Do my Turbinates look normal?

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I have been struggling with nasal problems for years. Every single day, I feel extremely congested, especially, in my right nostril. I have already had 2 surgeries to reduce the size of my right inferior turbinate. I am still experiencing great difficulty breathing, and I frequently feel painful pressure in my right nostril. The pain is so bad that it causes me to miss work.

I believe that my difficulty breathing is caused by an enlarged right inferior turbinate and that the pressure and pain is caused by an enlarged right middle turbinate. It is very frustrating because when I go to doctors, they say that my nose looks fine and that my turbinates don't appear enlarged. I belive that my turbinates are primarily swelling up at night and perhaps because blood is rushing to my head when I lie down. This makes it very difficult to prove to a doctor after being vertical all day.

I have tried many OTC medications to try to treat this issue, and the only thing that had any noticable impact was Afrin, which I do not want to use because it causes rebound congestion and can cause septum perforations. I stopped using Afrin in April. The fact that it provided temporary (intense) relief supports the theory that my problems are caused my enlarged turbinates because Afrin shrinks the blood vessels in the turbinates and shrinks the turbinates themselves. My understanding is that rebound congestion from Afrin should not last very long so I don't think that I my nose should still be rebounding from Afrin after not using it for 3 months.

I do not believe that this is an allergey issue because I bought an air purifier, thoroughly cleaned my house, and used Flonase for multiple weeks. None of this has any noticable impact on my nasal problems whatsoever.

What's very odd about my issue is that it changes throughout the day. I researched the "nasal cycle" which states that your nose alternates blood flow form the left to the right turbinates throughout the day. Most people should not notice this, but I definitely do. When the right turbinates are big, I have the issues with extreme congestion and pain on the right side. When the turbinates on the left side get big, it restricts breathing a bit, but is not so bad. When the left turbinates are swollen, I can breathe well on the right side. 

I am somewhat at my wit's end trying to figure out what to do because doctors keep reassuring me that my turbinates look fine when I talked to them in person. It has been difficult to coordinate an appointment when my right turbinates are big during their nasal cycle. So, I bought an endoscope on to see exactly what's going on in there. I'm thinking if I show the following attached 2 pictures to a doctor, that will prove to them that my turbinates do in fact have a problem. I took these pictures when my right side felt swollen, big, painful, and my breathing felt obstruced.

The first picture is of my inferior turbinate.It looks like one large pink mass against another large pink mass with a thin line between the two (less than 1mm wide). My inferior turbinate is on the left of this picture and my septum is on the right of this picture.

The second picture is of my middle turbinate. The circular mass in the middle is my middle turbinate. My septum is on the right of this picture. The middle turbinate is actually touching my septum. I took another picture of the middle turbinate an hour later where I felt that I could breathe better, and I noticed that the middle turbinate was no longer touching the septum.

Do my middle turbinate and inferior turbinate look enlarged? Is it normal for the middle turbinate to touch the septum? 

I'm a bit afraid of showing these pictures to a doctor because they might be unhappy that I put an endoscope in my nose and tried to diagnose myself, but I have been to 6-7 ENT's regarding this issue and had 2 surgeries already over the past 4 years, and I still cannot breathe correctly.

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22 Replies

  • Posted

    Have you had a CT scan or MRI?

    These should reveal structural issues.

    Also you mentioned the pain is pressure. Do you have green, white, or yellow mucus?

    Is your nose dry or feels dry?

    Having two surgeries is not ideal to be sure.

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    • Posted

      No, I have not had a CT scan or MRI yet. I think that the next time I see an ENT, I will insist upon a CT scan. I was born with a deviated septum, and my first surgery was supposed to fix that, but I believe that the inner part of my septum, which touches the turbinates, might still be deviated.

      I have not had any mucus.

      Yes, my nose frequently feels dry, especially on the right side.

      Are you guys able to see the 2 pictures that I posted? Does this look normal?

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    • Posted

      Good- my experience has been that at a minimum a CT is required. Surprised an ENT didn't order this. A GP can also order and the wait shouldn't be too long. It will at a minimum rule out any serious structural issues.

      It is good your mucosa appears pink.

      Do you have normal mucosal flow? Eg: it is clear and runny. Does your nose feel dry?

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  • Posted

    Talos, I can relate to what you describing exactly.

    I had the very same problem, blocked nose, had surgery - muddle turbinectomy, which did nothing at all, went to see other ENTs, who suggested to do further turbinectomy, + correct the deviated septum. I said no to further surgeries, as there was no guarantee it would help, moreover there is a risk of ENS (empty nose syndrome). 

