Constant congestion
The nose breathes poorly in both halves or alternately, especially when lying down.
CONDITION / CARRY
Hypertrophy of nasal turbinates.
Hypertrophy of the nasal turbinates is an increase in the lower concha, due to which the nose is constantly blocked. If drugs do not help, the shells are reduced surgically - by vasotomy or conchotomy, mostly preserving the mucous membrane.
CONCEPTUAL VISUALIZATION- what is it
- Enlargement of the lower turbinates due to swelling or growth of the mucous membrane, less often - bones.
- How often
- Nasal congestion is one of the most frequent complaints of both family doctors and ENT specialists.
- When to operate
- If congestion does not go away after treatment of rhinitis.
- Who treats
- ENT doctor; the operation is performed through the nostrils, without incisions on the face.
01 / WHAT IS ITWhat is
What is
concha hypertrophy.
The lower turbinates are ridges on the side walls of the nose, covered with a mucous membrane with a dense network of vessels. They warm and moisten the air and regulate its flow: normally, they alternately swell a little on one side, then on the other.
With hypertrophy, the shells increase constantly. Most often - due to chronic swelling of the mucous membrane in rhinitis, over time - due to tissue growth, which is no longer reduced by drops.
The concha is not surgically removed, but reduced: modern methods preserve the mucous membrane, because it moistens the air and cleans the nose.
This is general information. The doctor will tell you after the examination whether you need an operation.
02 / SIGNSHow is
How is
hypertrophy manifested.
The main symptom is congestion that does not go away. Nasal congestion is the leading symptom of persistent allergic rhinitis.
Mouth breathing
At night and during exercise, you have to breathe through your mouth, in the morning - dry mouth.
Snoring
Narrowed nasal passages increase snoring.
Getting used to the drops
Vasoconstrictor drops help worse and worse and for a shorter time.
Vasomotor rhinitisMucus and runny nose
Mucus runs down the throat or flows from the nose, more often with rhinitis.
03 / REASONSWhy the turbinates
Why the turbinates
increase.
Nasal congestion can have anatomical, physiological, or neurological causes—often several at the same time.
Allergic rhinitis
Year-round allergies keep the mucous membrane of the shells constantly swollen.
Non-allergic rhinitis
The mucous membrane overreacts to cold, smells, weather changes, although there is no allergy.
Vasomotor rhinitisThe structure of the nose
A curved septum narrows one nasal passage, and congestion increases.
Distortion of the septumLong run
Over the years, tissue growth is added to the swelling, which is no longer reduced by medication.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Hypertrophy of shells does not require emergency care. But congestion that lasts for weeks is a reason to see an ENT doctor: it can be caused by other conditions, such as polyps or a deviated septum.
103 immediately if:
- nose bleeding does not stop after 15 minutes of pressing;
- swelling of the eyelids or deterioration of vision against the background of a runny nose.
See a doctor in the coming days if:
Only one side is obstructed and bloody discharge appeared from it, or the obstruction is accompanied by pain in the face and temperature. If your nose has been breathing badly for a long time, make an appointment for a scheduled consultation.
05 / DIAGNOSTICSHow to determine the
How to determine the
cause.
- Examination and endoscopy
The doctor evaluates the size of the shells, the condition of the mucous membrane and septum.
- Sample with drops
If, after vasoconstrictor drops, the shells noticeably decrease, swelling prevails; if not, tissue growth.
- Allergy
If necessary, an allergy test to treat the cause of the swelling.
- CT scan if necessary
If it is necessary to evaluate the septum, bony base of shells or sinuses.
06 / TREATMENTHow to treat
How to treat
hypertrophy.
Rhinitis, which causes swelling, is treated first. Surgery is offered when the blockage persists despite treatment.
01
Reduction of sinks
In a review of 62 studies, all techniques reliably improved nasal breathing.
- Vasotomy
- Under the mucosa, part of the vessels and tissue are destroyed, the shell shrinks and becomes less swollen. The mucosa remains intact.
- Conchotomy with a microdebrider
- A rotating instrument under the endoscope removes excess tissue under the mucosa. In a meta-analysis of 7 randomized trials, this method gave a better long-term result than radiofrequency; another review found no difference between them.
- Radio frequency, laser, coblation
- Other ways to reduce the sink. According to the results, they are close; coblation in one study was less painful than microdebrider.
