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Friday, April 18, 2014
Ear, Nose, and Throat Disorders
Turbinate Surgery - Long-term Complications
What can you tell me about possible long-term complications or side effects from turbinate surgery? My doctor has told me I’m a candidate for the surgery to treat chronic rhinitis. I asked him about possible side effects and he said there are none. I find this hard to believe.
What are the possible long-term complications? What percent of people experience them? How severe are they? Is there any way to minimize possible post-surgical complications?
I’ve tried to do some initial research on the Internet. I’ve seen mention of crusting and atrophic rhinitis but I’m not sure what these are. I’ve also not been able to find any references to the severity or incidence of these side effects. Are they experienced by 1%? By 30%? Are they minor or can they be debilitating?
(A brief background on my situation. I’ve had chronic allergic rhinitis (dust mites) for over 20 years. I’m currently taking Allegra, Nasarel, and OTC generic Sudafed. I get some relief with each of these but continue to have daily post-nasal drip, fatigue, and congestion. In the past I’ve also tried Nasalcrom, Atrovent, Astelin, and allergy shots. I also diligently follow all the recommendations for dust mite avoidance)
Thank you very much for any information you can provide!
If in fact you do have allergic rhinitis, the first thing to do is maximize allergy treatment. It sounds as though you are making an effort to do just that, but you might consider pursuing immunotherapy once again.
Regarding turbinate surgery, I assume you are referring to the inferior turbinates. Reduction of the inferior turbinates is usually performed for hypertrophy (enlargement) and symptoms of nasal obstruction. There are a number of methods that have been utilized to reduce the turbinates, and this influences the likelihood of post-surgical complications.
The turbinates help to create turbulent airflow in the nose, and help to condition the air. Complete removal of the turbinates can lead to a more laminar flow pattern and a `sense` of nasal obstruction, even though anatomically the passage is wide open. A lack of conditioning can cause dryness and crusting in the nose (atrophic rhinitis), the severity of which can vary from mildly annoying to very debilitating. The incidence of this complication is difficult to pinpoint, as many studies report no such complication, while others report this complication with a frequency as high as 15% to 20%.
Most surgeons would try to avoid total turbinectomy for the reasons stated above. An alternative is to cauterize the turbinate tissue with either a laser or some sort of electric cautery. This creates a lot of crusting for several weeks, but this then resolves. The final improvement in the nasal airway is variable and somewhat unpredictable.
Another alternative is called a turbinoplasty, where an attempt is made to preserve the outer membrane of the turbinate, but remove the underlying bone and some of the soft tissue. This has the effect of reducing the size of the turbinate but preserving its mucosal function. This may be the best alternative, but is technically more difficult.
Your best bet is to discuss these options with your surgeon, and express your concerns.
Allen M Seiden, MD
Professor of Otolaryngology, Director of Division of Rhinology and Sinus Disorders, Director of University Taste and Smell Center, Director of University Sinus and Allergy
College of Medicine
University of Cincinnati