Turbinate Surgery
A blocked nose is one of the commonest problems I assess in practice, and enlarged inferior turbinates are often a major part of the picture. I perform inferior turbinate surgery regularly, both as a standalone procedure and in combination with other nasal operations such as septoplasty or endoscopic sinus surgery. All of these procedures are performed endoscopically, meaning they are done through the nostrils with a camera and no cuts on the outside of the nose or face.
The aim is not simply to make the turbinates smaller at any cost. The turbinates are important structures, and good surgery is about improving airflow while preserving their shape, lining, and function as much as possible.
What are the turbinates?
The inferior turbinates are normal prong-like structures on the side wall inside the nose. There is one on each side. Their job is to warm, humidify, and regulate the air as you breathe. They also naturally swell and shrink during the day as part of the normal nasal cycle. When they become persistently enlarged, they can contribute significantly to nasal blockage.
What symptoms do enlarged inferior turbinates cause?
The commonest symptom is a blocked nose. This may affect one side more than the other, or it may alternate from side to side.
That alternating pattern is common because the turbinates are involved in the normal nasal cycle. In some patients the swelling becomes exaggerated, so the nose feels obviously blocked first on one side and then on the other.
Other symptoms may include:
a feeling of poor airflow through the nose
mouth breathing
disturbed sleep or snoring
ongoing congestion despite sprays
pressure or a feeling of fullness in the nose
If nasal discharge or dripping is a major part of the problem as well, that sometimes changes the overall surgical plan.
Why do the turbinates become enlarged?
The turbinates can become enlarged because of allergy, chronic rhinitis, irritant exposure, compensation for a deviated septum, or the normal nasal cycle becoming exaggerated. Often there is more than one factor involved, which is why proper assessment matters.
When might surgery be considered?
Surgery is usually considered when medical treatment has not helped enough.
That usually means appropriate treatment has already been tried, such as:
saline rinses or sprays
antihistamines where relevant
nasal steroid sprays or drops
treatment for associated sinus disease
If the turbinates remain a major cause of obstruction despite that, surgery may be helpful.
How do I assess whether turbinate surgery is appropriate?
I usually want to understand:
how much the nose feels blocked, and on which side
if the blockage is constant or alternating
any associated allergy, rhinitis, sinus symptoms, or nasal discharge
what treatments have already been tried, and for how long
if a deviated septum is also contributing
how much the symptoms are affecting sleep, exercise, or day-to-day life
Examination often includes looking inside the nose with a headlight or a thin camera. This helps confirm that the turbinates are genuinely a major part of the blockage and that there is not another cause.
What does the operation involve?
There are different ways to reduce the turbinates, and the best approach depends on the patient and on the pattern of turbinate enlargement.
The important principle is to preserve as much normal lining and function as possible while improving the airway. Depending on the situation, the procedure may involve:
simple outfracture of the turbinate, where it is repositioned slightly outwards
microdebrider turbinoplasty, where tissue beneath the lining is reduced while preserving the surface lining
posterolateral nasal artery ligation in selected patients
a combination of techniques where needed
Sometimes an outfracture alone is enough, particularly when turbinate surgery is being combined with a septoplasty. In other patients, a more formal turbinoplasty is needed. In some cases, combining techniques gives the best result.
Posterolateral nasal artery ligation, sometimes abbreviated to PLNA, means targeting part of the blood supply to the inferior turbinate so that the turbinate shrinks while the surface lining is preserved as much as possible.
Can turbinate surgery be combined with other procedures?
Yes, very often.
Inferior turbinate surgery is commonly combined with:
other endoscopic nasal procedures
This is often the most sensible way to deal with all the important contributors to a blocked nose in one operation.
What if nasal discharge is a major problem as well?
If blockage is the main problem, turbinate reduction may be enough.
If watery rhinorrhoea or vasomotor rhinitis is also a major feature, it may sometimes be worth considering posterior nasal nerve neurectomy as well. This is a more specialist endoscopic procedure aimed at reducing the overactive nerve supply that drives nasal secretion and congestion. It is not needed for everyone, and not every surgeon offers it, but in selected patients it can be very helpful.
The advantage over vidian nerve neurectomy is that posterior nasal nerve surgery is usually more focused and generally carries fewer unwanted side effects, particularly dry eye.
What are the benefits of surgery?
For the right patient, inferior turbinate surgery can:
improve nasal airflow
reduce the feeling of constant blockage
improve sleep and breathing through the nose
make treatment for rhinitis work better
improve the overall nasal airway, especially when combined with other procedures
It is important to be realistic. Surgery can be very effective, but it does not switch off the underlying tendency to inflammation. If allergy or rhinitis is still driving swelling, some medical treatment may still be needed afterwards.
What are the main risks of inferior turbinate surgery?
Inferior turbinate surgery is a common and usually safe operation, but like any procedure it carries risks.
The more common issues include:
bleeding or blood-stained discharge
temporary blockage from swelling or dressings
crusting during healing
infection
persistent symptoms if the underlying problem is not fully addressed
Crusting is one of the commoner parts of recovery, particularly in the early healing period. This usually improves with time and with good postoperative care, but it is an important part of what patients notice after surgery.
Other risks include:
adhesions, where healing surfaces inside the nose stick together
dryness
ongoing need for medical treatment
rarely, over-reduction of the turbinate causing an unsatisfactory dry or uncomfortable nose
One of the reasons turbinate surgery needs to be done carefully is the rare risk of empty nose syndrome. This is an uncommon but important complication in which the nose may be too open, yet the patient paradoxically feels blocked, dry, uncomfortable, or unable to sense airflow normally. The turbinates do not just occupy space; they help condition airflow and contribute to the normal sensation of nasal breathing. If too much turbinate tissue is removed, that sensory feedback can be disrupted, and the brain may no longer register airflow normally even though the nasal cavity is physically open. That is why preserving turbinate shape and mucosa is so important.
What happens at the end of the operation?
At the end of surgery, I often use a dissolvable dressing inside the nose to support healing and reduce bleeding.
Sometimes internal splints are also needed, particularly if there is a risk of adhesions or if the surgery has been combined with other procedures such as septoplasty. If splints are used, they are usually removed about a week later.
What is recovery like?
Most turbinate procedures are done as a day case, although if surgery is combined with other nasal operations some patients may stay overnight.
The nose usually feels more blocked before it starts to feel better. That is normal in the early healing period.
Saline spray
Most patients are advised to use regular saline spray such as Sterimar, or a similar pharmacy equivalent, after surgery. This helps reduce crusting and keeps the inside of the nose moist while it heals.
Naseptin
Most patients are also prescribed Naseptin (an antibiotic ointment) after surgery, depending on the exact procedure and the appearance of the nasal lining. This helps reduce crusting and lower the risk of infection during healing.
Activity and work
I usually advise taking it easy for the first few days. Heavy lifting, strenuous exercise, gym work, straining, and anything likely to provoke bleeding should then be avoided for 6 weeks. This is particularly important if the surgery has been combined with septoplasty or sinus surgery.
Nose blowing
Do not blow the nose for about a week, and then start very gently. If you need to sneeze, sneeze with your mouth open.
Follow-up
Follow-up is important. Depending on the type of procedure and how the nose is healing, I may need to review you, clear crusting if needed, and adjust the postoperative treatment plan.
When should I seek urgent advice?
Urgent advice is needed if there is:
heavy or persistent fresh bleeding
increasing pain or swelling
worsening blockage with a bad smell
fever or signs of infection
concern that healing is not going in the right direction
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Disclaimer
This page is intended as general information only. It does not replace a consultation, examination, or individual medical advice.