Turbinates, also known as nasal conchae, are shelf-like structures located inside the nose that play a fundamental role in respiratory function. These structures are made of bone and covered in a thick layer of soft tissue called mucosa, which is highly vascularized. Their primary purpose is to manage the flow of air entering the body and prepare it for the delicate respiratory system. When functioning properly, turbinates ensure that the air reaching the lungs is clean, moist, and at an appropriate temperature.
Where They Are Located
Turbinates are fixed to the lateral walls of each nasal passage, protruding inward toward the nasal septum. There are typically three distinct pairs of turbinates: the superior (highest), the middle, and the inferior (lowest) turbinates. The inferior turbinate is a separate bone and is the largest of the three structures.
The middle and superior turbinates are bony projections of the ethmoid bone within the skull. Each turbinate creates an open space beneath it, called a meatus, which serves as a drainage pathway for the paranasal sinuses and the eyes. The scroll-like shape of the turbinates significantly increases the total surface area inside the nasal cavity, forcing inhaled air to swirl and make contact with the mucosal lining. The inferior turbinates are the most prone to swelling that causes breathing difficulties.
How Turbinates Condition the Air
The turbinates condition the air to protect the lower respiratory system. The dense network of blood vessels beneath the mucosal layer allows the turbinates to quickly warm incoming air to near body temperature.
The thick mucosal lining constantly secretes mucus, which adds moisture to the inhaled air. Humidifying the air prevents the respiratory lining from drying out and becoming irritated. The mucus layer also acts as a biological filter, trapping dust particles, pollen, and airborne pathogens.
Tiny, hair-like projections called cilia on the mucosal surface sweep the trapped debris and mucus toward the back of the throat to be swallowed or expelled. This combined action ensures that the air reaching the lungs is clean, warm, and adequately humidified. The volume of the turbinates changes rhythmically throughout the day and night in a process known as the nasal cycle, directing airflow predominantly through one nostril at a time.
Common Causes of Enlargement
When the soft tissue covering the turbinates becomes inflamed, the structures swell, a condition known as turbinate hypertrophy. Chronic allergies are a frequent cause, as the body’s immune response triggers inflammation and fluid accumulation in the mucosa. Exposure to environmental irritants, such as tobacco smoke, air pollution, and strong chemical fumes, can also lead to persistent turbinate swelling.
Acute respiratory infections like the common cold or sinusitis cause temporary inflammation as the body fights off the virus or bacteria. Prolonged inflammation can lead to chronic enlargement, particularly of the inferior turbinates. In some cases, the underlying bone structure of the turbinate may become permanently enlarged. Hormonal fluctuations, such as those that occur during pregnancy or due to certain medical conditions, can also contribute to turbinate swelling.
Treatment Options for Swollen Turbinates
The first approach to managing swollen turbinates is typically medical management, aimed at reducing the underlying inflammation and swelling. Intranasal steroid sprays, such as fluticasone or mometasone, are a common initial treatment, working to shrink the soft tissue over several weeks of consistent use. Antihistamines, either oral or in spray form, are also used to control the allergic response that often triggers the swelling.
Over-the-counter decongestant sprays, like oxymetazoline, offer rapid but temporary relief by constricting the blood vessels within the turbinates. These are strictly limited to short-term use, usually three to five days, because prolonged use can cause rebound congestion, worsening the swelling. Saline nasal rinses can help clear the mucus and irritants from the nasal passages, providing gentle relief.
If medical treatments do not provide lasting relief, surgical options may be considered to reduce the size of the turbinate structure and improve airflow. Procedures like turbinoplasty or submucosal resection aim to reduce the volume of the turbinate while carefully preserving the mucosal lining. This preservation is important to maintain the turbinates’ function. A partial turbinectomy involves removing a portion of the turbinate, but surgeons prioritize less invasive techniques to avoid the risk of excessive dryness and crusting inside the nose.