Turbinate Surgery

What are the turbinates?

The turbinates are lumps of tissue inside each nostril. They are also called “inferior turbinates” or “concha”

What is the function of the turbinates?

The turbinates control the flow of air through the nose. They also warm and humidify the air that we breathe and catch small particles of dust.

What problems can occur in the turbinates?

There are three main problems that may affect your turbinates:

1. The turbinates are too bulky causing blockage
2. If you have allergy (Hayfever/ Allergic rhinitis), the turbinates can swell up causing blockage
3. If you have a deviated septum, when you undergo septoplasty surgery to correct the deviation, the turbinates must be corrected at the same time, otherwise they will cause blockage.

What happens when turbinates are too big?

Big or bulky turbinates can block the nose. This can result in breathing through the mouth and snoring at night.

How can I find out if I have a problem with my turbinates?

Always see your GP first. Your GP will look inside your nose and may order some tests or prescribe some medications. Your GP may have difficulty directly seeing your turbinates without the right equipment. If your GP cannot fix your nasal problems, ask your GP for a referral to see Dr Singh.

How can Dr Singh find out if I have a problem with my turbinates?

Dr Singh is a nose and sinus specialist. Dr Singh uses special tests to find out if you have a problem with your turbinates.

What tests can Dr Singh perform?

Dr Singh will examine your nose using special instruments.

Dr Singh will pass a super-fine camera into your nose to look at the septum and turbinates (the nose is made numb first using a special numbing spray). You can watch the camera on a TV monitor and see the turbinates for yourself.

Dr Singh's in-house nurse can perform special tests to accurately measure the flow of air through your nose (Rhinomanometry and Acoustic Rhinometry) along with tests to see if you have allergy (Skin prick tests).

What other tests can be ordered?

The complete range of tests that Dr Singh or your GP may order include:

• CT scan - This can show the anatomy of your nose and sinuses. Unfortunately, CT is NOT a very accurate way to diagnose turbinate problems. Most radiologist (Xray doctor) reports UNDERESTIMATE turbinate problems. The most accurate test is to have Dr Singh examine the nose with a special camera.
• Skin prick tests - These can show if you have allergy (Allergic Rhinitis).
• Blood tests (Allergen-specific IgE/ RAST/ ImmunoCAP) - These can show if you have allergy (Allergic Rhinitis). Blood tests are not as accurate as skin prick tests but are easier to perform.
• Rhinomanometry and Acoustic Rhinometry - These scientifically measure the airflow through your nose.

Our office is unique as all of these tests can be performed on-site, in one appointment.

Despite all the tests and high-technology available, the single most accurate tool is your doctor’s skill, knowledge and experience!

Can my turbinate problem be fixed?

Yes.

Almost every case of turbinate problems can be treated.

How are turbinates treated?

See your GP if you think you have turbinate problems. Treatment options include:

• Do nothing - If the symptoms are not severe, treatment may not be necessary
• Anti-Allergy treatments (Nasal Steroid sprays, antihistamines, De-sensitisation) – Daily medications may be enough to shrink the turbinates and control the nasal blockage
• Referral to Dr Singh for surgery to the Inferior Turbinates (usually inferior turbinoplasty)

How are big turbinates treated surgically?

The turbinates are treated while you are asleep under a general anaesthetic. The turbinates are treated through the nose – there are no cuts made on the outside of the nose.

There are many different ways to treat the turbinates. Older style ways to treat the turbinates include:

• Diathermy/ Cautery (Burning the turbinates at high temperatures)
• Turbinectomy (removing all of the turbinates)
• Laser (This was trialled in the 1980s, but is no longer routinely performed as it carries high risks, is not very effective and can cause serious complications)

Dr Singh treats the turbinates using inferior turbinoplasty.

What is inferior turbinoplasty?

Inferior turbinoplasty is an operation to partially reduce the bulk of the inferior turbinates, while preserving their function.

How is inferior turbinoplasty performed?

Dr Singh performs inferior turbinoplasty while you are asleep (general anaesthesia). There are no cuts on the outside of the nose. The shape of the nose is not changed (unless you choose to undergo rhinoplasty at the same time). There is no bruising and no plaster (unless you choose to undergo rhinoplasty at the same time).

Dr Singh treats only a small part of the inferior turbinates (at the front of the turbinate in the region of the “internal nasal valve”). Dr Singh only treats the “lateral” portion, preserving the “medial” portion. This maintains normal turbinate function, while reducing bulk.

Are there any alternative treatments to surgery?

Yes. There are always options and it is always your choice as to whether to have surgery. In general, you can try other options first and choose surgery if nothing else works. Non-surgical options include:

1. Do Nothing. If your problem is not severe, you may choose not to have any treatment at all.
2. Simple treatments (Saline rinse). Try rinsing the nose 2-4 times a day with salty water from your pharmacy.
3. Medications. Try Nasal steroid sprays and antihistamine tablets/ sprays from your pharmacy or from your GP. They work best for people with allergy but may sometimes help people without allergy.

We recommend that you see your GP first and consider trying these non-surgical options. Then see Dr Singh when you are ready for surgery. There is a long waiting list to see Dr Singh and it is best if you see Dr Singh for surgery after the non-surgical treatments have failed.

Are there any risks to surgery?

Yes. Everything we do in life has risks. Even something as simple as crossing the street has risks... but we still cross the street. Dr Singh will explain the risks of your operation and provide you with an information pamphlet that explains the risks in detail. If you have any questions about risks, ask Dr Singh during your consultation.

Wait! I have read about the “empty nose syndrome” on the internet and have been told not to have inferior turbinate surgery! I’m confused…

The “empty nose syndrome” is a rare problem that can occur when the inferior turbinates are COMPLETELY removed (inferior turbinectomy). Dr Singh DOES NOT perform complete turbinectomy. Dr Singh only performs turbinoplasty. The “empty nose syndrome” does NOT occur with Dr Singh’s turbinoplasty technique, as the normal turbinate function is preserved. If you have any questions about the “empty nose syndrome”, ask Dr Singh during your consultation.

What should I do next?

See your GP. If your GP is unable to fix your nasal problems, ask your GP for a referral to see Dr Singh

I have already seen a doctor – I was told nothing could be done for my nasal problems. What should I do?

Most cases of turbinate problems can be fixed or improved. Dr Singh is a nose and sinus specialist and has expertise in difficult and complex cases.

Consider asking your GP for a referral to see Dr Singh.