    I suffered for about 2 years, I had both nostrils blocked, and like yours evenings were lot worse. 

    Also tried all the costeroid sprays, natural ones, nasal rinse, you name it, with 0 result.

    So as Drs were no help at all, I had to figure it out myself what's going on.

    My turbinates were swollen all the time, along with the blood vessels, because of allergy - most likley to dust and humidity (tropical climate). So after I was clear about it, that the tropical climate was the problem, I packed up and moved to a drier climate. It has improved pretty much immediately, I still have blocked nose especially when it's humid rainly, windy, and at night one side gets always blocked, but I got used to it, as I can breat through the other side. During the day no problem.

    Surgery unfortunately doesn't solve the problem, because despite your turbinates been shrinked, it still gets swollen enough to cause a great deal of discomfort. Same with the blood vessels.

    So you need to figure out what's causing your turbinates to swell up. Air purifier does nothing, I had it too, useless.

    If you can check out different places, and check if climates make any difference. Do you feel better when you are at an air conditioned place? or worse?

    Have you ever had an allergy test? Skin prick test usually is a good indication to what you could be allergic to. (animals, dust, dust mites, dairy, these are the common ones).

    Don't do anymore surgery only as a very last resort.

    It;s horrible to live with constant sinus problems, I hope you will soon find some relief.


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    • Posted

      I live in the midwest of the United States, where the climate varies from extremely cold during the winter to hot during the summer. My turbinates have the same problem all year long.

      I don't think I notice much difference between an air conditioned place vs. a non-air conditioned place.

      No, I have never had an allergy test. That's a good idea. I think I will request that along with a CT scan. Allergy to dairy can cause turbinates to swell?

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    • Posted

      Your right side is the "blocked" side which also feels dry correct?

      Sometimes, especially with surgery there can be some chronic dryness and even nerve damage which can cause paradoxical obstruction (you feel blocked yet CT scan shows wide open).

      Good you are getting the scan.

      Good luck.

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    • Posted

      Any allergy can make all kind of problems, you could try to eliminate all dairy from your meal and see if that makes any difference.

      There are two type of allergy test; blood test, not so accurate, and skin prick test, they test you for the most common ones, not everything, but the ones they do the test for are very accurate. Easy and quick.

      What you might want to check in your house:


      dust mites - you can buy dust mite proof sheets, pillow covers

      mould in kitchen / bathroom

      have you got any pets? 

      For me dust is a killer, I pretty much need to wear a mask when I vacume.

      Unfortunately it's not easy to figure it out, but keep track of what you doing / eating / where you go and see if any of it makes any difference


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    • Posted

      I don't know, I'm not an expert analysing pictures. 

      But weather they are swollen or not, the picture won't give you the answer. If they're swollen you still don't know why, if they are not, it is probably just temporary. Either way, ENT would prescribe you a costeroid spray, or over the counter one, but you say you already tired a few and didn't help.

      You will need a CT, it will show if you have a deviated septum and if you have how bad it is. 

      If you feel terrible and have sinus pain, don't use decongestant sprays like afrin, you could use pseudoeffedrine tablets, not for long term either. It could speed up your heart rate, so better not take it at night.


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    • Posted

      I'm concerned that I might already have empty nose syndrome in my right inferior turbinate, the one that I had the two turbinate reduction surgeries on. How do I test if I have this?

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    • Posted

      Suggest finding an ENS friendly ENT. If you google Empty Nose forums there is a Yuku. You can enter as a guest and use the search function.
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    • Posted

      I don't think you have ENS, as far as I know it effects both nostrils and doesn't fluctuate up and down. ENS is extremely rare, two turbinctomy doens't mean you have it. But I'd be very careful to go under the knife again, try to explore all the natual, alternative options first.

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    • Posted

      I have ENS. It is rare but also appears to be severely underteported.

      The cause is surgery however one can have ENS-like symptoms.

      It's actually a collection of issues but very disabling. Key symptoms include: suffocation due to nerve damage and volume loss, lack of mucus (severe dryness), pain, lack of sensitivity to moisture or temperature in the air, anosmia or hyposmia, throat dryness.

      Yes you can have on one side but not all that common.

      I would be very cautious about any more surgery to say the least.

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    • Posted

      CT con't understand your problem..... swelling middle turbinate due to swollen blood vessels.. generally inferior turbinate swells.. but after turbinoplasty it's not possible generally... I think breathing issues is due to middle swollen turbinate.

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