From the Guidelines
Concha bullosa found on a CT head scan typically requires no specific treatment unless it causes symptoms or complications, and management should focus on alleviating symptoms and addressing any associated conditions. This anatomical variant, characterized by pneumatization of the middle turbinate, is present in a significant portion of the population and is often an incidental finding 1. The clinical implications of concha bullosa depend on symptom severity and associated conditions, such as nasal obstruction, facial pain, headaches, or recurrent sinusitis.
Management Approach
For patients with symptoms, initial treatment includes:
- Intranasal corticosteroids, such as fluticasone 50 mcg, 1-2 sprays per nostril daily
- Saline nasal irrigation, using pre-mixed solutions or 1/4 teaspoon salt in 8 oz warm water, twice daily
- Antihistamines if allergies are present
Surgical Considerations
For persistent symptoms despite medical therapy, surgical intervention may be considered, typically endoscopic partial resection of the concha bullosa (conchoplasty) to relieve obstruction while preserving the turbinate's physiological function 1. Surgery is particularly indicated when the concha bullosa obstructs the middle meatus, impairs sinus drainage, or contributes to recurrent sinusitis. Clinicians should note that concha bullosa may coexist with other anatomical variations like septal deviation, which might compound symptoms and influence treatment decisions 1.
Post-Surgical Care
Post-surgical care includes saline irrigation, avoiding nose-blowing for 1-2 weeks, and follow-up to ensure proper healing and symptom resolution. The use of CT scans, as mentioned in 1, is essential for evaluating the extent of sinonasal disease and for surgical planning, highlighting the importance of detailed imaging in managing concha bullosa and associated conditions.
From the Research
Definition and Prevalence of Concha Bullosa
- Concha bullosa is generally regarded as pneumatisation of the middle turbinate in the nose, but pneumatisation may also be seen in the superior and inferior turbinate 2.
- The prevalence of concha bullosa varies, with studies reporting incidence rates ranging from 12.2% to 53% in patients with chronic sinusitis 2, 3, 4.
- Concha bullosa can be unilateral or bilateral, with some studies reporting a higher incidence of bilateral cases 5.
Clinical Implications of Concha Bullosa
- Concha bullosa has been associated with chronic sinusitis, but the relationship between the two is still debated, with some studies finding no significant correlation 3, 5, 4.
- The presence of concha bullosa may require specific endoscopic surgical techniques, particularly if it is localized to the inferior part of the middle turbinate 3.
- Concha bullosa can also be a rare location for a fungus ball, which can present with different symptoms, including chronic facial pain 6.
Management of Concha Bullosa
- Computed tomography (CT) scans are essential for diagnosing concha bullosa and evaluating its relationship with surrounding structures 2, 6.
- Endoscopic surgery is the treatment of choice for concha bullosa, particularly for cases with significant symptoms or complications, such as fungus balls 3, 6.
- A preoperative CT scan is crucial for planning surgical approaches and avoiding complications 2, 6.
Classification and Radiological Evaluation of Concha Bullosa
- Concha bullosa can be classified according to its extension in the coronal plane or its axial extension, with different types having varying degrees of pneumatisation 5.
- Radiological evaluation of concha bullosa is important for defining anatomical variations and planning surgical approaches, particularly in cases with complex sinus disease 2, 5.