What is Concha Hypertrophy (Enlargement of Nasal Turbinates)?

Turbinate hypertrophy is defined as the abnormal growth of the nasal turbinates in the nose. This condition can lead to breathing difficulties. Nasal turbinates function to warm and humidify the air entering the nose. If these turbinates grow excessively, airflow is obstructed. As a result, the individual may experience breathing problems. Additionally, frequent infections and nosebleeds may occur. Common treatments for turbinate hypertrophy include medications and surgical procedures. The treatment method is determined based on the individual’s condition and the doctor’s recommendation.

Symptoms and Associated Conditions

Turbinate hypertrophy is a health issue that obstructs the airways in the nose, making breathing difficult. This condition presents itself with the following symptoms:

• Changes in the sense of smell.
• Dry mouth, especially in the morning, due to sleeping with the mouth open.
• A sensation of pressure in the forehead area.
• Mild facial pain.
• Persistent nasal congestion.
• Constant runny nose.
• Increased snoring.

These symptoms often resemble those of a persistent cold and can significantly reduce the quality of life. Turbinate hypertrophy is also associated with septal deviation. Septal deviation is a condition where the nasal septum is not straight and produces similar symptoms. If the nasal septum is not sufficiently straight, this curvature can restrict airflow and make breathing difficult. These two conditions often occur together and require detailed medical examinations for diagnosis. Doctors frequently request specialized scans, such as computed tomography, to determine the source of the problem. These scans provide detailed images of airway obstructions and structural anomalies, helping to make an accurate diagnosis.

Causes of Turbinate Hypertrophy

Turbinate hypertrophy occurs when the tissues of the nasal turbinates grow and swell. This condition can develop acutely or chronically. The most common factors causing turbinate tissue growth include environmental factors and various health issues. Continuous exposure to allergens, in particular, can cause turbinate tissues to grow as a response. This leads to airway obstruction and other symptoms that make breathing difficult. The following factors contribute to the development of turbinate hypertrophy:

• Chronic sinusitis
• Environmental irritants
• Seasonal allergies

Additionally, individuals with a family history of allergic rhinitis are more likely to develop turbinate hypertrophy. Allergic rhinitis causes constant irritation of the nasal mucosa, leading to its thickening. Hormonal changes can also affect the structure of the nasal mucosa and contribute to turbinate growth. Medications, especially with long-term or improper use, can cause changes in mucosal tissues. Lastly, infections like rhinitis and sinusitis can cause swelling and enlargement of turbinate tissues. This is a common complication associated with the common cold. Each of these factors plays a role in the development of turbinate hypertrophy and is important in determining appropriate treatment methods.

Methods to Reduce Allergens at Home

An effective strategy to reduce symptoms of turbinate hypertrophy is to minimize exposure to allergens. This involves managing allergen sources within the home environment. Several adjustments can be made at home to reduce allergens. First and foremost, it is important to reduce the amount of dust in the home. Dust triggers many allergic reactions. To achieve this, carpets, pillows, curtains, and furniture should be regularly vacuumed and cleaned.

• Pet hair can cause allergic reactions, so areas where pets are present should be cleaned frequently.
• Fabric-covered toys should be placed in the freezer for 24 hours to kill dust mites.
• Beds should be covered with dust-proof covers to protect against dust mites.

Cigarette smoke contributes to allergen accumulation indoors, so smoking indoors should be avoided. Additionally, allergens like mold and mildew multiply quickly in humid environments. These areas should be regularly cleaned with specially formulated cleaners to eliminate mold and mildew. Using high-efficiency particulate air (HEPA) filters is recommended to improve indoor air quality. These filters can significantly reduce the amount of allergens inhaled, especially when used in bedrooms. If there are pets in the home, keeping them out of specific areas like bedrooms can further reduce allergen exposure.

Medications and Home Treatment Methods

Turbinate hypertrophy involves the abnormal growth of the turbinates inside the nose. Several medications and home treatment methods are available to alleviate this issue. These treatments are important in addition to reducing allergens at home. Firstly, antihistamines for allergies can be used. These medications reduce the body’s response to allergens, making it easier to breathe.

