The nasal conchas (turbinates) are 6 in total, three in each nostril. It is called as upper, middle and lower Concha according to their placement in the nose. The inner part contains the bony structure, the surface contains soft tissue, and concha growth (hypertrophy) may concern both the bone and soft tissue part. The functions of turbinates are heating, hydrating and filtering the inhaled air. The nasal conchae can often be confused with adenoid hypertrophy, which is more common in childhood. In general, nasal concha hypertrophy occur during adulthood. Adenoid hypertrophy is also more common in childhood and settled in posterior part of the nose called nasopharynx.
Concha growths that cause complaints are most common in the lower concha. We see complaints associated with middle concha less and upper concha the least.
What are the most common causes of nasal concha hypertrophy?
The most common complaint in patients is due to hypertrophy of the lower concha. One of the most common reasons for hypertrophy of the lower concha is allergies. Allergy causes swelling, cell growth and increased blood supply in concha. Another common cause is compensatory hypertrophy that occurs due to septum deviation in the nose and enlarges the lower conchae on the opposite side of deviation. In addition, smoking, air pollution, uncontrolled and used for a long time some nasal sprays and drops (especially those containing xylometazoline, oxymethazoline, etc.) can also make concha hypertrophy.
In the middle conchae, we encounter the problems like paradox (reverse) middle concha and air spaces (concha bullosa), which may cause nasal congestion or sinusitis.
What is the most common complaint of patients and how is it diagnosed?
The most common complaint is nasal congestion (obstruction). Nasal concha enlargement alone may be a cause of blockage and when it is together with intranasal septum deviation, they create more obstruction problems. In addition, recurrent sinusitis infections are other problems of these patients. An endoscopic nasal examination is sufficient to diagnose the disease. Especially in the hypertropy of the lower concha, there is a chance to evaluate the conchae along with the endoscopy. In addition to endoscopic examination, performing tomography in middle concha problems is very useful in revealing both the state of the sinuses and the structural problems of the middle conchae.
How should nasal concha diseases be treated?
We can evaluate the treatment methods in two main groups as medical and surgical treatments.
Medical treatments: Some drug treatments used in nasal concha growth can give positive results.
Hypertonic salt water (sea water, saline solutions) are natural or close-to-nature solutions that are very frequently used, have little side effects and can be useful in removing short-term nasal congestion. It usually does not require time restrictions during use.
Another group of medicines are decongestants used intranasally in the form of sprays and drops, or can be taken orally. Of these, especially sprays and drops (containing xylometazoline, oxymetazoline etc.) are very effective in removing nasal congestion within the time they are used, but they should not be used continuously. With prolonged use, they may cause the conchae to grow more and to increase nasal blockage after a while. They should not be used in those with high blood pressure, heart and kidney diseases and eye pressure.
Antiallergic pills and sprays and cortisone sprays can be used for long-term treatments, especially in allergy-related nasal concha hypertrophy, thereby reducing the need for surgery.
Surgical treatments: Many treatment methods have been defined in this regard to date. These include Radiofrequency, Laser, Cauterization, Microdebrider and Surgical removal of the concha by partially or completely. Regardless of which of these methods used, the first aim is to provide shrinking of the nasal mucosa with minimum damage. Therefore, it is mainly tried to be provided shrinking by using heating-burning methods to the inside of concha. If there is growth in the bony part of the concha, soft tissue can be preserved and only the bony part is removed. In this way too, successful results can be obtained.
The reduction of the lower conchae with radiofrequency is the most preferred method nowadays. In this method, radiofrequency energy is given to the nasal concha with the help of a special device and shrinkage occurs in the tissue within 6-8 weeks with the heat generated. The procedure can be performed under local or general anesthesia and lasts short (total 10-15 minutes). It can also be applied by easily adding to surgical procedures performed during septum surgery (septoplasty) and chronic sinusitis surgeries (such as endoscopic sinus surgeries). In the early postoperative period, there may be an increase in nasal congestion due to swelling and crusting. To reduce these problems and accelerate recovery, nasal washing and moisturizing are carried out and recovery is completed in 6-8 weeks. In this way, approximately 80% successful results are obtained after radiofrequency processes. In cases where there is not enough efficiency with surgery or if the concha growths are repeated with some external factors (allergy, cigarette smoke, dirty air, use of vasodilating blood pressure medications, etc.), the procedure can be repeated easily.
Figure 1: Demonstration of the lower, middle, upper concha and radiofrequency interference to the lower conchae
In the presence of middle concha problems, if the patient has not had problems such as nasal congestion or sinusitis, no intervention is required. In case of such problems (nasal congestion, sinusitis etc.), the operation of reducing the air filled vesicles (concha bullosa structure) in the middle concha is performed by surgery generally using endoscopic methods.
