Enlarged Nasal Turbinates: Examination and Surgery (Turbinoplasty)
The nasal turbinates – also known as the nasal conchae or erectile tissue of the nose – warm and humidify the air you breathe in. When they become enlarged, they can block the nose, especially at night, and many people end up using decongestant nasal spray every day.
At Charlottenlund Private Hospital, the cause of nasal congestion is assessed by specialists in ear, nose and throat conditions. Overuse of nasal spray is gradually reduced, and when medical treatment is not sufficient, the nasal turbinates can be reduced with endoscopic surgery (turbinoplasty).
What are nasal turbinates?
The nasal turbinates, conchae nasales, are erectile structures that fill part of the nasal cavity. There are three on each side: an upper, middle and lower turbinate.
The small nerve fibres responsible for the sense of smell are located around the upper turbinate. The middle turbinate lies opposite the opening to the maxillary sinus, while the lower turbinate is located at the bottom of the nose, exactly where the air needs to pass.
The turbinates have a rich blood supply and are therefore warm and moist. This is how they warm and humidify the air and trap dust and particles before the air reaches the lungs.
They are also commonly referred to as nasal conchae because each turbinate is built around a thin, shell-shaped bone.
Why do the nasal turbinates become enlarged?
It is not known exactly why the turbinates begin to enlarge in some people. Irritation from smoking and allergies is thought to contribute.
If the nasal septum deviates to one side, the inferior turbinate often enlarges on the opposite, more spacious side. This is known as compensatory turbinate hypertrophy and is a well-recognised condition.
According to a review article in Ugeskrift for Læger, both conditions should be corrected during the same procedure when nasal congestion is caused by both a deviated nasal septum and enlarged turbinates.
Long-term use of over-the-counter nasal spray for a blocked nose can itself cause the mucous membrane covering the turbinates to become thicker.
What symptoms do enlarged nasal turbinates cause?
The typical symptom is nasal congestion affecting one side, alternating between sides or completely blocking the nose. It is almost always worse at night and when lying down.
Many people snore, sleep poorly and wake up with a dry mouth. Enlarged turbinates may also contribute to facial pressure, a reduced sense of smell and frequent sinus infections.
One characteristic feature is that over-the-counter decongestant nasal spray works particularly well because it causes the mucous membrane to shrink. With a deviated nasal septum, where the obstruction is caused by cartilage and bone, the effect is much smaller.
Can you become dependent on nasal spray?
Yes. Over-the-counter decongestant nasal sprays cause the mucous membrane to shrink and are intended only for short-term use. According to the Danish Rhinological Society, they should not be used for more than 10 days.
If they are used for longer, the mucous membrane becomes accustomed to them, the nose becomes blocked again more quickly and the spray has to be used more often. This creates a vicious cycle known as rhinitis medicamentosa.
According to a 2025 review article in Ugeskrift for Læger, this affects 1–7% of patients seen by ear, nose and throat specialists, and many people are unaware that the spray itself is causing the problem.
The first step is therefore always to stop overusing the spray. The specialist can help you gradually reduce its use and may start treatment with a corticosteroid nasal spray – a different type of spray that reduces swelling without causing dependence.
How is the nose examined?
The specialist examines the inside of the nose using a thin endoscope and assesses the size of the turbinates, the shape of the nasal septum and any signs of nasal polyps or sinusitis.
Cotton wool containing a medication that causes the mucous membrane to shrink is then placed in the nose, allowing you to notice how much your airflow improves.
This test shows how much of the problem is caused by the turbinates and therefore what improvement can reasonably be expected from surgery.
If allergy is suspected, the examination is supplemented with allergy testing, and in some cases a CT scan of the sinuses is reviewed.
If the examination shows that another procedure would be more appropriate – for example correction of the nasal septum or external nose – the options are discussed during the same appointment.
How are enlarged nasal turbinates treated without surgery?
Surgery is never the first choice.
Any overuse of over-the-counter decongestant nasal spray is stopped first, and treatment with a corticosteroid nasal spray and saline nasal rinsing is tried. If there is an allergy, this is treated as well.
If medical treatment has not already been attempted, it is started and followed up at Charlottenlund Private Hospital.
Surgery is only considered if these measures do not provide sufficient airflow through the nose.
How is a turbinoplasty performed?
A turbinoplasty is an endoscopic procedure in which the surgeon removes excess tissue from the inferior turbinates through the nostrils – on one or both sides.
