Do I need sinus surgery?

I get a lot of questions asking about having surgery of the turbinates. Here are some answers.

What are turbinates?

The turbinates are shelves on the side of the nose. The main ones are the middle and the inferior. They normally enlarge and shrink. They especially enlarge with a cold or infection because blood is coming to the area to fight infection. They enlarge with allergy, and become pale and swollen.

Sometimes they happen to be swollen on the day you see the doctor, and if you are complaining that your breathing feels blocked, it makes sense to reduce their size. Enlargement of the turbinates can, at times, be seen on an X- ray.


What Do Turbinates Do?

The turbinates serve a major function. They warm inhaled air before it enters the lungs. They are covered by millions of cilia which defend the body against contaigons and irritants in the inhaled air. They provide an environment for the good white blood cells, and a bacteria-fighting enzyme called lysozyme, to gather and fight infection. They act as a baffle to better direct the flow of air.

No matter how much your turbinates seem to cause you trouble, you don’t want to just remove them. If you did, you would have dryness, crusting and sensations of burning pain. Doctors have therefore come up with various ways to reduce the blockage of your nasal passages without removing your turbinates and their cilia.

Surgery Methods

One technique is to just remove a small amount, not enough to take away too much cilia. In certain cases the position of the turbinates is such that the middle turbinate blocks sinus drainage. Here it is necessary to modify the turbinate to allow sinus drainage. Whatever is done to the turbinates, however, there are different ways of doing it.

One procedure is called a submucus resection of the turbinates. This means that you make an incision and lift up the turbinate skin called mucosa. Then you remove the bone so that the turbinate assumes a new position, close to the side walls. This technique usually preserves the cilia and all functions.

In yet another procedure, the turbinate is scored either with acid or a laser. Parallel lines are drawn with spaces in-between. Unfortunately, with this method you lose good cilia. A laser can be directed under the mucosa, so it only affects the tissue under the turbinate covering. I have seen patients loose some ciliary function with this method.

The physicians in our medical group use a radio frequency current to coagulate the material under the mucosa. This therapy is precisely directed, and does not damage nearby tissue as do other methods which generate heat. . It seems to be the best approach. It is an office procedure and is painless. This is the same system we use for snoring surgery or Somnoplasty, done in our office.

Sleeping and Turbinates

The turbinates are important for the sleep mechanism. When you sleep, you are supposed to turn some 50 times a night. This prevents you from getting pressure sores. What happens is that you sleep on the right side, with the right turbinate down. After a time, this right turbinate fills up with fluid, and expands so that it pushes against the septum in the mid line and this makes you turn on the left side until that side fills up and turns you again. This is why when you sleep cramped, where you can’t turn, you get achey muscles and bed sores.

Turbinates and The Common Cold

Many factors contribute to getting colds, some rather surprising. It is generally believed that the viruses spread more easily during winter because we tend to spend more time indoors in poorly ventilated rooms. Another factor could be that sunlight kills viruses and that there is far less sunlight during the dark days of winter. However, in recent years these explanations of the seasonality of common colds have been modified as scientists have realized that changes in the weather affect humans in unexpected ways. The cold wet weather and lack of sunlight certainly makes many of us feel ‘under the weather’, or depressed, and these psychological changes can reduce the effectiveness of our immune system. However, not everyone who lives in cold places gets colds frequently, so there are other factors which we are still trying to figure out.

We do know that poor ciliary function increases the risk of contracting a cold. This is one of the reasons that getting chilled is associated with contracting a cold: when one gets chilled, the ciliary function is decreased.

Pulsatile nasal irrigation helps improve poor turbinate function. The pulsating action of the saline beating against the cilia help the cilia come back to moving at their normal speed. The pulsation also acts in a massaging manner to bring more circulation to the turbinates. The rinsing action of the saline removes thick mucus, which allows the turbinate cilia to recover. The removal of certain virus receptors called ICAM 1 and bacteria may help significantly in reducing colds.

Strange as it may seem, the cilia of the oyster work the same as the cilia of the nose and respiratory tract. If the water is stagnant, the cilia slow down. If you agitate the water, the cilia speed up. In humans, the pulsating saline provides the agitation to speed up the ciliary motion to the speed of healthy cilia.

More Information

A good explanation of many sinus and ear nose and throat topics is given here.