Turbinate Reduction

What the turbinates do, and why size matters

The turbinates sit on the side wall of each nasal passage, and they humidify inhaled air. Allergy or chronic inflammation can enlarge them, which is called turbinate hypertrophy, and an enlarged turbinate narrows the airway.

Reduction lowers their bulk while preserving mucosa, the lining that does the humidifying. Turbinates are reduced rather than taken out, because removing them wholesale creates its own problems.

Their size cannot be judged from a photograph, and the operation is done for airflow, not appearance.

Medical treatment first, then an examination

Obstruction is a symptom, not a diagnosis, and more than one cause is usually present. Which cause is which is settled at examination, not from a photograph.

• A speculum or endoscope in each passage, repeated after a decongestant. What improves was swelling; what stays narrow is structural.
• The side wall watched on a deep breath in, since valve collapse shows only on inspiration.
• A Nasal Obstruction Symptom Evaluation, or NOSE, score recorded as a baseline.

The NOSE scale was validated in 2004 in Otolaryngology-Head and Neck Surgery. Five items are scored from 0 to 4 each. The total is multiplied by 5, and higher means more blocked.

The score is subjective and does not show where the narrowing sits, so it never replaces examination.

Specialty society guidance puts valve repair at 12 weeks or more of persistent moderate to severe obstruction, after counselling on non-surgical options. That threshold is written about the nasal valve rather than the turbinates.

Why reduction is usually added to another operation

Turbinate reduction is usually added to another procedure rather than performed on its own. Septal surgery is one such operation, because a septum and turbinates can both narrow the same nose.

Treating one cause while another persists leaves the person blocked. That is the argument for having the septum, the turbinates and the nasal valve examined at one appointment. Where the outside is reshaped as well, the operation is a septorhinoplasty.

The randomised evidence in this area is about the septum, not the turbinates. The NAIROS trial in the BMJ in 2023 randomised 378 adults with septal deviation and a NOSE score above 30 to septoplasty or to a nasal steroid and saline.

The trial reported its harms alongside that benefit:

• Seven patients, 4 per cent, were readmitted with bleeding.
• Antibiotics were required by 20 patients, 12 per cent.

What happens when too much is taken

A surgeon reduces rather than removes because the tissue was doing a job, humidifying the air that passes over it.

Breathing difficulty is itself a recognised risk of nasal surgery, usually temporary but occasionally lasting. That risk is the argument against operating where examination finds nothing structural to correct.

Surgery does not cure allergy. Where allergy enlarged the turbinates, allergic patients often still need their spray afterwards.

How long breathing takes to improve

Breathing usually feels worse before it feels better, because the lining is swollen from surgery.

1. First 10 to 14 daysThe nose is commonly blocked on both sides, from swelling, splints or dressings.
2. Around week 1Splints or dressings are typically removed.
3. Weeks 1 to 2Most people take one to two weeks off work. Flying is commonly discouraged for around 14 days.
4. Up to 3 monthsPublished UK ENT patient guidance notes breathing can take up to three months to become clear.

Judge the result by repeating the obstruction score months later, not by how the nose feels on a given morning. The day by day timeline covers the rest.