, and many other conditions that limit nasal breathing. Even when a deviated septum is present, the turbinates are often responsible for an even greater degree of nasal obstruction than the septum.
This video describes the turbinates, their functions, the conditions that impact their size and cause nasal obstruction, and the available treatment options to consider including medications and procedures. I also discuss the risks of turbinate procedures, including atrophic rhinitis (or Empty Nose Syndrome), and how this dreaded condition can be avoided with appropriate surgical techniques and managed when already present.
If you or someone you know is struggling to manage their nasal obstruction symptoms, snoring routinely, or unable to tolerate treatments for obstructive sleep apnea, an ENT evaluation can quickly uncover problems and provide treatment options that are more likely to succeed at improving nasal breathing and management of sleep apnea.
If you would like to see me as a patient in Houston or The Woodlands, Texas, please contact us at My Houston Surgeons (713-791-0700) or request an appointment online at www.premiersinus.com.
Thanks for watching, and please feel free to ask related questions in the comments.
- Shawn Allen MD (Snot Doc TX)

[@snotdoctx8742]

I haven’t seen any patients develop classic empty nose syndrome following nasal airway surgery performed by me. Specifically, none have presented back to me with complaints of nasal obstruction that on workup appears paradoxical (wide open nose), feeling short of breath, burning/irritation in their nose, etc. I rarely perform more extensive (extended) sinus procedures that create a MUCH more open nose and sinuses compared to standard surgery due to complexities of the diseases I’m treating, and rarely some of these patients will have issues with dryness/crusting or occasionally burning irritation that improves with topical sinus irrigations, emollients, etc. However, these cases represent a trade-off (required more extensive surgery for specific pathology knowing that this was a potential risk).

[@timcepin3386]

I can barely breathe through my nose.

[@shore022]

Hi Doc. Thanks for your video and the info. In your experience how often does Empty Nose Syndrome occur after turbinate reduction and/or septoplasty?

[@snotdoctx8742]

I haven’t seen any patients develop classic empty nose syndrome following nasal airway surgery performed by me. Specifically, none have presented back to me with complaints of nasal obstruction that on workup appears paradoxical (wide open nose), feeling short of breath, burning/irritation in their nose, etc. I rarely perform more extensive (extended) sinus procedures that create a MUCH more open nose and sinuses compared to standard surgery due to complexities of the diseases I’m treating, and rarely some of these patients will have issues with dryness/crusting or occasionally burning irritation that improves with topical sinus irrigations, emollients, etc. However, these cases represent a trade-off (required more extensive surgery for specific pathology knowing that this was a potential risk).

[@shore022]

Thanks for the quick response. It's good to know you haven't seen any such cases. Would it be possible to perform a polypectomy without correcting a deviated septum with spur and enlarged turbinates? Or would that not be considered worth it unless the surrounding structures can be fixed as well? I was just wondering if removing the polyps could lead to a natural reduction of turbinates on their own when neither deviation or turbinates had given any prior problem. Look forward to hearing from you.

[@snotdoctx8742]

@@shore022 that really depends on how deviated the septum is and how large the turbinates are. If they’re in the way, then the straight scopes and instruments may not be able to access the sinuses and clear polyps reliably. The reason to have surgery should always be viewed in the context of what you need long term. For most with sinus disease and nasal polyps, the polyps are just a sign of more severe inflammation and polyp removal alone does nothing for them long term. The goal of surgery in that situation is to open up the nose and sinuses properly so that inflammation everywhere (including inside of the sinuses) can be better managed with topical steroids (which have to be delivered either in a medicated rinse or in certain cases by a nasal nebulizer or Xhance spray). With that in mind, I also generally recommend getting everything corrected at once. Same recovery, significantly less expensive compared to multiple procedures, less anesthesia time overall, less need to torture the nose removing polyps down the road when it’s open and easily accessible for these topical treatments. Most folks with deviated septum and enlarged turbinates are also used to that level of nasal obstruction and can only appreciate they had a problem once it is corrected and they can feel the difference in breathing.

[@shore022]

Thank you for the detailed answer. I really appreciate it. Your videos are very informative and well done. You've got a new subscriber in me and wish you the best. Cheers

[@timcepin3386]

I’m not trying to be funny doctor, but I would seriously rather have a total rhinectomy than deal with my nose. I really want one.

[@cristianvasquezdiaz471]

Hi, thanks for the information. Do you use nasal plugs after submucosal resection surgery of the inferior turbinates?

[@snotdoctx8742]

I don’t use nasal plugs ever. I use septal splints after septoplasty when the anterior cartilage is repositioned or needs added support temporarily, and dissolvable nasal packing (PosisepX) in the upper portions of the nasal cavities adjacent to the sinuses or in the ethmoids following sinus surgery if I’m worried about bleeding post-op. After routine nasal airway surgery (turbinoplasty with or without septoplasty) no packing is generally needed unless the middle turbinates are also addressed and appear risky for ongoing bleeding. The inferior turbinates respond well to targeted nasal cautery during surgery.

[@kauaireed9006]

Doctor please give me a percentage of risk of getting ENS , I know 1 in a thousand is the risk for FESS surgery and those odds aren’t very good if you ask me . Thank you

[@snotdoctx8742]

There haven’t been any large scale studies, particularly focusing on modern turbinoplasty techniques, that I’m aware of looking at the incidence of ENS. As I’ve mentioned, I haven’t seen it in my patients as far as I aware, and I follow many for years particularly if I’m managing their sinus problems as well. The key to safely improving breathing without risking ENS is to focus on preserving the mucosal lining and remove tissue inside of the turbinates, such as the bone, and only limited soft tissue removal. No procedure is risk free, but luckily the vast majority go according to plan. Nobody should have this surgery unless they really need it to improve quality of life (I.e. failed medication options, allergy control measures, etc).

