Enlarged Turbinates and Radiofrequency Reduction

Enlargement of the inferior turbinates (turbinate hypertrophy) is one of the most common causes of a blocked nose. In cases that do not respond to medication, radiofrequency applied in the clinic under local anaesthesia reduces the volume of the turbinates and opens the airway.

Why do turbinates enlarge, and how is this related to allergy?

Turbinate enlargement can have more than one cause, and they do not all work the same way:

• Allergic rhinitis: The most common cause. The nasal lining reacts with inflammation to allergens (such as house dust, pollen and mould), which thickens the soft tissue (mucosa) of the turbinate; the bone does not change in this process. Turbinate enlargement is seen in about 65–80% of people with allergic rhinitis.
• Compensation for a deviated septum: When the inside of the nose is bent, the turbinate on the wider side enlarges to balance the airflow. This enlargement usually involves thickening of the bone as well, so it is somewhat different from allergic enlargement.
• Vasomotor (non-allergic) rhinitis: Swelling caused by irregular nervous control of the blood vessels in the nose.
• Medication-related (rhinitis medicamentosa): Long-term or incorrect use of decongestant nasal sprays can lead to a dependency-forming swelling.

In children, allergy-related turbinate enlargement can also be associated with fluid behind the eardrum and recurrent ear infections, so this complaint should not be taken lightly in children.

An important difference for treatment: because the bone does not change in allergic enlargement, if surgery is needed, reducing only the soft tissue (mucosa) is enough. But if the underlying allergy is not brought under control, the risk of the enlargement coming back after the procedure increases. That is why it is important to treat the allergy alongside radiofrequency.

Is radiofrequency done in the clinic under local anaesthesia?

Yes. The procedure is done in the clinic under local anaesthesia, after numbing the area with a medication applied inside the nose. No hospital stay or general anaesthesia is needed.

How long does the procedure take, and when does it work?

The procedure itself takes about 15 minutes. During the application we can see the turbinate visibly shrink, but because the procedure also causes some swelling, the nose may not feel fully open in the first few days. Clear relief usually starts from day 2 or 3. I recommend rinsing the nose with salt water for 2 weeks after the procedure; this supports healing.

Can turbinate reduction be done together with septoplasty?

Yes, the two are often done together. In fact, whenever I plan a septoplasty I routinely assess whether the patient also needs turbinate radiofrequency, because a deviated septum and enlarged turbinates are often problems that go hand in hand.

Are the results of radiofrequency permanent?

In most patients it gives long-lasting, satisfying relief, but “permanent” would not be quite accurate: in some patients the turbinate can enlarge again over time. In a large group of patients in the literature, treatment proved insufficient during follow-up in about 13% and a further procedure was needed; in most of these (9%) the problem was solved by repeating the radiofrequency, with no additional complications after the repeat procedure.

There are also clues as to who is more likely to need a repeat: older age, some accompanying health conditions (such as diabetes, sleep apnoea or high blood pressure) and more advanced turbinate enlargement increase the chance of a further procedure. So in most patients the result is close to permanent, but some may need reassessment over time.