Obstruction on one side
One half of the nose breathes worse, especially if the cavity is large.
CONDITION / CARRY
Conch bulosa.
Concha bullosa is an air cavity inside the middle concha. It is present in about a third of people and mostly does not interfere with anything; operate only when the enlarged shell makes breathing difficult or causes pain.
CONCEPTUAL VISUALIZATION- what is it
- An air cavity in the middle turbinate is a structural feature, not an inflammation.
- How often
- According to a meta-analysis of 37 studies (16,753 people), concha bullosa is present in approximately 36% of people.
- Whether to treat
- Only if there are complaints: congestion, pain, impaired sense of smell. An incidental finding on a CT scan does not require treatment.
- Who treats
- ENT surgeon; the operation is performed endoscopically, through the nostrils.
01 / WHAT IS ITWhat is
What is
conch bulosa.
In the nose on each side there are three nasal turbinatess - bony plates covered with a mucous membrane. They warm and humidify the air. Conch bullosis is a condition where an air cavity forms inside the middle shell, like in a sinus.
The cavity can be small - only in the upper part of the sink, or it occupies the entire sink. Most often there are small variants; the bulbous form, when the air is only in the lower part of the shell, is the rarest.
In itself, concha bullosis is a structural variant, not a disease. Problems arise when the enlarged concha narrows the nasal passage and presses on the septum.
This is general information. Whether you need treatment, the doctor will tell after the examination and CT scan.
02 / SIGNSHow the
How the
conch bulosa manifests itself.
More often than not: conch bullous is found accidentally on a CT scan made for another reason. Complaints appear when the shell is large.
Pain in the area of the nose and eyes
The sink can touch the septum and cause a throbbing headache.
Deterioration of smell
An enlarged concha prevents air from reaching the upper parts of the nose.
Distortion of the septum
It is often combined with a bullous conch — the septum deviates in the opposite direction.
Deviation of the nasal septum, in particular after an injury03 / REASONSWhy does this
Why does this
happen.
Bullous conch is a feature of the development of the air cavities of the skull. Its frequency varies in different regions: from 31% in Asia to 47% in Europe.
Anatomy
The air cells of the ethmoid "enter" the middle shell. In one CT study of 3133 people, the mean concha bullosa was 44.74%.
Both sides or one
Unilateral (21%) and bilateral (17%) forms occur approximately equally often.
Partition
Concha bulosa occurs more often with curvature of the septum, mostly on the opposite side: it was found in 45.34% of people with curvature, in 18.95% without it.
Children
It also occurs in children - in 39.8% of those who had a head CT scan, more often after 4 years.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Concha bullosis is not an emergency. You should go to the doctor if your nose is not breathing well on one side for a long time, you have a headache in the area of your nose and eyes, or your sense of smell has worsened. Studies do not confirm the connection of conch bulosa with sinusitis, so the cause of the complaints is investigated separately.
103 immediately if:
- swelling of the eyelids, double vision or deterioration of vision against the background of a runny nose;
- severe headache with high temperature and stiff neck.
See a doctor in the coming days if:
Pain in the area of the face with temperature and purulent discharge does not go away in a few days or intensifies. If congestion and headaches last for months, make an appointment for a scheduled consultation.
05 / DIAGNOSTICSHow it
How it
is detected.
- Nasal endoscopy
The doctor examines the nasal passages with a thin camera and sees an enlarged middle concha.
- CT scan of the sinuses
Confirms the air cavity in the shell, shows its size and the condition of the sinuses.
- Evaluation of the partition
They check for distortion, which often accompanies conch bullous.
- Communication with complaints
It is important to understand whether it is the sink that is causing the blockage or the pain - this will determine whether surgery is needed.
06 / TREATMENTHow to treat
How to treat
conch bulosa.
If the conch shell does not bother you, you do not need to treat it. Medicines do not change the shape of the shell, therefore, if the shell is the cause of the complaints, it is corrected by surgery.
01
Endoscopic surgery
Through the nostrils, without incisions on the face.
- Lateral laminectomy
- The surgeon removes the side wall of the "inflated" shell, preserving its base. In a randomized study (30 patients), this method was better than crushing the shell.
- Crushing the shell
- The cavity is compressed with a special tool. Breathing, smelling, and feeling improved in all study groups.
- Partial techniques
- In a review of 14 studies of sinus surgery, partial intervention on the middle turbinate was likely to produce a better outcome than preservation of the turbinate without intervention and may improve olfaction.
