From the Guidelines
Bilateral concha bullosa is a common anatomical variation where both middle nasal turbinates contain air cells, causing them to become enlarged or "pneumatized," and treatment is only necessary when symptoms such as nasal congestion, recurrent sinusitis, headaches, or facial pain occur. This condition affects both sides of the nasal cavity simultaneously, and the middle turbinates normally help filter, warm, and humidify air as it passes through the nose. However, when they become enlarged due to this air-filled expansion, they can sometimes obstruct normal airflow or sinus drainage, as noted in the management of comorbid conditions such as nasal obstruction from severe nasal septal deviation or inferior turbinate hypertrophy 1. Many people with bilateral concha bullosa experience no symptoms at all, as it's often an incidental finding on imaging studies.
Symptoms and Treatment
Some individuals may develop symptoms including nasal congestion, recurrent sinusitis, headaches, or facial pain if the enlarged turbinates significantly narrow the nasal passages or block the sinus drainage pathways. Treatment options may include decongestants, nasal steroids, or in more severe cases, surgical reduction of the enlarged turbinates through endoscopic procedures, similar to the surgical approaches for inferior turbinate hypertrophy 1. The condition develops during normal facial growth and is not considered a disease but rather a normal anatomical variant that occurs in approximately 14-53% of the population to varying degrees.
Management and Prevention
It is essential to note that surgery may play a beneficial role in the management of conditions associated with rhinitis, such as mechanical nasal obstruction caused by anatomical variants like concha bullosa, as mentioned in the diagnosis and management of rhinitis 1. Patients with rhinitis who develop acute bacterial sinusitis will usually require antibiotics, and in some cases, surgical intervention may be necessary to prevent complications such as periorbital edema, meningitis, brain abscess, cavernous sinus thrombosis, or subperiosteal abscess with the risk of permanent vision loss or even death 1.
From the Research
Definition and Description
- Bilateral concha bullosa refers to the pneumatization of both middle turbinate bones in the nasal cavity, which can be a relatively common anatomic variant 2, 3.
- This condition is characterized by the enlargement of the middle turbinate bones, which can cause nasal obstruction, headaches, and other symptoms 3, 4.
- Concha bullosa can also occur in the inferior or superior turbinate bones, although this is less common 5, 6.
Symptoms and Diagnosis
- Patients with bilateral concha bullosa may experience symptoms such as nasal obstruction, headaches, and hyposmia (reduced sense of smell) 3, 4.
- Computed tomography (CT) scans are often used to diagnose concha bullosa, as they can provide detailed images of the nasal cavity and turbinate bones 2, 5.
- Nasal endoscopy may also be used to examine the nasal cavity and diagnose concha bullosa, although this may be difficult in cases where the nasal cavity is completely obstructed 2.
Treatment Options
- Surgical intervention, such as resection of the lateral half of the concha bullosa, may be necessary to relieve nasal obstruction and other symptoms 2, 5.
- Endoscopic surgery is a common treatment option for concha bullosa, as it allows for minimally invasive removal of the affected tissue 2, 5.
- The term "conchae bullosis" has been proposed to describe cases where multiple turbinate bones are affected by pneumatization, such as bilateral triple turbinate pneumatisations 6.