Imaging Studies
Sinus CT scanning is useful for delineating the extent of disease in patients who have underlying chronic rhinosinusitis or acute recurrent rhinosinusitis. Anatomic relationships between the middle turbinate, the septum, and lateral nasal wall may also be useful in the evaluation of nasal headaches. Preferred scans are those in a coronal plane with 2- to 3-mm thickness and bony windows. Contrast is not helpful. See Nasal Cavity Anatomy, Physiology, and Anomalies on CT Scan.
Other Tests
Rhinomanometric testing is useful as a research tool to evaluate certain parameters of nasal airflow. Rhinomanometry is most useful for comparing nasal airflow from side to side and also in the preoperative evaluation of nasal airflow as compared with the postoperative situation. See the Medscape Reference article Nasal Physiology.
Histologic Findings
Eosinophilic infiltration of the mucosal membranes leads to suspicion of allergic causes for turbinate inflammation. Infiltration by other inflammatory cells is also observed but is less diagnostic.
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Normal-sized right inferior turbinate with a moderate inferior septal deflection.
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Bony hypertrophy of the right inferior turbinate following topical vasoconstriction.
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Mucosal hypertrophy of the right inferior turbinate with total airway obstruction.
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Mucosal hypertrophy of the left inferior turbinate with impingement of the septum and narrowed nasal airway.
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A stab incision is made at the anterior head of the inferior turbinate. Blunt dissection beneath the mucoperiosteum elevates tissue for subsequent microdebridement. The microdebrider is turned in all directions, but mucosa is entirely preserved. Video courtesy of Vijay R Ramakrishnan, MD.