Coblation Turbinate Reduction (Turbinoplasty/Turbinectomy) for Nasal Congestion, Nasal Obstruction, & Rhinnitis

Coblation Turbinate Reduction for Nasal Congestion,
Nasal Obstruction, & Rhinnitis (www.TurbinateReduction.com)
by Fauquier ENT of Virginia • Last Modified 2/21/2009 •

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Watch Video on Turbinate Reduction

Often, people present to their ENT complaining of nasal obstruction and nasal congestion. Sometimes, these symptoms are due to allergies and at other times, they may be due to anatomical factors such as a deviated septum, adenoid hypertrophy, or turbinate hypertrophy. Though most people understand that the septum (a wall that divides the nasal cavity into a right and left side) as well as large adenoids contribute to nasal obstruction, many don't realize that turbinates also play a significant role. Normally, turbinates are tissue masses extending into the nose from the sides which warm and humidify the air we breathe (arrow in picture). Click here to watch a short movie clip showing the inferior turbinate as a scope enters the nose.

However, in many patients, the inferior turbinates become so unusually large that they contribute to not only nasal obstruction, but also:

nasal congestion and/or obstruction either all the time, that fluctuates, or worse when laying down
a persistent clear runny nose (vasomotor rhinnitis)
alternating nasal obstruction on the side one lays down on (right nasal obstruction when laying down on the right which than switches side when laying down on the left).

These symptoms are true for not only adults, but kids as well! Generally speaking, adenoids cause nasal obstruction in the back of the nose whereas turbinates cause nasal obstruction in the front aspect of the nose. The septum can cause obstruction anywhere in the nose.

The turbinates can fluctuate in size in the same individual so that nasal obstruction may vary throughout a given day and depending on the position of the head (laying down versus standing up). Here are some actual images taken of the inferior turbinates.


Normal Turbinate Appearance & Size	Moderate Turbinate Hypertrophy	Severe Turbinate Hypertrophy

Turbinate reduction (also known as turbinoplasty or turbinectomy) is a surgical procedure that reduces the overall size of the turbinates allowing for airflow which results in symptommatic relief of nasal obstruction and congestion. In people who suffer from persistent clear rhinnitis (runny nose) also known as vasomotor rhinnitis, there is an average reduction of nasal drainage by about 50%.

Keep in mind that IF you have allergies, turbinate reduction does not work as well and the risk of symptoms coming back over time is high. In other words, this procedure does NOT cure allergies and nasal symptoms related to allergies. A more reasonable expectation for people with allegies is partial symptom improvement over a period of time (a few months to years) before possible symptom recurrence.

In any case, there are 2 main ways turbinate reduction is performed depending on exam and symptom complaints:

Method #1: Coblation Sub-Mucosal Turbinate Reduction (SMR) is by removing internal turbinate tissue as well as shrinking the turbinate by a method called submucosal coblation and can be done under local in an office-like setting (no IV is even needed). There is no packing, no pain, no downtime, no recovery period, and for most people, it is permanent. From start to finish, the procedure does not exceed 10 minutes. Often patients are able to resume all activites within 15 minutes after the procedure is completed. Keep in mind that there is NO pain during the procedure. Here's a movie from the patient's perspective. The pictures shown below were taken from this movie clip. Both kids as well as adults benefit from this procedure, though kids generally will require anesthesia as they usually can't stay absolutely still when having this procedure done.


Here the coblation device is inserted into the inferior turbinate.	Appearance prior to coblation turbinate reduction	Appearance immediately after coblation turbinate reduction performed. Overall size decreased by 50%.

Method #2: Extra-Mural Turbinate Reduction is by physically removing a portion of the turbinate. This method needs to be performed under anesthesia in the operating room and takes about 10 minutes to perform. It usually takes about 3 weeks before things heal to the point that patients start to notice a significant improvement. This method is only rarely recommended. At most, no more than 25% of the turbinates are removed.

Caveats For Turbinate Reduction (Regardless of Method)

We do NOT advocate complete or near-complete turbinate removal regardless of the method used. Why? Because it may lead to a devastating condition known as empty nose syndrome. Read a LA Times article about empty nose syndrome here.

Also, keep in mind that there is NO guarantee that this procedure will work for everyone. Some individuals may need to get this procedure done more than one time for adequate relief. Some individuals no matter what is tried, will have recurrence or minimal (if any) improvement. Typically if Method #1 fails, Method #2 is typically pursued.

In order to determine candidacy, make an appointment in our office! Sub-mucosal turbinate reduction (Method #1) is performed every Friday afternoon at Fauquier Hospital in an office-like setting. There is no downtime and the patient is able to resume all normal activities within minutes after the procedure. Some degree of nasal congestion/obstruction may occur for up to 2 weeks after the procedure before resolving (reactive swelling occurs from the surgical manipulation done in the nose). Large scabs are usually present and removed after 2 weeks.

Read the post-procedure instructions here.

To read more about other causes of nasal obstruction including a deviated septum, go here.

If You Live Far Away...

We do not maintain a list of physicians who offer this procedure throughout the United States. Your best bet is to contact your local ENT and ask if they or anybody they know offers this locally to where you live.

PLEASE keep in mind that at least for our practice, we now require insurance coverage that we participate with as well as follow-up visits after the procedure. If you are not willing to commit to follow-up appointments, do not make an appointment with us. Why are we requiring this? After this procedure, it is not unusual that a patient may experience some problems or encounter a situation in which they are not sure what to do. In this scenario, it is very difficult if not impossible to answer questions over the phone without an examination leading to frustration and even anger (as follow-up examinations are very inconvenient especially if you live far away). As such, do NOT make an appointment with us unless you are willing to commit to follow-up visits.

Click here for more information.

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