Turbinate hypertrophy means the shelves of tissue along the side wall of your nose, the turbinates, have become persistently enlarged, so they take up space that should be airway. It is one of the commonest causes of a persistently blocked nose, and it is the usual explanation when the septum is straight yet the nose still will not clear, or when septal surgery alone has not fixed the blockage.
The enlargement comes in two forms that behave completely differently. Mucosal hypertrophy, where the soft tissue lining is swollen, shrinks with a decongestant and often responds to medication. Bony hypertrophy, where the bony core itself is enlarged, does not shrink with anything, and no spray will touch it. Telling these apart is the entire basis of deciding what to do, and it takes about two minutes in clinic.
I want to deal with one question up front, because it is the commonest one I hear about enlarged turbinates: can they simply be taken out? They can. It is the fastest way to open a nose, and it is one of the worst operations you can have done to you. I will explain why further down, because the reason tells you almost everything about how this surgery should actually be done.
What do the turbinates actually do?
Your turbinates are three pairs of scroll-shaped ridges running along the side wall of each nasal passage. There are superior, middle and inferior turbinates on each side, and between them they occupy a surprising amount of the nasal cavity. They are not spare tissue. They warm incoming air to body temperature, humidify it to near saturation, filter particles, and generate most of the sensation of airflow that tells your brain you are breathing properly.
That last function is the one people discover only when it is gone.
The inferior turbinates are the largest and the ones that cause most of the trouble. Each has a bony core wrapped in soft tissue full of blood vessels, and that mucosa is designed to swell and shrink, which is how your nose regulates airflow and conditions air. The middle turbinates sit above them and matter far less for blockage, but they lie right beside the point where the sinuses drain, which is why sinus disease and turbinate swelling so often travel together.
What causes enlarged turbinates?
Turbinates become enlarged for a handful of reasons, and more than one is usually in play.
Allergy. Allergic rhinitis, from chronic exposure to house dust mite, pollen or pets, keeps the tissue permanently swollen. The commonest cause by a distance. In children it is usually allergy too, though a persistently blocked nose in a child is more often the adenoids, and that is where the assessment should start.
Non-allergic rhinitis. Same appearance, negative allergy tests. Triggered by temperature change, strong smells, alcohol, or certain blood pressure medications.
Chronic rhinosinusitis. Long-standing inflammation of the nose and sinuses keeps the turbinate mucosa swollen, and that swelling then narrows the very channels the sinuses drain through, so the problem feeds itself. If repeated sinus infections, facial pressure and a dulled sense of smell come alongside the blockage, the turbinates are one part of a bigger picture rather than the whole of it, and treating them alone will disappoint you. Nasal polyps sit at the far end of the same inflammatory spectrum.
Hormonal change. Oestrogen and progesterone act directly on nasal mucosa. Rhinitis of pregnancy is common, tends to appear in the second half of pregnancy, and settles within a few weeks of delivery, which is precisely why nobody should be operating on it. Saline and sleeping propped up will get you through it, and decongestant sprays are the thing to avoid. An underactive thyroid and the combined contraceptive pill can do something similar.
Rebound from decongestant sprays. Xylometazoline and oxymetazoline, used beyond about a week, cause the tissue to swell harder as each dose wears off. Long-term users develop genuinely enlarged, boggy turbinates. This is reversible, and it is the first thing to unpick before anyone considers surgery.
Compensatory hypertrophy. This one is underappreciated. If your septum is deviated to the left, the right side has extra space, and the right turbinate grows to fill it. That is a normal adaptive response, not a disease. It also explains why some people feel blocked on both sides for two different reasons, and why correcting only the septum can leave them disappointed.
What does turbinate hypertrophy feel like?
The symptoms of turbinate hypertrophy overlap with every other cause of a blocked nose, so the pattern matters more than any single complaint.
Blockage on both sides that varies, worse lying down, worse in the mornings, and often alternating from side to side. That alternation is the nasal cycle at work: the two sides of a healthy nose take turns to congest and decongest over a period of hours, which is why one nostril often feels more blocked than the other at any given moment. You are not normally aware of it, because the open side carries the airflow. Enlarged turbinates leave so little spare room that the cycle becomes something you feel, side to side, all day. Frequently there is a runny nose and post-nasal drip alongside. Sprays help somewhat but never quite enough.
