Imaging Studies

CT

CT is not indicated in the workup of inferior turbinate hypertrophy alone. However, if a CT scan of the head, facial bones, or sinuses has been obtained for other reasons, it may provide useful information. Axial and particularly coronal images can help assess the amount of bony versus mucosal hypertrophy.

If clinical presentation raises the concern of other obstructive processes such as nasal polyps or masses, perform CT imaging of the nose and sinuses.

Rhinomanometry

Rhinomanometry is a technique for measuring nasal airway resistance. It is limited in that it does not provide a diagnosis or etiology of the obstruction. It provides a measure of nasal resistance at a specific time.

Perform the technique by applying a tight-fitting mask with a central aperture connected to a low-resistance pneumotachograph flow meter. Measure transnasal pressure at the nostril with a catheter with a pressure-tight seal. A second catheter measures air pressure in the mask. The catheters are attached to a differential pressure transducer and the outputs are recorded as a pressure flow diagram.

This technology has been used in a variety of studies to document changes in nasal resistance with nasal surgery. It has also been used to try and differentiate mucosal from bony hypertrophy with variable results. The use of this technique in routine clinical practice has not been demonstrated.

Allergy testing

The microscopic analysis of nasal mucus for eosinophils can be useful in making the diagnosis of allergic rhinitis.

Patients with allergic rhinitis that is not responsive to medications such as topical corticosteroids and antihistamines may benefit from allergy testing and possible immunotherapy.

Rigid nasal endoscopy

When indicated by clinical presentation, more extensive examination of the nose can be performed with a rigid or flexible endoscope. This examination allows additional assessment of the septum posteriorly, the nasopharynx, and the sinus ostia. Nasal masses or polyps as a cause of obstruction can be evaluated.

Purulent drainage may indicate sinusitis. Evidence of a septal perforation may indicate prior surgery, cocaine or topical decongestant abuse, or an inflammatory disease. Significant crusting or abnormality of the mucosal appearance may indicate a systemic disorder.

Treatment & Management

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Media Gallery

(A) Endoscopic view of left nares showing caudal septal deflection to the left. (B) Endoscopic view of right nares showing compensatory right inferior turbinate hypertrophy.
Lateral outfracture.
Intramural cautery.
Submucous resection.
Partial inferior turbinectomy.
Inferior turbinoplasty.
Total inferior turbinectomy.

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Author

Elizabeth Whitaker, MD, FACS Clinical Assistant Professor, Department of Otolaryngology, Division of Facial Plastic Surgery, Atlanta Surgical Group, PC

Elizabeth Whitaker, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American College of Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

George Peck, MD

George Peck, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery

Disclosure: Nothing to disclose.

Chief Editor

Mark S Granick, MD, FACS Professor of Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School; Professor of Surgery, Rutgers Robert Wood Johnson Medical School; Medical Director, University Hospital Wound Care Center

Mark S Granick, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American College of Surgeons, American Society of Plastic Surgeons, New Jersey Society of Plastic Surgeons, Northeastern Society of Plastic Surgeons, Phi Beta Kappa, Wound Healing Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: PolarityTE; Misonix<br/>Serve(d) as a speaker or a member of a speakers bureau for: Misonix, PolarityTE<br/>Received income in an amount equal to or greater than $250 from: Misonix, PolarityTE.

Additional Contributors

Frederick J Menick, MD Clinical Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Arizona College of Medicine; Facial and Nasal Reconstructive Surgeon, Tucson, Arizona

Frederick J Menick, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Canadian Society of Plastic Surgeons

Disclosure: receive royalities as author of textbook aesthetic nasal reconstruction for: aesthetic nasal reconstruction.com.