The difficulty in breathing well through the nose is a very common and annoying disorder. Turbinate hypertrophy is one of the most frequent causes. These are croissants covered with a mucous membrane below which there is a very rich tissue of blood vessels, which it works like a kind of sponge, able to inflate and deflate in a physiological way to regulate the air flow. If the mechanism does not work well, and it can happen for several reasons, the turbinates, especially the lower ones, can undergo a chronic swelling, hypertrophy, resulting in respiratory obstruction and increased mucus secretion.

What is the function of the turbinates?

Turbinates can be considered such as air conditioners and air purifiers passing through the nose. In particular, these structures perform three fundamental tasks: heat the inhaled air (so that when it reaches the bronchi it is at body temperature), humidify it and clean it of microbes and irritants, such as dust, smog and pollen. The high vascular component of the turbinates makes them very sensitive to various stimuli that can induce a sudden increase or decrease in the blood supply – he says Paolo Castelnuovo, director of the complex structure of otolaryngology of the Circolo Hospital of Varese and full professor of otolaryngology at the University of Insubria of Varese -. Normally the turbinates are in opposite conditions and we notice it, for example, when during the day or at night, we notice that they alternate moments when one nostril breathes better than the other. This is a perfectly normal phenomenon, however sometimes some people develop a persistent increase in the volume of the lower turbinates (hypertrophy), which can involve, in addition torespiratory obstruction alternating nasal, other annoying ailments.


What are the triggers?

The lower turbinates can become congested and hypertrophic (enlarged) due to several factors that interfere with the autonomic nervous system which regulates its functioning. Hypertrophy can occur as a result of viral infections, such as repeated colds, or due to allergy to pollen, mites or other respiratory allergens, again, due to an individual susceptibility to physical factors, such as changes in temperature and humidity. To relieve the resulting nasal obstruction, many people start using spray decongestionanti nasals which can give quick relief, but they don’t solve inflammation. On the contrary, their prolonged use can even favor the chronicization of the disease.

How can you intervene?

To counteract nasal obstruction and restore the correct functioning of the turbinates, a hypertonic nasal showers to which they can be added hyaluronic acid and cortisone. The hypertonic solution “dries” the turbinates, while the hyaluronic acid favors the tissue regeneration and, together with cortisone, it helps reduce inflammation. This treatment, continued with constancy for at least one or two months, can be very beneficial. If this is not enough, you can consider a minimally invasive surgical approach, for example by radiofrequency, with the aim of coagulating submucosal blood vessels. In the most serious situations, in which the hypertrophic turbinates have now become fibrous, they can be emptied by surgery.

What does it look like?

At first the swollen turbinates clog the nose inconsistently, then more and more continuously. Typical the change in nasal obstruction in a short time or in relation to the position. The disorder usually worsens in the evening when you lie down in bed, due to a stagnation of blood. Turbinate hypertrophy also causes a increased mucus secretion with symptoms such as runny nose, sneezing, watery eyes and decreased sense of smell.

How is the diagnosis made?

The diagnosis of turbinate hypertrophy is based primarily on one complete otolaryngological evaluation, with endoscopic examination of the nasal cavities. Endoscopy allows not only to highlight any hypertrophy of the lower turbinates, but also to ascertain or exclude concomitant disorders, such as the presence of nasal polyps or one deviation of the nasal septum. To understand the origin of the problem also useful analyze the inflammatory cells present in the nose. For this purpose, a sort of cotton swab is used, the cells produced are taken and analyzed under a microscope. In cases where you lean towards to intervene surgically, always good to perform also a Tac to rule out a possible hidden chronic sinusitis, explains Professor Castelnuovo.

April 10, 2021 (change April 10, 2021 | 19:45)

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