That is only part of it. People describe difficulty breathing through the nose during exercise, mouth breathing overnight with a dry mouth and a sore throat on waking, snoring, broken sleep, a dulled sense of smell and taste, and a low background pressure across the cheeks and forehead. Reducing the turbinates can improve snoring by restoring nasal airflow, though it is not a treatment for obstructive sleep apnoea, which needs its own assessment. Smell that returns with a decongestant is a good sign, because the odour molecules were simply being blocked from reaching the olfactory area high in the nose. Smell lost for months without much blockage is a different problem and needs assessing separately. Crusting and the occasional nosebleed are common once the lining has been dry and irritated for months. None of it is dangerous in itself. All of it grinds down quality of life, which is the honest reason most people end up in my clinic.
The variability is the clue. A deviated septum is boringly consistent. Turbinates swell and shrink, so the blockage moves.
How is turbinate hypertrophy diagnosed?
Diagnosis is made in clinic, not on a scan. I look inside with a flexible camera, a nasal endoscopy that takes seconds, then spray a decongestant, wait a few minutes, and look again.
That before-and-after comparison answers everything. Turbinates that shrink dramatically are mucosal, and they will very likely respond to medical treatment. Turbinates that barely change are bony or fibrotic, and no spray will fix them.
Doing this properly is why I am reluctant to operate on anybody who has not had it done. Operating on a turbinate that would have responded to a correctly used spray is unnecessary surgery. Most people have already seen a doctor and been handed a spray long before they reach me, which is exactly why I want to know how they have been using it.
I am also looking for the conditions that masquerade as this one, because nasal obstruction rarely has a single cause. A deviated nasal septum is the obvious one. Nasal valve collapse, where the side wall draws inwards as you breathe in, is the one most often missed, and reducing turbinates will do nothing for it. If the history points to sinus disease, polyps, or something odd on one side only, a CT scan answers that and nothing else will.
Can enlarged turbinates be treated without surgery?
Very often, yes, and this is where treatment starts, in order.
Stop any decongestant spray. If you have been using one for more than a week, this comes before everything. Expect a difficult fortnight.
Saline rinses, large volume, daily.
A steroid nasal spray, used correctly, for eight weeks. This is the mainstay of medical treatment and it is almost always used badly. Head tilted slightly forward, aimed outwards towards the cheekbone on the same side, opposite hand, no hard sniff afterwards. Most people aim it at the septum, which achieves nothing and causes nosebleeds.
Treat any allergy properly. That means allergy testing, either skin prick testing or specific IgE blood tests, rather than guessing, because avoidance, antihistamines and immunotherapy are different answers to different results. If your allergies stay untreated, the swelling comes straight back.
These treatments take weeks rather than days to show what they can do, and stopping at a fortnight is the commonest reason people conclude that nothing works. Only if all of that fails does surgery come into it. I have set out the full non-surgical picture, which applies equally here, in can you fix a deviated septum without surgery.
What does turbinate reduction surgery involve?
The principle of modern turbinate surgery is to reduce the size of the turbinate while preserving the surface lining. The lining is what conditions the air and generates airflow sensation. Destroy it and you cause a permanent problem. All of the sound options are performed as day surgery, and each is a short procedure measured in minutes of surgical time rather than hours.
Submucous diathermy or radiofrequency reduction. A probe is passed inside the turbinate and energy applied to shrink the tissue from within, leaving the surface intact. Quick, often done under local anaesthetic, low risk. The effect can wear off over a few years and it can be repeated.
Microdebrider-assisted turbinoplasty. A powered instrument removes swollen tissue from inside the turbinate through a small incision, again preserving the surface. More durable than diathermy, and a common choice where the enlargement is substantial.
Submucous resection of the turbinate bone. Where the bony core of the inferior turbinate is the problem, the bone is removed from beneath the lining. This is the only reliable answer to genuine bony hypertrophy.
Outfracture, gently repositioning the turbinate outwards. Often combined with the above. On its own the effect tends to be modest and temporary.
Total or near-total turbinectomy. Removing the turbinate entirely. This is the one to avoid.
What is empty nose syndrome?
If too much turbinate tissue is removed, some people develop a paradoxical and distressing condition: the nose is wide open on examination and on a scan, and yet they feel permanently blocked and unable to breathe. It comes with dryness, crusting, a persistent sensation of suffocation, disturbed sleep and, in severe cases, significant psychological distress.
