Inferior Turbinate Enlargement

The inferior turbinates are long, narrow structures along the side walls of the nose. They play a crucial role in humidifying, warming, and filtering the air we breathe. They also contain airflow receptors, which signal the sensation of air entry to the brain, and their torpedo shape helps direct a smooth, laminar stream of air from the front to the back of the nose.

When enlarged, however, the turbinates can obstruct airflow — particularly at night or during physical exertion — leading to persistent nasal congestion.

Despite the common label of “inferior turbinate hypertrophy,” this term is often inaccurate. In most cases, the issue is vascular engorgement, not permanent overgrowth. The distinction is critical to appropriate diagnosis and treatment.

Mr Patel recognises that most cases of turbinate enlargement are not caused by structural hypertrophy but by tissue engorgement — a dynamic, reversible process driven by vascular dilation.

This explains why many patients experience immediate relief with vasoconstrictors (e.g. xylometazoline). True hypertrophy would not resolve so quickly.

Understanding this difference is central to Mr Patel’s approach. He uses structured, physiology-first testing to determine whether the problem is mucosal, structural, or mixed — and tailors treatment accordingly.

• Persistent, fluctuating or alternating nasal blockage
• Difficulty breathing through the nose, especially at night
• Snoring or mouth breathing
• Sensation of a congested nose
• Reliance on nasal sprays to relieve obstruction
• Poor nasal airflow during exercise or speech

Mr Patel performs a detailed same-day assessment, including:

• Nasal endoscopy to examine turbinate anatomy and other nasal structures
• Nasal Inspiratory Peak Flow (NIPF) testing before and after decongestant use, helping distinguish turbinate engorgement from more fixed causes such as septal deviation or nasal valve collapse
• Holistic evaluation of coexisting contributors, including allergy and structural abnormalities

Medical

• Nasal steroid sprays
• Salt water irrigation
• Short-term nasal decongestants (with caution)

Surgical

There are several techniques available to reduce turbinate size. These include:

• Outfracture for bony enlargement
• Coblation or radiofrequency turbinate reduction
• Microdebrider-assisted turbinoplasty
• Partial or total turbinate resection
• Posterolateral nasal artery (PLNA) ligation

Mr Patel selectively offers only those techniques that align with his function-preserving philosophy.

Not all enlarged turbinates need surgery. Mr Patel’s priority is to identify whether the enlargement is reversible mucosal engorgement or bony hypertrophy, and to address the underlying cause — not just the symptoms.

He aims to preserve normal turbinate function, including its shape, sensory receptors, and surface area, avoiding techniques that remove or destroy these critical structures.

Where surgical reduction is required, Mr Patel prefers PLNA ligation, which addresses the underlying vascular cause by reducing blood flow to the turbinate. For patients undergoing concurrent procedures (such as septoplasty), he may offer more limited techniques where appropriate.

• Mr Patel is one of very few UK surgeons offering PLNA ligation for turbinoplasty
• Recognition that most turbinate enlargement is reversible engorgement, not hypertrophy
• Objective differentiation of dynamic vs fixed obstruction using pre- and post-decongestion NIPF testing
• Thorough evaluation of the internal nasal valve and coexisting structural issues
• Commitment to preserving turbinate function
• Objective outcome tracking using NIPF and PROMs
• Clear, honest advice when surgery is not required

All patients undergoing PLNA Ligation surgery under Mr Patel’s care are monitored using both objective airflow testing and patient-reported outcome measures. This allows for transparent, data-driven evaluation of results.

Nasal Airflow Improvement

Patients experience an average 48% increase in nasal airflow at 3 months following PLNA Ligation, as measured by Nasal Inspiratory Peak Flow (NIPF) testing.

Note: All measurements are taken without nasal decongestants to reflect natural breathing capacity.

Symptom Reduction

On average, patients report a 91% reduction in nasal obstruction symptoms at 3 months post-operatively, based on NOSE scores.

Safety Data

No patients have experienced a post operate haemorrhage following PLNA Ligation. Post operative haemorrhage can be seen more frequently with some more aggressive techniques for turbinate reduction