The operation is always performed under general anaesthesia and takes approximately 30–45 minutes.
The entire procedure is performed through the nostrils, so there are no visible scars and the appearance of the nose does not change.
The operation can be performed on its own or together with correction of the nasal septum or sinus surgery. In these cases, the procedure takes longer.
You are observed after the operation and can go home the same day.
How long do you need to take off work after a turbinoplasty?
Most people return to work within one week, while strenuous physical work and sport should be avoided for around 14 days.
During the first few days, the nose will feel blocked and there may be mild discomfort.
The turbinates have a rich blood supply, so mild bleeding or blood-stained discharge may occur for up to a week.
On the day of surgery, the specialist will explain the recovery process, pain relief and how to rinse the nose.
Heavy or persistent bleeding after surgery should be assessed by a doctor.
When should you see a doctor?
A nose that has been blocked for several months, interferes with sleep or can only be kept open with daily use of over-the-counter nasal spray should be assessed by an ear, nose and throat specialist.
The same applies if you cannot stop using the spray for more than a few days at a time.
Nasal congestion affecting only one side, particularly when accompanied by blood-stained discharge, should always be investigated.
A deviated nasal septum and enlarged nasal turbinates often occur together
The two procedures can be performed under the same anaesthetic.
The treatment pathway at Charlottenlund Private Hospital
The treatment pathway begins with a preliminary examination by an ear, nose and throat specialist – either in Charlottenlund or at one of the hospital's other locations.
The diagnosis is established, any overuse of nasal spray is gradually reduced and medical treatment is tried.
If surgery becomes necessary, it is agreed whether the turbinates should be operated on alone or together with the nasal septum or sinuses.
The operation is performed in Charlottenlund by ear, nose and throat specialists, including Jacob Fisker and Kåre Håkansson.
Referral and payment
Most patients at Charlottenlund Private Hospital are treated through private health insurance. Insurance companies typically require a referral from your GP and prior approval.
Self-paying patients do not require a referral, and prices are available in the price list.
If the waiting time in the public healthcare system exceeds 30 days, you may be entitled to treatment paid for by the region through the extended free choice of hospital scheme.
The hospital also has a public-sector agreement within the ear, nose and throat specialty for patients referred from the Capital Region of Denmark. This treatment is provided in Charlottenlund.
The two procedures can be performed under the same anaesthetic.
Frequently asked questions
What are nasal turbinates?
The nasal turbinates, or conchae nasales, are structures of erectile tissue that fill the nasal cavity. There are three on each side—one upper, one middle and one lower.
The tiny nerves involved in the sense of smell lie around the upper turbinate. The middle turbinate is level with the opening to the maxillary sinus, while the lower turbinate lies at the bottom of the nose, right where the air needs to pass through. These structures have a rich blood supply, which keeps them warm and moist. This allows them to humidify and warm the air before it reaches the lungs, and to trap foreign particles in the air before they reach the lungs.
How do enlarged nasal turbinates develop?
We do not know exactly why some turbinates begin to grow. Irritation from smoking and allergies is thought to contribute, as is the fact that in some cases the turbinate on one side grows when the nasal septum bends towards the opposite side. This is known as reactive turbinate hypertrophy and is very well recognised.
Most patients with enlarged nasal turbinates get significant relief from over-the-counter nasal spray, as it causes the lining of the nose to shrink. Patients also find that their symptoms get worse when they lie down. This combination is very typical of the patients we see with enlarged nasal turbinates.
When should enlarged nasal turbinates be treated?
Most people experience one or both sides of their nose becoming blocked when they have a cold. If the symptoms persist, many turn to over-the-counter nasal spray for a blocked nose—and can quickly become dependent on it. Over time, this makes the nose more congested. The first step is therefore always to stop any overuse of over-the-counter nasal spray; a specialist can help you taper off and start an alternative treatment. Surgery is only considered if this is not enough. Surgery is never the first choice.
How long do you need to take off work after a turbinoplasty?
Most people return to work within a week. Strenuous physical work and sports should be avoided for about 14 days, and slight bleeding may occur for up to a week.
Can you become dependent on nasal spray?
Yes. Over-the-counter nasal spray for a blocked nose should not be used for more than 10 days. With prolonged use, the lining of the nose becomes used to the spray and the nose becomes more blocked. A specialist can help you taper off.