Turbinoplasty: turbinate reduction surgery with coblation and radiofrequency

Turbinoplasty is the operation to breathe better through the nose when enlarged turbinates block it. It is done from inside the nose, with no external cuts, and it does not remove them: it reduces their volume and aims to preserve the lining, the layer that warms and humidifies the air. It is also called "turbinate reduction"; the problem itself is called turbinate hypertrophy. It is not the same as a turbinectomy, which does remove part of the tissue.

Symptoms of enlarged turbinates

• A blocked nose almost every day, sometimes switching sides, and worse when lying down.
• Breathing through the mouth at night and waking up with a dry mouth.
• Snoring: people with nasal symptoms on 5 or more nights a month snore habitually more often [3].
• Depending on a decongestant spray, which, used for many days in a row, causes a rebound effect.

A deviated septum or polyps cause similar symptoms. That is why the nose has to be examined with an endoscope before deciding. To put a number on how blocked it feels, fill in the NOSE questionnaire; how the nose relates to snoring and apnea is explained in the guide blocked nose, snoring and sleep apnea.

Turbinoplasty, turbinectomy, radiofrequency and coblation: differences

"Turbinoplasty" is the general name for the techniques that reduce the turbinate while preserving its surface. Radiofrequency and coblation are two ways of doing it.

No technique is best for everyone. Those that remove more tissue open the nose more [12], but with a higher risk of bleeding [6]. The gentler ones recover sooner, but may last less if the allergy remains uncontrolled [13].

If you use CPAP or an oral appliance and your nose is blocked

• CPAP: the higher the nasal resistance at the start, the more likely people were to reject it [14]. In addition, with a blocked nose it is common to switch to a nose-and-mouth mask, which is associated with higher pressure and fewer hours of use than a nasal mask [15].
• Mandibular advancement device: it works by breathing through the nose with the mouth closed. Higher nasal resistance was associated with a poorer response [16].
• What to do: tell your sleep doctor. First, medical treatment. If that is not enough, consider reducing the turbinates. Afterwards, review the CPAP pressure or the fit of the appliance with your sleep unit; your doctor will tell you when.

When it is not indicated

• If the obstruction comes mainly from another cause: the septum, polyps or a nasal valve that closes when you breathe in (functional septorhinoplasty).
• If a proper course of medical treatment has not been tried first (see chronic rhinitis and snoring).
• If the nose is blocked by overuse of decongestant sprays: those must be stopped first.
• If the turbinates have already been operated on and there is dryness or crusting: removing more tissue can make it worse [1].

Duration

About 30 minutes [1]

Anaesthesia

Local (the nose is numbed) or general [1]; your surgeon will tell you which one in your case

Discharge

The same day [2]

Discomfort

Mild, 2-3 days, with ordinary painkillers [2][11]

Nose more blocked at first

Like a heavy cold, for 10-14 days [1]

Mucus with a little blood

Normal for up to about 2 weeks [1]

No nose blowing

1 week; sneeze with your mouth open [1]

Work

At least 2 days of rest; 1 week if you lift heavy loads [1]

Saline rinses

You may be asked to use them [1]. After radiofrequency, a trial found they did not improve blockage or crusting; they only reduced itching and sneezing between days 5 and 7 [18]

Sport and first check-up

Your surgical team will tell you when

Result

Gradual: usually noticeable around the first month and keeps improving over the following months [10][17]

This is what is usual; your surgeon will give you the instructions for your case.

• Bleeding: Some bleeding is very common after any nasal surgery [1]. In one coblation series, 2 of 24 patients had a nosebleed afterwards [17].
• Crusting: Less with coblation than with more aggressive heat techniques [8], and more with turbinectomy [4].
• Dryness: Usually temporary. If too much tissue is removed, the so-called "empty nose syndrome" can rarely appear [1].
• Adhesions (synechiae): Bridges of scar tissue between the turbinate and the septum. They are relatively uncommon [1], and less so with coblation [6].
• Relapse: With radiofrequency, about 8 out of 10 patients had not relapsed at 3 years. Allergic patients relapsed more [13].

Your specialist will assess your case and explain the expected course before deciding.