• Medications containing cetirizine or loratadine alleviate symptoms caused by seasonal allergies.
• Oral decongestants containing pseudoephedrine or phenylephrine provide temporary relief from nasal congestion, though they may not be suitable for individuals with high blood pressure.

Additionally, nasal decongestant sprays can be used to reduce nasal swelling. These provide rapid relief, especially in acute cases.

• Nasal sprays temporarily reduce swelling but are not recommended for long-term use.

Effective use of these medications helps control symptoms and improve the individual’s daily quality of life. Particularly, antihistamines and decongestants are effective in managing the congestion and other bothersome symptoms caused by turbinate hypertrophy. However, the choice and duration of medication should be adjusted according to the individual’s health condition and doctor’s recommendations.

Surgical Treatment Options for Turbinate Hypertrophy

Surgical methods play an important role in treating turbinate hypertrophy. Surgical options vary based on the severity of symptoms and the patient’s overall health condition. Here are the three most common surgical treatment methods:

• Inferior Turbinate Bone Resection (ITBR): This method involves removing part of the bone structure of the lower turbinates to widen the airway.
• Partial Inferior Turbinectomy (PIT): This operation removes part of the soft tissue of the turbinates.
• Submucosal Diathermy (SMD): This procedure uses heat energy to reduce the size of the soft tissue of the turbinates.

Each of these turbinate surgeries aims to improve nasal airflow to alleviate symptoms. Doctors take care to remove only the necessary amount of tissue, preserving the functionality of the turbinates. Complete removal of the turbinates can lead to a condition known as “empty nose syndrome,” where the patient experiences constant dryness and nasal congestion. Therefore, a careful balance must be maintained during surgical interventions. Your doctor will consider these factors when recommending the most appropriate surgical method. Choosing the correct surgical technique is crucial for achieving a good surgical outcome.

Potential Complications of Turbinate Hypertrophy

If left untreated, turbinate hypertrophy can lead to serious health issues. This condition causes increased nasal congestion, making it difficult for the individual to breathe. Particularly at night, congestion reduces sleep quality and prevents restful sleep. Such sleep disturbances can significantly affect daily productivity. Breathing problems can lead to constant fatigue and decreased energy. Additionally, turbinate hypertrophy often sets the stage for frequent sinus infections. Infections can lead to the following complications:

• Headaches
• A feeling of pressure in the face
• General fatigue

These health issues can lead to a decline in work or school performance. Difficulty breathing and frequent infections negatively impact the individual’s social and professional life. Therefore, early diagnosis and effective treatment of turbinate hypertrophy are of great importance.

Definition and Effects of Empty Nose Syndrome

Empty nose syndrome is a condition that occurs in some individuals following nasal surgeries and negatively affects the breathing process. This syndrome arises particularly when internal nasal structures are removed or altered during surgery. Post-surgery, the reduction of tissues inside the nose abnormally increases airflow. This increased airflow causes the individual to feel insufficient air movement within the nose.

Individuals typically feel as if their nose is empty, which creates a constant sense of discomfort. These changes in breathing can lead to various health problems:

• Disruptions in sleep patterns
• Chronic fatigue
• Psychological effects such as anxiety and stress

Symptoms of empty nose syndrome include:

• Excessively dry nose
• A constant feeling of nasal congestion
• Difficulty breathing

Treating this syndrome can be challenging because standard treatment methods are often insufficient to alleviate symptoms. Doctors generally recommend supportive treatments to manage symptoms. Here are

some of these methods:

• Humidifiers
• Saline sprays
• Special nasal strips

Indicators of Empty Nose Syndrome

This health issue manifests with various symptoms that make breathing difficult and lower the quality of daily life. Individuals usually experience dryness and irritation in their nose, stemming from inadequate moisture in the nasal mucosa. Additionally, reduced airflow makes it difficult to breathe comfortably through the nose.

Symptoms include:

• Difficulty breathing through the nose
• Recurrent choking sensation
• Shortness of breath and a need for rapid breathing
• Nasal dryness and crusting
• Frequent headaches
• Nosebleeds
• Overall reduced airflow
• Dizziness
• Reduced sense of smell and taste
• Decreased mucus production
• Thick mucus dripping back into the throat
• Palpitations
• Swelling and pain in the nasal area
• Fatigue, especially related to disrupted sleep patterns
• Anxiety and depression
• Difficulty concentrating on daily tasks

These symptoms are commonly observed in individuals diagnosed with empty nose syndrome. Particularly, nasal dryness and crusting, combined with a lack of mucus, cause significant discomfort in the nasal mucosa. These symptoms negatively impact the social and psychological health of patients. Therefore, it is important for individuals experiencing these symptoms to seek medical help to improve their condition.