02
Along with other operations
- With septoplasty
- If there is also a curvature of the septum, both problems are corrected in one operation. In a study of 119 patients after functional septorhinoplasty, those who had the concha bullosa removed at the same time had more complaints before the operation and stronger improvement after.
- With a headache
- When pain is caused by contact of the shell with the septum, endoscopic surgery in a summary of 978 patients reduced pain from an average of 7.3 to 2.7 points out of 10.
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
At the Dr. Valikhnovsky's Institute of Surgery, concha bulosa is operated in the "New Nose" direction - endoscopically, along with correction of the septum, if it is needed.
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
- Resection of the bullous middle shell — endoscopically, through the nostrils.
- Endoscopic septoplasty — if concha bulosa is combined with curvature of the septum.
- Vasotomy and conchotomy of the lower shells — if the congestion is strengthened and the lower shells are enlarged.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
How is the treatment in us
- ConsultationTalking about complaints and endoscopy of the nose.
- CT scan of the sinusesConfirms the bullous conch and shows the condition of the septum and sinuses.
- PlanThe doctor explains whether the complaints are related to the sink and whether the operation is necessary - separately or together with septoplasty.
- OperationEndoscopic resection of the shell through the nostrils.
- RecoverySwelling in the nose passes gradually; the doctor will explain what is possible and what should be avoided after the operation.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
Is conch bulosis a disease?
No, this is a variant of the structure of the nose: according to a meta-analysis, it is present in about 36% of people. Treatment is needed only when it causes complaints.
Can concha bullosa cause sinusitis?
Studies do not confirm this: studies on 296 and 206 patients did not find a significant connection between concha bullosa and sinusitis. Therefore, the cause of sinusitis is sought separately.
Is it possible to cure concha bullosis without surgery?
No. Medicines can reduce swelling of the mucosa, but the air cavity in the bone remains. If there are no complaints, there is no need to treat.
Do you have a headache from conch bulosa?
Maybe if the sink touches the partition. After endoscopic surgery, such pain in a summary of data of 978 patients decreased on average from 7.3 to 2.7 points out of 10.
Will the shape of the nose change after surgery?
No. The operation is performed inside the nose through the nostrils, the external shape does not change.
Does concha bullosis occur in children?
Yes: in a study of 384 children, it was 39.8%, more often after 4 years.
Sources
10 sources · reviews, guidelines and studiesShowCollapse
- Meta-analysis of concha bullosa anatomy with emphasis on Middle Eastern and Asian populationsFolia Morphologica, 2026doi:10.5603/fm.110966 ↗
- The incidence of concha bullosa: a retrospective radiologic studyEuropean Archives of Oto-Rhino-Laryngology, 2023doi:10.1007/s00405-022-07552-y ↗
- Prevalence of concha bullosa in a pediatric populationInternational Journal of Pediatric Otorhinolaryngology, 2024doi:10.1016/j.ijporl.2024.112108 ↗
- Relationships among concha bullosa, nasal septal deviation, and sinusitis: Retrospective analysis of 296 casesEar, Nose & Throat Journal, 2016pubmed.ncbi.nlm.nih.gov/27929597 ↗
- Concha bullosa, nasal septal deviation and paranasal sinusitis; a computed tomographic evaluationB-ENT, 2014pubmed.ncbi.nlm.nih.gov/25654953 ↗
- Concha bullosa and septal deviationEuropean Archives of Oto-Rhino-Laryngology, 2010doi:10.1007/s00405-010-1228-9 ↗
- Surgical Treatment of Concha Bullosa: A Comparison of the Short-term Results of Crushing and Lateral Laminectomy with and without Mucosal PreservationIndian Journal of Otolaryngology and Head & Neck Surgery, 2024doi:10.1007/s12070-023-04462-1 ↗
- Effect of Functional Septorhinoplasty with Concha Bullosa Resection on Sinonasal SymptomsLaryngoscope, 2023doi:10.1002/lary.30428 ↗
- Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysisEuropean Archives of Oto-Rhino-Laryngology, 2021doi:10.1007/s00405-021-06724-6 ↗
- Efficacy and safety of middle turbinate surgery: a systematic reviewEuropean Archives of Oto-Rhino-Laryngology, 2024doi:10.1007/s00405-024-08825-4 ↗
The figures on the page are from these sources.
The nose breathes
worse on one side?
Describe the complaints or send a CT scan if you have one. The doctor will tell if they are related to the shell and if surgery is needed.