From the Guidelines
Nasal turbinate hypertrophy is typically graded on a scale from 1 to 4, with Grade 1 representing minimal enlargement (less than 25% obstruction), Grade 2 showing moderate enlargement (25-50% obstruction), Grade 3 indicating significant enlargement (50-75% obstruction), and Grade 4 representing complete or near-complete obstruction (75-100%). Treatment options should follow a stepwise approach based on severity. For mild to moderate cases (Grades 1-2), first-line treatment includes:
- Intranasal corticosteroids like fluticasone (2 sprays per nostril daily) or mometasone (2 sprays per nostril daily)
- Antihistamines such as loratadine (10mg daily) or cetirizine (10mg daily) for allergic causes
- Saline nasal irrigation (twice daily) 1. For moderate to severe cases (Grades 2-3) not responding to medical therapy, consider adding:
- Decongestants like oxymetazoline for short-term use (3-5 days maximum to avoid rebound congestion)
- Oral steroids like prednisone (short course of 5-7 days, 20-40mg daily with taper) 1. For severe cases (Grades 3-4) or those resistant to medical management, surgical interventions include:
- Radiofrequency turbinate reduction
- Turbinoplasty
- Partial turbinectomy, with submucous resection with outfracture being the most effective surgical therapy with the fewest complications 1. These procedures aim to reduce turbinate size while preserving mucosal function. The stepwise approach is recommended because turbinate tissue serves important physiological functions in warming, humidifying, and filtering inspired air, so complete removal should be avoided to prevent empty nose syndrome, a debilitating condition characterized by paradoxical nasal obstruction and dryness. Inferior turbinate reduction surgery is a reasonable option for those patients with inferior turbinate hypertrophy who have continued symptoms despite medical management or in those patients who cannot tolerate medical treatment 1.
From the Research
Grades of Nasal Turbinate Hypertrophy
- The grades of nasal turbinate hypertrophy are not explicitly defined in the provided studies, but the conditions and treatments are discussed in detail 2, 3, 4, 5.
- Nasal turbinate hypertrophy can be caused by various factors, including allergic and non-allergic rhinitis, and can significantly affect a patient's quality of life 3, 4.
Treatment Options
- Medical treatment, such as fluticasone propionate aqueous nasal spray, can be effective in reducing turbinate hypertrophy and improving nasal obstruction 4.
- Surgical options, including turbinectomy with lateralization, submucosal electrocautery, and laser cautery, can also be effective in reducing nasal obstruction and improving quality of life 2, 5.
- High-intensity focused ultrasound (HIFU) is a minimally invasive surgical option that has been shown to be effective in treating nasal obstruction caused by inferior turbinate hypertrophy 3.
Assessment and Diagnosis
- A standardized nasal exam protocol, including grading systems and physical exam maneuvers, can be useful in diagnosing and assessing nasal obstruction 6.
- The use of validated scales and grading systems, such as the Sino-Nasal Outcome Test 20 questionnaire, can help to objectively measure the outcomes of treatment 5.