Coblation Turbinate Reduction for Nasal Congestion, Obstruction, & Rhinitis
by Dr. Christopher Chang, last modified on
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 very narrow nose, 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).
Reproduced with Permission from ArthroCare Corporation.
Watch a video of different turbinate sizes.
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.
Appearance & Size
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 improvement of nasal drainage in 50% of patients.
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 very little 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. Generally, no more than 20% of the total volume of the turbinate is reduced.
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%.
To see what the nose may look like as it heals, click here. Changes one may observe include normal mucosal blistering as well as normal white plaque formation which all typically resolve in about 2 weeks.
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. 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.
This procedure is covered by insurance. It is performed at Fauquier Hospital as an outpatient procedure. As such, a patient who undergoes this procedure will receive two billing statements... one from our office for the surgeon's fee and another from Fauquier Hospital for hospital charges.
Please note that our office has NO control over what charges the hospital bills for as well as how much they charge. Any complaints with hospital charges should be directed to their billing department. Again, we have no say, influence, or authority over what the hospital charges. You can reach Fauquier Hospital's finance department at 540-316-2970.
Only for those patients who do NOT have insurance, a discounted price from ONLY our office will be provided.
We should also add that our office receives absolutely NO payments, fees, or kickbacks whether financial or not from the hospital. It would be considered illegal as well (Stark Laws).
On a related note, media has written stories about this situation, especially given how surprisingly high hospital charges can be. Read a story about this issue here as well as here. Read blog article.
If You Live Far Away...
At this time, we are accepting new patients from the Northern half of Virginia (Fauquier and bordering counties only) only. You can appeal this limitation by sending us an email. Appeals by phone will NOT be accepted. In only very rare and selective cases have we made exceptions. Read why we instituted this policy.
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.
Also, please be aware that should you wish to see Dr. Chang, this procedure is generally NOT performed on the same day of the visit. The procedure (which is performed only on Friday afternoons if unsedated) will be scheduled only after Dr. Chang performs an intial evaluation. If you live very far away, please email Dr. Chang your interest along with a copy of your allergy test results and statement of how well you responded to both steroid nasal sprays and anti-histamine nasal sprays. If you have a high degree of anxiety and do not feel the procedure can be done without being asleep, you are not a good candidate for the procedure performed without sedation (it will have to be done in the operating room under twilight anesthesia with correspondingly much higher costs).
PLEASE keep in mind that at least for our practice, follow-up visits after the procedure are recommended. If you are not willing to commit to possible 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. Although not mandatory, a routine follow-up appointment is generally made for 2 weeks after the procedure.
Click here for more information.
Related Blog Articles
- With A Deviated Septum, Why Does Nasal Obstruction Come and Go?
- Pinched Narrow Nose Rhinoplasty to Correct Nasal Obstruction
- Normal Appearance After Turbinate Reduction
- Nasal Congestion Affected By How Well the Nose is Able to Cool Itself
- How Can Nasal Obstruction Cause Post-Nasal Drainage?
- Why Is a Nosejob Sometimes Necessary to Resolve Nasal Obstruction?
- Does Sinus and/or Nasal Surgery Help with Sleep Apnea?
- Nasal Surgery Helps With Snoring
- Nasal Congestion or Obstruction During Pregnancy
- How Can Nasal Obstruction CAUSE Clogged Ears?
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