What the turbinates are and what they do
Inside each nostril, on the outer wall of the nose, there are three turbinates (also called conchae): the large inferior turbinate, the middle turbinate and the small superior turbinate. Their lining contains many blood vessels and glands. As air flows over them it is warmed to near body temperature, humidified and cleaned of dust and microbes, which are trapped in mucus and carried to the throat.
The turbinates swell and shrink in a normal «nasal cycle», so one side of the nose is usually a little more open than the other at any time. Lying on one side makes the lower turbinate swell, which is why many people feel blocked on the side they lie on at night.
Symptoms of swollen turbinates
- Long-lasting nasal blockage, often alternating from side to side.
- Worse when lying down and at night.
- Breathing through the mouth, dry mouth on waking and snoring.
- Postnasal drip, throat clearing and a sensation of mucus in the throat.
- Reduced sense of smell and a nasal-sounding voice.
- Headache or pressure around the nose, although sinus pain has other causes too.
Night-time blockage is explored further in blocked nose at night and in our guide to a stuffy nose.
Why turbinates become enlarged
- Allergic rhinitis: allergy to dust mites, pollen, pets or moulds causes swelling, sneezing, itching and a runny nose.
- Non-allergic rhinitis: swelling triggered by temperature changes, smells, smoke, spicy food or hormones; see non-allergic rhinitis.
- Rebound congestion (rhinitis medicamentosa): using decongestant sprays such as oxymetazoline for more than a few days makes the turbinates swell even more when the spray wears off.
- Infections: colds and sinusitis cause temporary swelling.
- Hormones and medicines: pregnancy, some blood pressure medicines and other drugs can enlarge the turbinates.
- Deviated septum: the turbinate on the wider side often enlarges to fill the extra space.
- Concha bullosa: an air pocket inside the middle turbinate makes it bulky; it is common and only matters if it causes blockage or sinus problems.
How an ENT specialist assesses the turbinates
The doctor looks inside the nose with a light, before and after a decongestant spray. If the turbinates shrink a lot with the spray, the swelling is mostly soft tissue and responds well to medical treatment or radiofrequency reduction; if they stay large, bone may be contributing. A thin camera (nasal endoscopy) shows the back of the nose, the middle turbinates, polyps and the septum. Allergy tests help if allergic rhinitis is suspected. A CT scan is not needed for turbinates alone but is used when sinus disease or surgery is being planned. Polyps, which are different from turbinates, are explained in nasal polyps.
First-line treatment
- Saline rinses: clean mucus and allergens and ease swelling; see neti pot sinus rinse.
- Steroid nasal sprays: reduce inflammation over 2 to 4 weeks of regular use, and work best with correct technique (aim slightly outwards, away from the septum).
- Antihistamine sprays or tablets: for allergic symptoms.
- Allergen avoidance: mite-proof covers, washing bedding hot, and keeping pets out of the bedroom if relevant.
- Stop decongestant sprays: if they have been used for more than a week, with a steroid spray to help through the rebound period.
- Immunotherapy: for selected people with proven allergy and persistent symptoms.
Turbinate reduction: when and how
If the nose stays blocked after a good trial of sprays, usually at least two to three months, turbinate reduction can help. The aim is to shrink the swollen tissue while preserving the lining that warms and humidifies the air. Common techniques are radiofrequency reduction, which uses controlled heat under the lining and can often be done under local anaesthetic, and submucosal reduction with a microdebrider, sometimes combined with gently moving the turbinate bone outwards (outfracture). It is frequently combined with septoplasty when the septum is deviated.
Recovery usually involves one to two weeks of crusting and congestion before breathing improves, with saline rinses during healing. Risks include bleeding, crusting and, if too much tissue were removed, a dry nose. Removing whole turbinates is avoided today because it is linked to empty nose syndrome, a rare condition in which the nose feels blocked despite being very open.
When to see a doctor
- Nasal blockage lasting more than a few weeks or affecting sleep.
- Dependence on decongestant sprays.
- Blockage on one side only that does not alternate, especially with bleeding or bloody discharge.
- Snoring with breathing pauses or daytime sleepiness.
- Loss of smell that does not recover.
- Facial swelling, eye swelling or severe headache with a blocked nose, which need urgent care.
Key points to remember
- Turbinates warm, humidify and filter air, and normally swell and shrink in a cycle.
- Persistent swelling causes a blocked nose, mouth breathing and snoring.
- Saline, steroid sprays and stopping decongestants help most people.
- Turbinate reduction that preserves the lining helps when medical treatment is not enough.
Questions about nasal turbinates
These answers are general information and do not replace an examination or individual medical advice.
Can swollen turbinates go back to normal?
Often, yes. Treating allergies or rhinitis, stopping decongestant overuse and using steroid sprays can shrink them over weeks.
Is turbinate reduction painful?
Most people describe discomfort and congestion rather than severe pain for one to two weeks. Radiofrequency reduction is usually the gentlest option.
Do turbinates grow back after reduction?
Some swelling can return over years, especially if allergies are not controlled, but most people keep a lasting improvement.
What is the difference between turbinates and polyps?
Turbinates are normal structures that can swell. Polyps are soft, painless growths of inflamed lining, usually from the sinuses.
Can swollen turbinates cause snoring?
Yes. A blocked nose forces mouth breathing and can make snoring and sleep-disordered breathing worse.
Why is my nose blocked on one side at night?
The turbinates on the lower side swell when you lie down. Persistent one-sided blockage should be examined.
Sources
- AAO-HNSF · Clinical practice guideline: Allergic rhinitis (update), 2015
- AAO-HNS · Clinical consensus statement: Septoplasty with or without inferior turbinate reduction (2015)
- NHS · Allergic rhinitis
- NHS · Non-allergic rhinitis
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.