Causes of Empty Nose Syndrome

Empty nose syndrome is a complication observed in some patients following nasal surgeries. It particularly occurs after septoplasty and turbinate reduction procedures. This syndrome is related to the disruption of pressure and temperature perception in the nasal cavities. Here are the factors leading to empty nose syndrome:

• Pressure and Temperature Perception: Surgical procedures can affect the pressure and temperature receptors inside the nose. These receptors are typically found in the turbinates. Damage to these receptors during surgery makes it difficult for the individual to feel their breathing.
• Increased Air Volume: The expansion of the nasal cavity post-surgery increases the amount of air passing through the nose. This further worsens the ability to sense airflow.
• Changes in Nasal Mucus: The nasal mucus can also be damaged during the surgical procedure. Mucus plays an important role in maintaining the balance of beneficial bacteria in the nose.

Consequently, these changes in nasal mucus post-surgery:

• Decrease in beneficial bacteria
• Increase in harmful bacteria

When harmful bacteria multiply and colonize within the nose, the symptoms of empty nose syndrome worsen. This condition leads to serious discomfort that makes nasal breathing difficult and negatively impacts the individual’s overall quality of life.

Diagnostic Methods for Empty Nose Syndrome

Empty nose syndrome is not yet widely recognized as a medical condition. Therefore, standardized diagnostic methods are still being developed. Diagnosis is based on the individual’s symptoms and CT scan results. Firstly, doctors evaluate the symptoms.

In addition to the symptoms, doctors examine the information obtained from the CT scan. The CT scan reveals whether the structures inside the nose, called turbinates, are damaged. The presence of damage strengthens the likelihood of empty nose syndrome.

What to Look for in a CT Scan:

• Abnormalities in turbinate structures
• Enlarged nasal passages

Lastly, airflow tests are conducted. These tests measure the speed of airflow inside the nose. A low airflow rate could be an indicator of empty nose syndrome. However, this condition can also be confused with other respiratory problems. Therefore, before making a diagnosis, the individual’s overall respiratory health should be thoroughly evaluated.

These steps are critical for accurately diagnosing empty nose syndrome. Each step helps to better understand the condition and determine the correct treatment method.

Treatment Methods for Empty Nose Syndrome

This health issue increases nasal airflow while also causing a range of uncomfortable symptoms. Treatment is generally planned to alleviate symptoms and improve quality of life. Various treatment options are available for affected individuals. These options include:

• Using humidifiers to keep the nasal passages moist at home.
• Living in warm and humid climates, especially in areas with salty air.
• Using nasal sprays containing antibiotics to kill harmful bacteria in the nose.
• Applying hormonal creams inside the nose to increase the size of the remaining turbinate tissue.
• Taking medications such as phosphodiesterase inhibitors, which can temporarily increase nasal congestion.
• Surgically placing volume-increasing materials inside the nose.

The treatment options are recommended by the doctor based on the individual’s overall health and the severity of symptoms. The suggested treatments help control symptoms and contribute to improving nasal function. Each treatment method offers specific advantages and can be tailored to individual needs. The key is to focus on how the treatment will improve the individual’s quality of life and alleviate symptoms.

Prof. Dr. Murat Topdağ

KBB ( Kulak Burun Boğaz)  Doktoru Prof. Dr. Murat Topdağ, 1978 yılında Malatya’da doğmuştur. Cerrahpaşa Tıp Fakültesi İngilizce Bölümü’nden mezun olduktan sonra, 2004-2009 yılları arasında Kocaeli Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Anabilim Dalı’nda uzmanlık eğitimini tamamlamıştır. 2017’de Acıbadem Altunizade Hastanesi’nde görev yapmaya başlamıştır.. 2022 yılından itibaren İstanbul Kadıköy’de bulunan kendi kliniği MD ENT İstanbul’da da hastalarına hizmet vermektedir.