[@enanahmedenan1626]

which technique will be better for one side nose obstruction after septoplatsy operation...one of my ent doctor suggest SMD.....other one suggest microdivider

[@snotdoctx8742]

I always steer towards removing bone via incision, and haven’t touched the microdebrider in years because I don’t think it does as good of a job reducing volume long term. If the turbinate was already reduced with bone removal and the soft tissues are the only source of obstruction, then that would be an exception when I would consider microdebrider, RFA, or laser ablation of soft tissue approaches

[@johnathanmcfadden8978]

Not sure if you will see this but he goes. I am having a balloon sinuplasty this coming Wed and am absolutely terrified because I'll be awake. Is it that bad I am more worried about feeling the needle even with the numbing cream...

[@snotdoctx8742]

@@johnathanmcfadden8978 there’s a lot of clinics doing balloon sinuplasty awake. A simple balloon of a few sinuses is feasible awake without too much discomfort as long as you don’t also have significant septal deviation. The reality is it won’t be pain free, but it is possible to numb the areas so you only feel the numbing process initially, then mostly pressure after that. Hope all goes well, if you get anxious you may want to ask for an anxiety medicine. Helps a lot!

[@johnathanmcfadden8978]

@@snotdoctx8742 Thanks. They did give me 2 Triazolams but still. I just wish they'd do it under general anesthesia for people like me.

[@purplelil5450]

If you need limited turbinate reduction as your turbinates aren't very large, can you still have traditional submucosal resection?

[@snotdoctx8742]

@@purplelil5450 If you have already tried topical nasal steroid sprays, then my next recommendation would be either nasal rinses with added medications (usually mometasone steroid and azelastine for allergy control) or for those that prefer not to continue using medications I would offer a conservative submucous resection. But I would have to agree that the turbinates are enlarged enough to cause the symptoms prior to offering the procedure. They can be evaluated by nasal endoscopy (prior to spraying decongestant) or by CT Sinus scan. They also enlarge while lying down, and I’ve seen patients where their symptoms were only present while trying to sleep. As long as the submucous resection is done carefully and sized to fit the patients needs, the outcome is improving breathing particularly while lying down at night and usually avoiding the need for nasal steroid sprays/rinses unless needed for control of other inflammatory symptoms.

[@purplelil5450]

@@snotdoctx8742 Are many of your patients who undergo submucosal resection often already had previous turbinate reductions using less invasive techniques that didn't work for them hence this approach?

[@snotdoctx8742]

@@purplelil5450 They definitely present like that on a regular basis. The problem with the less invasive techniques - they don’t remove bone well, and soft tissue that is partially reduced can grow back if allergies aren’t well controlled. They get as much relief as anyone from submucous resection with careful bone removal from within the turbinate. This yields a more permanent size reduction and makes them sit to the side of the nasal airway (I.e. makes them more compliant and further from the septum). The result is much better than with less invasive techniques, which I only use if soft tissue growth is the only source of obstruction and the bone has already been removed previously

[@purplelil5450]

@@snotdoctx8742 I've had Diathermy first then Radiofrequency coblation, both didn't work due to allergies, but radiofrequency worked for less than a month. My next try would be to try Microdebrider-assisted submucous reduction, is that a good idea? After that I'd try submucos resection

[@ps7539]

what about reducing turbinate size using laser? is that better/safer compared to radio-frequency?

[@snotdoctx8742]

Laser is a much less frequently used technique for turbinate reduction, but the availability of cheaper smaller lasers for in office use makes it appealing. I’m trying it out over the next few months and it might replace radio frequency ablation for awake turbinate procedures if I’m impressed. It’s the same concept - ablate within the soft tissue and watch it contract to reduce turbinate volume as it heals. Minimal bleeding with a laser, which is an advantage, and it can also be used in other areas within the nose to improve overall nasal breathing (reducing septal swell bodies, improving nasal valve collapse, ablating the posterior nasal nerves to reduce vasomotor drainage, reducing palate vibration and snoring, etc.). I’ll have more of a personal use-based opinion in a few months and if worthy of it I’ll make a separate video.

[@ps7539]

@@snotdoctx8742thank you for the reply. A local DR is using both techniques. I was afraid that the laser due to much higher temps, might cause worse scarring that doesn't heal as well or could make a mistake by the Dr more probable.

[@snotdoctx8742]

@@ps7539 the laser I’ve seen used for this sort of work in the office is low risk, only damages tissues when very close to the beam emitter as the beam defocuses with any distance, and should be safe. It likely causes much less heat damage to surrounding tissues compared to radiofrequency ablation, because the heat is a smaller more localized area during ablation and the laser works much faster preventing spread of heat over time. If they’re using a device such as the one I’ve seen used, safety is not compromised and is comparable or better than cautery. They will likely provide eye protection, as any laser energy can damage the sensitive nerves in the eyes.

[@papazoo1]

Hello, good info I appreciate you posting this information. I recently completed radiation therapy on the left side if my nose near the opening and now inside has healed shut except for very small openings. The ENT said I need surgery with a stent to fix it . Have you had any experience with this situation?

[@snotdoctx8742]

Depending on how much of the nostril/outer portion of the nose is involved in the scarring process, this can be a challenging problem to address. Plastic surgeons are more experienced with the grafting often required for this outside areas, and Rhinologists such as myself are well suited to handle any scarring and stenosis within the nasal cavity beyond the nostril area. I’ve corrected scars and adhesions within the nose, but not this problem specifically. If you’re near an academic center with an ENT department they might be a good bet for achieving a desirable outcome. If you’re in houston or The Woodlands, TX I’m happy to evaluate and see what you would need to correct the problem.