The Anatomy of the Inferior Nasal Concha

The inferior nasal concha is a scroll-shaped, paired bone that rests at the lateral wall of the nasal cavity. It helps to filter and humidify the air that we breathe. The nasal conchae (plural of concha) are also sometimes called turbinates.

Anatomy

The inferior nasal conchae are a pair of bones, with one concha on either side, that separates the middle and lower nasal meatus, or nasal cavity.

They are often described as being "spongy" bones. While the superior and middle nasal conchae are technically part of the ethmoid bone, the inferior nasal concha forms a completely separate bone.

Function

Along with the superior and middle nasal conchae, the inferior nasal concha works to filter, humidify, and warm the air that we breathe preventing cold air from reaching the lungs. The nasal conchae are able to accomplish this by increasing the surface area of the nasal cavities.

Additionally, these bones are lined with mucous membranes containing cilia. Cilia are tiny hairs that function to sweep mucus and filtered debris towards the nasopharynx where it can be swallowed, (rather than entering the lungs).

Associated Conditions

The blood vessels lining the nasal concha can become inflamed and enlarged resulting in increased mucus production.

Enlarged nasal concha, (also called turbinate hypertrophy or just enlarged turbinates), may be temporary or chronic depending on the root cause. Upper respiratory infections and the common cold are typically to blame and you may periodically experience temporary enlargement of your nasal concha throughout your life.

Symptoms of enlarged nasal concha may include:

• Congestion
• Runny nose
• Nasal obstruction
• Difficulty breathing
• Sleep apnea
• Post-nasal drip

Causes of enlarged turbinates that may be more chronic in nature can include severe allergies, (especially environmental allergies to mold, pollen or dust mites), and chronic sinusitis.

Some people may be born with large nasal concha. Enlarged nasal concha often occurs in conjunction with another condition called deviated septum and surgery to repair these conditions is often done simultaneously.

The parasympathetic nervous system supplies the nasal concha and any medication or underlying disease process that affects this part of the nervous system can also cause symptoms such as nasal congestion, runny nose, post-nasal drip, and difficulty breathing.

Treatment

Over-the-counter nasal decongestants such as phenylephrine and oxymetazoline are often used to reduce these symptoms caused by enlarged nasal concha. They should not be used more than three days in a row, however, to avoid rebound congestion. Oral decongestants such as pseudoephedrine may be better options if decongestants need to be used longer than three days.

Treatment of allergies may include the use of decongestants, trigger avoidance, antihistamines, or immunotherapy. Persistent (chronic) turbinate dysfunction may affect up to 40% of the population so it is a very common condition.

Surgical Reduction of the Nasal Concha

When medications such as decongestants or antihistamines have failed to control the symptoms of chronic turbinate dysfunction surgical reduction of the nasal concha may be necessary.

The procedure is usually performed using an endoscope. The surgeon goes in through the nostrils so no external incision needs to be made. Parts of the bone, the mucosa, or both may be removed in an effort to reduce the size of the inferior nasal concha.

Since other nose and sinus problems often occur simultaneously with enlarged turbinates other procedures including septoplasty or ethmoidectomy often are done at the same time as a turbinate reduction.

Other Surgical Techniques

Other surgical techniques may be used to perform a resection of the inferior nasal concha but are not as common since they require the use of costly equipment. These may include the use of cryosurgery, radiofrequency ablation, or superficial thermal ablation. The surgeon may not decide which technique to use until the procedure is underway and he is able to fully visualize the nasal concha.

After Surgery

Removing too much of the inferior nasal concha can impair its ability to humidify the air we breathe and results in a condition called dry nose syndrome or empty nose syndrome.

After surgery to reduce the inferior nasal concha you can expect to have some pain and burning in your nose or sinuses. It is also common to have a bloody nose for a few days. Your healthcare provider or nurse will give you detailed instructions about what to expect and how to take care of yourself following surgery. You should take care to follow these instructions precisely.