In a healthy individual, the histamine liberated by antibody sensitization in the nose area, is almost immediately neutralized. This does not happen in those individuals who, because of genetic predisposition, have a reduced capacity to metabolize histamine, with subsequent developing of chronic inflammation of the mucosa in the inferior turbinates.
In case of allergic rhinitis due to nasal mucosa sensitization by pollen (pollinosis), animal epidermal residues (cats and dogs hair), fungus spores (mould) or environmental dust (dust mites), the nasal reactions in the corpus cavernosum of the turbinates occur only when the antigen load is sufficiently high. The reactions can thus be seasonal (grass allergic rhinitis) or perpetual (dust mites allergic rhinitis).
In simple vasomotor or pseudo allergic rhinitis, the lack of natural antihistaminic power in the nasal mucosa allows histaminic reactions every time that even non-specific stimuli (cold, heat, sunlight) cause the liberation of histamine in the inferior turbinates.
INFERIOR TURBINATES HYPERTROPHY: SYMPTOMS AND COMPLICATIONS
– Nasal obstruction, more pronounced when lying or sleeping.
– Alternation of closed nasal cavity (some hours on the left side, others on the right)
– Increased mucus and phlegm production, dripping down the throat
– Frequent headaches with no apparent reason
– Nasal polyps
– Chronic sinusitis
– Frequent colds that heal slowly and with difficulty
– Proneness to sneezing
– Sleeping apnea
– Socially disturbing snoring
– Reduced sense of smell
– Muffled ear and reduced sense of hearing
– Frequent otitis
– Dry tickly cough
– Bronchial asthma
– Decongestant spray abuse and addiction (Azelastine spray, Naphazoline spray and others)
VASOMOTOR RHINITIS AND TURBINATES HYPERTROPHY DIAGNOSIS
Stage one necessary expert analysis:
– Digital video fibroscopy of nasal cavities, nasopharynx and larynx
– Micro video otoscopy
– Skin Prick Testing for inhalant allergy
Additional examinations if the specialist identifies any specific risk factor for specific complications or were there any diagnostic uncertainty:
– Maxillofacial CT without contrast (useful for the study of nasopharyngeal polyps and some forms of hyperplastic chronic rhino-sinusitis)
– Home digital Polysomnography (recommended when nasal obstruction is part of a respiratory obstructive sleep apnea syndrome)
– Rhinomanometry (useful to understand if a nasal obstruction is not due to the turbinates, but to nasal bone deviation)
– Spirometry (In patients suffering also from bronchial asthma)
– Nasal cytology (refinement of diagnosis in case of vasomotor allergic rhinitis)
SIMPLE VASOMOTOR RHINITIS DRUG THERAPY
– Cortisone based nasal spray (recommended for therapy cycles of no less than three weeks. An excessive use could thin the respiratory nasal mucosa, causing frequent and abundant bleeding and dry nose)
– Systemic administration of antihistaminic pills (drugs of this category can cause, to varying degrees, day sleepiness and slow reflexes)
– Nasal cavities washing with sterile saline solutions
– Inhalation therapy at thermal baths
– Local or general antibiotic therapy (when, together with inferior turbinates hypertrophy, a bacterial infection is also identified)
– Nasal strip (recommended as night nasal obstruction adjuvant)
– Decongestant sprays or endonasal vasoconstrictor (their frequent use, or even abuse, can cause an additional disease: drug induced rhinitis, which is incurable because the corpus cavernosum of the turbinates loses its flexibility and becomes permanently obstructed)
TURBINATE SURGERY TO CURE VASOMOTOR RHINITIS
Surgical treatment of turbinate hypertrophy involves operating under general anesthesia with nasal tampon, or ambulatory treatment under local anesthesia without nasal tampon, which can be considered a good innovation in nasal surgery.
According to the specialist’s diagnosis a procedure will be recommended, either in surgery or ambulatory.
Treatments under general anesthesia (surgery):
– Inferior turbinates reduction with CO2 laser
– Inferior turbinates reduction with Nd:YAG laser
– Inferior turbinates reduction with diodes laser
– Computerized radio-frequency decongestion of inferior turbinates sub-mucosa
– Inferior turbinates reduction with Argon Plasma
INFERIOR TURBINATES DECONGESTION AND REDUCTION WITH LASER