Nasal Congestion - Deviated Septum & Turbinate Hypertrophy

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What are the turbinates and septum?

The nasal cavity provides a conduit for air-flow into the nasopharynx and the lungs. The cavity has a partition in the center called the nasal septum, effectively creating two passages called the nostrils. The nasal septum is composed of bone and cartilage, which is covered under mucosa. Ideally, the nasal septum is straight and flat, reducing nasal obstruction and maximizing air-flow. Most patients are born with some degree of deflection of the septum (septal deviation).

The turbinates are elongated bony shelves covered under mucosa that protrude into the nose. There are three turbinates in each nostril: the inferior, middle, and superior turbinate. The mucosa is very well vascularized and can cause the turbinate to rapidly change in size from engorgement of the vessels and secretion of fluid. The turbinates can naturally alternate in size between the left and right side of the nose. This physiologic process is called the “nasal cycle.” It occurs about every four hours and may be noticeable in some patients who already have a narrow nasal passage.

What are the functions of the septum and turbinates?

The nasal septum at the center provides structural support for the nose and maximizes laminar (smooth) flow through the nose. The top part of the septum also contains sensory cells that detect the sense of smell. In patients with a large hole in the septum (septal perforation) or degeneration of the septum, the air flow becomes more turbulent.

The turbinates function as a humidifier, warming and moisturizing the air before they smoothly direct air to the lungs. The turbinates also contain sensory cells that detect smell.

What is a septal deviation and turbinate hypertrophy?

The septum can be crooked (deviated septum) either from birth or from trauma. In most patients, the septum is slightly crooked and does not cause any problem. In a small subset of patients, the deviation can cause symptoms of congestion and obstruction. In addition, the turbinates can inherently be enlarged or become enlarged due to inflammatory conditions such as a sinus infection, allergy, or an upper respiratory infection. Enlargement of the turbinates can lead to nasal congestion and loss of smell.

How does nasal obstruction from a deviated septum and enlarged turbinates typically present?

Patients with a deviated septum may have chronic nasal congestion despite treatment. The deviation can develop from birth or from trauma. You may experience recurrent nose bleeds (epistaxis), recurrent sinus infections, loss of smell, chronic mouth breathing, and snoring when you are exerting physically (such as exercising) or when you are sleeping. You may experience worsening congestion when the turbinates become enlarged due to an upper respiratory infection, a sinus infection, or allergy.

What can you expect during your ENT doctor visit for nasal obstruction?

There are multiple causes of nasal obstruction. During your visit, your ENT doctor will perform a complete history and physical exam to determine the exact cause of your nasal obstruction. A procedure called a nasal endoscopy with a fiberoptic endoscope may be performed to further evaluate the nasal anatomy and sinus pathology deep inside your nose. Depending on your history and examination, your physician may refer you to obtain additional studies including blood tests, allergy tests, a sleep study, and radiographic exams.

How is nasal obstruction from a septal deviation and turbinate hypertrophy medically treated?

A septal deviation is a static (fixed) deformity that will not change with medical management. However, topical medications and oral medications can help shrink the turbinates and decongest the nose to a tolerable level. There are numerous prescribed, over-the-counter, and alternative medications that target enlarged turbinates.

In general, topical steroid sprays such as fluticasone (Flonase) or mometasone (Nasonex) can be effective in decongesting the nose. These are good first-line medications for chronic congestion related to allergy. They may be slow to act and can take up to a few weeks before any significant improvement is noticed. Topical decongestants such as oxymetazoline (Afrin) and neo-synephrine are vasoconstrictors (temporarily shrink the vessels in the turbinates) that are rapidly effective and can be used in an acute upper respiratory infection. However, prolonged use of vasoconstrictive decongestant can lead to a rebound effect and “addiction” to nose spray. As a result, medications such as Afrin and Neo-Synepherine should not be used for more than three days in a row. An oral decongestant such as pseudoephedrine can alleviate nasal congestion. They can increase your heart rate and blood pressure and should not be used for a prolonged period of time.