Definition of Inferior Turbinate Hypertrophy
Inferior turbinate hypertrophy is an abnormal enlargement of the inferior nasal turbinates—shelf-like structures on the lateral nasal wall—that causes chronic nasal obstruction and affects approximately 20% of the population. 1, 2
Anatomical Understanding
The inferior turbinates are normal structures within the nose that serve critical physiological functions, including:
- Warming and humidification of inspired air as it passes through the nasal passages 3
- Filtering particulate matter and maintaining normal nasal mucociliary clearance 1
- Regulating nasal airflow through their position on the lateral nasal wall 3
Types of Hypertrophy
Inferior turbinate hypertrophy can involve different tissue components, which is critical for treatment selection:
- Mucosal hypertrophy: Enlargement of the soft tissue lining due to chronic inflammation, venous engorgement, and edema 2, 4
- Bony hypertrophy: Enlargement of the underlying turbinate bone structure 2
- Combined mucosal and bony hypertrophy: Both components are enlarged, which is the most common presentation requiring surgical intervention 2, 4
Clinical Significance
When turbinates become pathologically enlarged, they cause:
- Chronic nasal obstruction that persists for more than 3 months 5
- Reduced nasal airflow and difficulty breathing through the nose 4
- Sleep disturbances and mouth breathing 4
- Impaired quality of life despite medical management 1, 2
Diagnostic Assessment
The distinction between types of hypertrophy can be assessed by:
- Physical examination showing visibly enlarged turbinates on nasal endoscopy 2
- Topical decongestant test: Applying topical decongestant and observing whether the turbinate size reduces (indicating mucosal edema) or remains enlarged (suggesting bony hypertrophy) 4
- CT imaging to confirm the degree of bony versus mucosal involvement 2
Common Causes
Turbinate hypertrophy develops from:
- Chronic allergic rhinitis with persistent allergen exposure leading to mucosal inflammation 4
- Non-allergic rhinitis with vasomotor instability 6
- Chronic inflammation from environmental irritants 4
- Compensatory hypertrophy in response to septal deviation on the contralateral side 4
Treatment Implications
Understanding that this is a structural problem helps frame management:
- Medical management is first-line with intranasal corticosteroids for at least 4 weeks 2, 4
- Surgical intervention becomes necessary when medical therapy fails and documented hypertrophy causes significant symptoms 1, 2
- The surgical approach must be tailored to whether the hypertrophy is predominantly mucosal, bony, or combined 2, 4
Important Caveat
Excessive removal of turbinate tissue can cause serious complications including nasal dryness, reduced nasal mucus production, atrophic rhinitis, and decreased sense of well-being, which is why preservation of turbinate tissue is critical in any surgical approach. 1, 4