Most people with rhinitis are successfully managed with a combination of allergy avoidance and medical therapies, including antihistamine medication, topical steroid nasal sprays and salt water douching or sprays. Occasionally, stronger treatment is required in the form of steroid nose drops or even a short course of an oral steroid, which may be used, for example, in patients with very severe intermittent symptoms caused by an allergy.
However there are certain situations in which surgery may have a role.
Indications for surgery in allergic rhinitis:
• Persistent symptoms resistant to medical treatment
• Anatomically large, swollen intranasal tissue (inferior turbinates)
Surgery in general involves either reducing the mucosal lining of the turbinates only, or resection or reduction of the inferior turbinates themselves. The inferior turbinates are structures within the nose that swell up in response to allergy or infection. Excessive and persistent exposure to an allergen can result in swelling to such a degree that causes a permanent enlargement of these turbinates. This results in nasal block, which cannot always be reversed by medications alone.
- Diathermy either linear (along the surface) or sub mucous (i.e. beneath the surface).
- Radiofrequency reduction
Inferior turbinate reduction
- Resection: Total resection restores the intranasal airway but can be associated with problems with crusting and bleeding because of destruction of the highly specialised mucosal lining. Because of these shortcomings, this procedure is rarely performed nowadays.
- Reduction: This involves reduction of the mucosal surface only. Improvement in the nasal airway does occur but the benefits are generally short-lived and the procedure often needs to be repeated. Diathermy is the most commonly adopted technique
- Turbinoplasty: In this procedure, the outer part of the inferior turbinate is removed, leaving the inner mucosal lining intact which is crucial in restoring normal nasal physiology.
Advantages of the mucosal reduction techniques are that they are generally less invasive with fewer complications, although this can mean that symptoms may recur after a few months or years. The procedure can however be repeated.
With regard to inferior turbinate reduction, advantages of the turbinoplasty technique over simple reduction include considerably less intraoperative bleeding, reduced likelihood of long-term crusting owing to preservation of the mucosa, and persistence of benefits in the long-term. This lower morbidity operation therefore offers the same advantages of both of the above alternative procedures without the associated disadvantages and is the procedure of choice in most patients.
Risks following turbinate reduction surgery
Turbinate surgery is a safe, low risk surgical procedure that is very effective in most cases. There are some possible complications and/or side effects that can happen as is the case after any surgical procedure. These include:
- Bleeding: This is an expected side effect following nasal surgery and usually lasts no more than a few days, occasionally lasting up to two weeks in some patients.
- Infection: This occurs in about 1 in 10 patients and can be treated with antibiotics.
- Pain/discomfort: The nose may be a little sore and this can usually be easily managed with simple painkillers.
- Blocked nose: It is expected that the nose will get more and more blocked after the surgery during the first seven to ten days, and then will gradually clear, usually taking three to four weeks and sometimes a little longer to clear fully.
- Adhesions/scarring: This can rarely happen if turbinate surgery is carried out at the same time as septoplasty. In some cases the scar tissue may need to be removed with another small operation.
- Persisting nasal block: It is possible that some restriction of nasal breathing may persist after the healing process has taken place. This could be due to a persisting residual turbinate swelling, or recurrent swelling, or due to another problem such as a nasal valve weakness or deviated nasal septum that was not corrected at the time of the original surgery.
- Atrophic rhinitis / empty nose syndrome. This is a risk that can rarely occur after turbinate reduction. It was more common in the past when more aggressive surgical techniques were used to remove the bulk of the turbinate tissue. The techniques currently used for turbinate reduction are very much more minimally invasive and gentle, involving cauterization or sub mucosal resection leaving the surface tissue intact. These procedures vastly reduce the risk of this complication.
Postoperative advice and preparation:
It is advised that you avoid contact with people and dirty/dusty environments for a period of one week after the surgery. For most people this means one week off work (or work from home if your job allows), although a longer period of recovery might be needed if septoplasty or other nasal surgery is carried out at the same time. This is to reduce your risk of getting an infection or virus.
You should also avoid any exercise/gym for one week otherwise your blood pressure might go up and cause more bleeding. After this time you can resume exercise gently to start with.
Please also avoid heavy lifting during the first one to two weeks.
Regarding blowing your nose, try to avoid this for two to three days then you can start blowing your nose gently. During this period, if you feel that you are going to sneeze, keep your mouth open so the pressure does not cause pain in the nose or bleeding.