The mechanism is thought to involve loss of the airflow-sensing receptors and of normal air conditioning. Wide-open is not the same as breathing well, because the sensation of breathing depends on the tissue that was removed.
There is no reliable cure. Treatment is largely supportive care, with humidification and saline, and attempts at rebuilding bulk with implants or fillers give inconsistent results.
It is uncommon, and it is entirely avoidable, because it is caused by the operation. That is why every technique I use preserves the lining and reduces volume rather than removing the structure. If a surgeon offers to take your turbinates out, ask exactly how much they intend to remove and what will be left.
Why is my nose still blocked after septoplasty?
If you are weighing up which operation fits your pattern of blockage, I walk through the decision in which breathing operation do you need.
This deserves its own answer, because it is a story I hear regularly. The septum was deviated, it was corrected, the surgery went well, and the nose still blocks.
Two culprits account for most of it. The first is turbinate enlargement that was never addressed. Remember compensatory hypertrophy: the turbinate on the wider side grows to fill the space, and it does not shrink back just because the septum has been straightened. A deviated septum and enlarged turbinates usually coexist, and treating one while leaving the other is the commonest reason people describe nasal surgery as having half worked. That is why turbinate reduction is so often done at the same time as a septoplasty, and why I assess both before recommending either.
The second is nasal valve collapse, which no amount of septal or turbinate surgery will fix, because the problem is the side wall of the nose rather than anything inside it. If this is your situation, the same decongestion test in clinic sorts out which of these is responsible, and the answer determines everything that follows.
What is recovery like after turbinate reduction?
Straightforward. Some blockage and crusting for one to two weeks while the lining heals, which is worse than you expect and then settles. Most people find the first week the worst. Saline rinses several times a day make a real difference. Light activity within a few days, strenuous exercise at around four to six weeks if it was combined with septal surgery.
When turbinate reduction is combined with septoplasty, the recovery is essentially the same as for septoplasty alone, set out week by week in septoplasty recovery week by week.
Frequently asked questions
What is turbinate hypertrophy?
Turbinate hypertrophy is persistent enlargement of the ridges on the side wall of the nose, from swollen soft tissue, an enlarged bony core, or both. It causes persistent nasal congestion, mouth breathing and disturbed sleep.
Can enlarged turbinates shrink on their own?
Mucosal swelling can settle with treatment of the underlying allergy or by stopping decongestant sprays. An enlarged bony core will not.
Is turbinate reduction painful?
Not especially. Most people describe congestion and pressure for a week or two rather than pain, managed with simple analgesia.
How long does turbinate reduction last?
Radiofrequency and diathermy may need repeating after some years. Microdebrider turbinoplasty and submucous bone resection are generally more durable.
Can turbinates grow back after reduction?
The tissue can re-swell if the underlying inflammation continues untreated, which is why ongoing allergy management matters after surgery.
Will my nose be too dry after turbinate reduction?
Not in the long term, provided the lining is preserved. A reduction that preserves the mucosal lining does not cause long-term dryness, because the tissue that humidifies the air is still there. Expect temporary dryness and crusting during the first weeks of healing, which saline rinses manage well. Long-term dryness is a feature of over-resection, which is precisely what lining-preserving techniques are designed to avoid.
How much does turbinate reduction cost?
Turbinate reduction is usually performed together with septal surgery rather than alone. Septoplasty with bilateral turbinate reduction starts from £7,100, and a functional septoplasty alone from £6,000. A consultation is £250, credited towards surgery. Full details are on my pricing page.
What is empty nose syndrome?
A chronic condition following excessive turbinate removal, where the nose feels blocked despite being anatomically wide open. It is avoided by preserving the lining.
Can I have turbinate reduction under local anaesthetic?
Radiofrequency reduction often can be. More extensive turbinoplasty, and anything combined with septal surgery, is normally under general anaesthetic.
Do I need a scan first?
Not usually. Examination before and after decongestion tells me most of what I need. A CT is reserved for suspected sinus disease.
If sprays have not worked and you want to know whether your turbinates are the problem, the examination that answers it takes minutes. You can book a consultation, and if I think a properly used spray would sort you out, I will tell you that instead of booking an operation.
Mr David Whitehead is a Consultant Ear, Nose and Throat (ENT) and Facial Plastic Surgeon in London, on the GMC Specialist Register for Otolaryngology and certified by the Royal College of Surgeons Intercollegiate Board in Cosmetic Surgery. More about my training and credentials.