Turbinate Reduction

After an evaluation by your Capitol ENT physician, you may be diagnosed with
turbinate hypertrophy as a cause of your nasal obstruction. If medical treatment has failed to relieve your symptoms, a turbinate reduction may be recommended. This is a surgical procedure designed to reduce the size of your turbinates, thereby helping you to breathe better through your nose.

This surgery is typically performed in the operating room under general anesthesia as an outpatient procedure, meaning you go home the same day as surgery. In many cases, this procedure is performed in conjunction with a septoplasty. In some instances, this procedure can be performed in the office under local anesthesia.

The goal of turbinate reduction surgery is to reduce the size of the turbinate, while preserving the lining of the turbinate, resulting in a more patent nasal airway. The turbinates normally function to warm and humidify inhaled air, and so it is important that the turbinate not be removed completely, because this can result in a very dry, crusty nose. Occasionally, turbinate tissue will re-grow after turbinate surgery, and the procedure may need to be repeated. This is preferable to the situation of removing the turbinate completely.

There are a variety of surgical techniques used to reduce turbinates, including cauterization, coblation, radiofrequency reduction, microdebrider submucosal resection, and partial resection. Cauterization, coblation, and radiofrequency reduction are techniques that rely on shrinking the turbinate tissue without removing any turbinate tissue or bone. With these methods, the turbinate tissue is heated up with a specialized device. Over time, scar tissue forms in the portion of the turbinate that was heated, causing the turbinate to shrink in size. Microdebrider submucosal resection refers to a technique where a specialized instrument is used to remove the tissue within the turbinate through a small opening while preserving the lining of the turbinate. As the turbinate heals, it will be much smaller than before surgery. Nasal packing may or may not be placed in the nose at the end of the procedure.

After surgery, the majority of patients will experience significant improvement in their symptoms. However, it does take time for the body to heal, and some patients may notice dramatic improvement immediately following surgery, while others may take several weeks before they feel substantially better. This depends on a number of factors including the extent of surgery that was done and the patient’s personal experience. Remember, it takes time for the nose to fully heal after surgery.

• Pain Some patients experience minimal pain after surgery, while others may experience significant pain for several days. You will be prescribed pain medication to help you control pain after surgery. If you are hesitant about using prescription pain medication, you can take over-the-counter Tylenol.
• Bleeding It is common to see blood-tinged nasal secretions during the first week after surgery. It is helpful to keep your head elevated and avoid blowing your nose. If you need to sneeze, it helps to sneeze with your mouth open to reduce pressure in your nose. Avoid strenuous exercise for the first 2 weeks after surgery. Also, avoid medications that can thin your blood such as aspirin, ibuprofen, Advil, Aleve, Motrin, Coumadin, plavix, herbal medications, and vitamins until cleared by your surgeon. It is NOT normal to have heavy amounts of bleeding after surgery. If you have significant bleeding that does not stop after holding pressure on your nose for several minutes, or are concerned that you are bleeding too much, call our office or on-call number immediately, or go to the closest emergency room for further evaluation.
• Nasal congestion/obstruction Some patients may notice dramatic improvement in their nasal congestion immediately after surgery, while other patients may not notice improvement for several days to weeks. After surgery, nasal congestion may be related to a number of factors including packing, crusting, and normal post-surgery swelling. Be patient, follow your post-operative care instructions, and follow up with your surgeon. It will get better.
• Fatigue It is common to feel tired in the first days to weeks after surgery. Remember to take it easy while your body is recovering.
• Return to work Plan to take some time off after surgery. Some patients will be ready to go back to work in a matter of days, while others will need 1-2 weeks to recover. This will depend on the extent of your surgery, your recovery experience, and the nature of your work. If you have a desk job, you may be able to go back to work before the end of a week, but expect to be tired and limit your work demands. If you have a job that demands strenuous labor, you may need to take as much as 2 weeks off until your body has time to heal. Be patient. If you push yourself too hard and too fast, you may risk slowing the healing process. With time, the vast majority of patients experience significant long-term improvement.
• Medications Your surgeon may prescribe medications for you take after surgery, and these may include antibiotics and pain medication. Take these as directed.
• Packing You may or may not have packing and/or splints in your nose after surgery. If you have packing, it comes in two varieties. One is absorbable and will dissolve on its own with time and regular saline irrigations. The other is not absorbable and will be removed by your surgeon at your follow-up visit. You should discuss this with your surgeon.
• Saline irrigations Your surgeon may instruct you to regularly spray or irrigate your nose with saline after surgery. These irrigations help facilitate your recovery after surgery and help to clean and moisturize your nose and sinuses.

Risks of turbinate reduction
As with any surgical procedure, turbinate reduction surgery does have associated risks. Fortunately, the risk of a complication is very small, but it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

• Bleeding Most nasal surgery involves some degree of blood loss, which is generally very well tolerated. However, very rarely, significant bleeding can occur and require termination of the procedure. Blood transfusion is rarely necessary and is only given in case of emergency. You should avoid any blood thinning medications including aspirin, ibuprofen, Advil, Motrin, Aleve, and herbal and vitamin supplements for 10 days prior to surgery.
• Persistent symptoms The goal of surgery is to improve the structural problems that are leading to your nasal blockage. A large majority of patients (over 90%) have significant improvement in their nasal obstruction symptoms after surgery. However, many different factors can impact the final outcome, and some patients may have persistent nasal obstruction after surgery. In very rare instances, patients may notice no improvement or worsening of their obstruction symptoms. Occasionally, turbinate tissue will re-grow after turbinate surgery, and the procedure may need to be repeated.
• Toxic shock syndrome This is a very rare infection that can occur in the nose, usually when packing is placed, but sometimes when no packing is used. This is a life threatening infection and requires immediate treatment. If you note a change in your blood pressure, heart rate, fever, and skin discoloration, please notify our office immediately.
• Other risks Other uncommon risks of surgery include alteration of sense of smell and/or taste, facial pain, change in the resonance or quality of the voice, and nasal dryness and/or crusting.



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