They are elongated bone structures, covered with nasal mucosa, which project from the nasal side walls and extend along the entire nasal airway.
In adults, the inferior turbinate is about the size of an index finger and the middle turbinate is about the size of the little finger.
They are the mucosal structures and most important moisture secretion of the nose.
They serve to regulate the heat (at body temperature). Humidify (at 98% humidity), filter, pressurize, elevate and optimize the air that flows through the nose.
They provide most of the nasal mucosa for air to flow and in doing so act as radiators, humidifiers and nose filters.
The unique air conditioning and processing conditions provided by the turbinates are important not only for adequate lung function, but also for maintaining the health, function and integrity of the rest of the nasal mucosa.
This is essentially the organ system of the nose, as it covers all the internal nasal chambers and the sinus cavities.
Turbinates, particularly lower ones, also play a crucial role in protecting the pharynx and larynx against the direct effect of airflow and dryness.
The turbinates are also highly innervated with pressure sensing receptors (cranial trigeminal nerve) that sense the flow of air and notify the brain that enough air passes through the nose to sustain life.
If most of these receptors disappear, nasal breathing becomes unsatisfactory, even if there is no structural blockage. This is called ‘paradoxical obstruction’ and is very common. This lack of air flow sensation causes much anguish and morbidity to the feeling of well-being.
Turbinates, especially lower ones, also provide most of the nasal resistance to the lungs.
The lungs need some resistance to allow them to reach their proper inflation and deflation rates during inhalation and exhalation.
The nose supplies 50% of the total resistance to the lungs. The turbinates supply the majority of these 50%.
The function of nasal resistance
It is little researched and understood. It is well known from clinical observation that a very low nasal resistance can cause similar difficulties of pulmonary respiration and shortness of breath as there is too much resistance.
Healthy nasal breathing is essential to maintain all aspects of physical and mental health. The turbinates also trap more than 75% of the water vapor that comes back from the lungs when exhaling and thus help protect the body from dehydration.
The little-known naso-pulmonary reflex may also play a role in the cause of pulmonary restraint in patients.
The implication of turbinectomies
Sometimes the turbinates become chronically swollen in such a way that it causes too much nasal obstruction.
The otolaryngologists and plastic surgeons can reduce its volume by the surgical procedure known as turbinectomy.
However, this is a code name that can mean anything from a minimal reduction to the complete resection of a full turbinate.
In many patients, type ENS similar symptoms develop even after what appear to be conservative reductions of the turbinates.
Especially if they include the anterior portion of the inferior turbinates, which are essentially a vital part of the internal nasal valve. However, these symptoms will not be as severe as in the aggressive reductions of the turbinates.
By taking into account the nasal anatomy and physiology, it is very easy to see how an excessive resection of the inferior and / or middle nasal turbinates.
This will make the nasal chambers too empty, too wide and too dry, which creates a marked decline of all nasal functions and sensations.
This has a profound effect on the quality of life and the feeling of well-being of the patient.
The term “empty nose syndrome” was originally coined in the early 1990s by Dr. EB Kern (MD) who at the time was head of the otorhinolaryngology ward at the Mayo Clinic in Rochester, Minnesota, USA. UU
He and his colleagues began to notice that more and more patients who had undergone aggressive resections of their lower or middle turbinates seemed to develop symptoms of nasal obstruction and difficulty breathing. Although their noses seemed to be open, after partial or total turbinectomies.
Other characteristic symptoms were chronic nasal dryness, difficulty concentrating and, often, clinical depression .
They found that all these symptoms and more, in all the patients examined, developed only after their inferior or middle turbinate was aggressively resected.
All the patients had scans showing abnormally wide and empty nasal cavities, so they called it ” Empty nose syndrome “.