02
What to expect
- When the result is visible
- Breathing improves most 3-6 months after surgery.
- Placebo effect
- In a randomized trial with a simulation of surgery, improvements were felt even after it, but the real techniques gave significantly more.
- Duration of effect
- Over the years, the effect may weaken.
03
Security
- Save the mucosa
- Methods without preserving the mucous membrane often cause bleeding, crusting and pain, so gentle ones are preferred.
- "empty nose" syndrome
- A rare late complication after complete or almost complete removal of shells. Therefore, the shells are not removed, but only reduced.
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
Hypertrophy of the nasal turbinates is treated at Dr. Valikhnovsky's Institute of Surgery in the direction of "New Nose" - together with the correction of the septum, if it also interferes with breathing.
DIRECTION TO THE CLINIC
A new nose
Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors.
Go to direction
What do we do in this condition
- Vasotomy of the lower shells — reduction of the shell while preserving the mucous membrane.
- Shaver conchotomy under an endoscope — cleaning excess tissue with a rotating tool through the nostrils.
- Septoplasty with vasotomy — if blockage is caused by both sinks and a curved partition.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
How is the treatment in us
- ConsultationA conversation about complaints, endoscopy of the nose, a test with drops.
- ExaminationCT scan if necessary.
- PlanWhat to reduce - the sinks, the partition or both - and how.
- OperationThrough the nostrils, without incisions on the face.
- RecoveryReviews after surgery; what is possible and what should be avoided, the doctor will explain individually. The greatest improvement in breathing is usually seen after 3-6 months.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
What is a vasotomy?
An operation during which part of the vessels and tissue are destroyed under the mucous membrane of the nasal turbinates. The concha shrinks and swells less, and the mucous membrane that moistens the air remains intact.
Is it possible to do without surgery?
Yes, if the congestion causes swelling, which is reduced by rhinitis treatment. Surgery is offered when treatment does not help.
Which method is better?
In a review of 62 studies, all techniques improved breathing. In a meta-analysis of 7 randomized trials, microdebrider had a better long-term outcome than radiofrequency, although another review (6 trials) found no difference between the two. The method is chosen based on the review.
When will the result be visible?
The greatest improvement is 3-6 months after surgery, when the swelling subsides and the mucosa heals.
What is "empty nose" syndrome?
A rare complication after complete or almost complete removal of conchas: the nose feels blocked, although the passages are wide, dryness and crusts appear. To avoid it, the shells are only reduced.
Can it be combined with septoplasty?
Yes. If the septum is crooked, it is straightened and the sinks are reduced in one operation.
Sources
9 sources · reviews, guidelines and studiesShowCollapse
- Systematic Review of Surgical Interventions for Inferior Turbinate HypertrophyAmerican Journal of Rhinology & Allergy, 2023doi:10.1177/19458924221134555 ↗
- Outcomes of microdebrider-assisted versus radiofrequency-assisted inferior turbinate reduction surgery: a systematic review and meta-analysis of interventional randomised studiesRhinology, 2020doi:10.4193/Rhin19.350 ↗
- A prospective, randomized, placebo-controlled study of inferior turbinate surgeryLaryngoscope, 2018doi:10.1002/lary.27103 ↗
- Inferior turbinate reduction; coblation versus microdebrider — a prospective, randomised studyRhinology, 2014doi:10.4193/Rhino13.183 ↗
- Surgical Management of Turbinate HypertrophyOtolaryngologic Clinics of North America, 2018doi:10.1016/j.otc.2018.05.008 ↗
- Surgical Interventions for Inferior Turbinate Hypertrophy: A Comprehensive Review of Current Techniques and TechnologiesInternational Journal of Environmental Research and Public Health, 2021doi:10.3390/ijerph18073441 ↗
- Chapter 2: Nasal obstructionAmerican Journal of Rhinology & Allergy, 2013doi:10.2500/ajra.2013.27.3889 ↗
- Empty nose syndromeCurrent Allergy and Asthma Reports, 2015doi:10.1007/s11882-014-0493-x ↗
- Management of Postsurgical Empty Nose SyndromeFacial Plastic Surgery Clinics of North America, 2019doi:10.1016/j.fsc.2019.07.005 ↗
The figures on the page are from these sources.
Breathing through the nose is
normal.
Describe how long you have had a blocked nose and what you have already tried. The doctor will tell whether the treatment of rhinitis will help, or whether it is necessary to reduce the shells.