Allergic rhinitis

Allergic rhinitis is inflammation of the inside of the nose caused by an allergen, such as pollen, dust, mould, or flakes of skin from certain animals.

Signs and symptoms

Allergic rhinitis typically causes cold-like symptoms, such as sneezing, itchiness and a blocked or runny nose. These symptoms usually start soon after being exposed to an allergen.

Some people only get allergic rhinitis for a few months at a time because they're sensitive to seasonal allergens, such as tree or grass pollen. Other people get allergic rhinitis all year round.

Most people with allergic rhinitis have mild symptoms that can be easily and effectively treated. But for some symptoms can be severe and persistent, causing sleep problems and interfering with everyday life.

The symptoms of allergic rhinitis occasionally improve with time, but this can take many years and it's unlikely that the condition will disappear completely.

When to see your GP

Visit your GP if the symptoms of allergic rhinitis are disrupting your sleep, preventing you carrying out everyday activities, or adversely affecting your performance at work or school.

A diagnosis of allergic rhinitis will usually be based on your symptoms and any possible triggers you may have noticed. If the cause of your condition is uncertain, you may be referred for allergy testing.

What causes allergic rhinitis?

Allergic rhinitis is caused by the immune system reacting to an allergen as if it were harmful.

This results in cells releasing a number of chemicals that cause the inside layer of your nose (the mucous membrane) to become swollen and excessive levels of mucus to be produced.

Common allergens that cause allergic rhinitis include pollen – this type of allergic rhinitis is known as hay fever – as well as mould spores, house dust mites, and flakes of skin or droplets of urine or saliva from certain animals.

Treating and preventing allergic rhinitis

It's difficult to completely avoid potential allergens, but you can take steps to reduce exposure to a particular allergen you know or suspect is triggering your allergic rhinitis. This will help improve your symptoms.

If your condition is mild, you can also help reduce the symptoms by taking over-the-counter medications, such as non-sedating antihistamines, and by regularly rinsing your nasal passages with a salt water solution to keep your nose free of irritants.

See your GP for advice if you've tried taking these steps and they haven't helped. They may prescribe a stronger medication, such as a nasal spray containing corticosteroids.

Further problems

Allergic rhinitis can lead to complications in some cases. These include:

• nasal polyps – abnormal but non-cancerous (benign) sacs of fluid that grow inside the nasal passages and sinuses

• sinusitis – an infection caused by nasal inflammation and swelling that prevents mucus draining from the sinuses

• middle ear infections – infection of part of the ear located directly behind the eardrum

These problems can often be treated with medication, although surgery is sometimes needed in severe or long-term cases.

Non-allergic rhinitis

Not all cases of rhinitis are caused by an allergic reaction. Some cases are the result of:

• an infection, such as the common cold

• oversensitive blood vessels in the nose

• overuse of nasal decongestants

This type of rhinitis is known as non-allergic rhinitis.


Normal Inferior Turbinates

Turbinates are spongy bone structures on the sides of the inner nose that regulate airflow and protect the inner nasal anatomy. The general function of the turbinates is to control airflow. From the bottom to the top of the nose, there are three (sometimes four) sections of turbinate structures: the inferior, middle, and superior turbinates (the fourth, the supreme turbinate, is not present in every person).

The inferior turbinate plays the largest part in directing airflow, but it also moistens, heats, and filters air coming into the respiratory system. The middle turbinate primarily protects the sinuses, while the superior turbinate primarily protects the olfactory bulb, which houses your smell receptors.

What can go wrong with the turbinates?

The primary issue people experience with their turbinates is turbinate hypertrophy (enlarged turbinates). Enlarged turbinates can be caused by allergies, chronic sinus inflammation, or environmental irritants. Turbinate hypertrophy can be situational or chronic. A common type of situational turbinate hypertrophy is the nasal cycle, in which the turbinates on one side of the nose will swell for four to six hours before returning to their normal size, at which point the turbinates on the other side will begin to swell.

Concha Bullosa (patient’s right nostril is blocked)

Concha bullosa is a condition unique to the middle turbinates where the middle turbinate is filled with air and enlarged like a balloon. When this happens, the concha bullosa blocks the flow of air to the sinuses via a small passageway called the sinus ostium. If the sinus ostium is blocked and air does not reach the sinuses, they can accumulate fluid and become infected.

How are turbinate hypertrophy and a deviated nasal septum related?

Enlarged Turbinates Caused by a Deviated Nasal Septum

A patient with a deviated nasal septum is more likely to have both turbinate hypertrophy and concha bullosa. Septal deviation causes turbinate hypertrophy because the structures within the nose tend to grow so that they fill open areas. If your septum is deviated to the left, that creates space for the right turbinate to grow larger.

How should I treat my enlarged turbinates?

Treatment options vary depending on the cause of your enlarged turbinates. Make sure you are certain of the cause before you begin treatment. If your enlarged turbinates are a result of allergies or environmental irritants, you can allergy-proof your home by following simple precautions to get rid of pollen, dust, and pet dander. The best long-term treatment for chronically enlarged turbinates – especially if caused by a deviated septum, is turbinate reduction surgery. Turbinate reduction surgery is often performed at the same time as a septoplasty. Consult a board-certified ENT to determine the best course of treatment for you.

What Surgical Techniques Treat Turbinate Hypertrophy?

1. Outfracture: Fracturing the enlarged inferior turbinate laterally will crush the turbinate bone and open the nasal airway significantly but does not reduce the thickness of the turbinate mucosa.

2. Submucosal Resection: This involves opening the front end of the turbinate and removing the bone below the mucosa. This more significantly reduces the inferior turbinate and the mucosa will heal in the area where the bone was removed.

3. Cautery Reduction: This uses heat to shrink the mucosa or submucosal tissue. Mucosal shrinking will cause a fair amount of crusting during healing.

4. Radiofrequency (Coblation): A probe is inserted into the front of the turbinate into the submucosa. The radiofrequency waves are used to treat the submucosal tissue. Over time the turbinate will shrink as the submucosal area becomes smaller. Submucosal shrinking usually does not crust and does less damage to the mucosa.

5. Turbinate excision: In this type of surgery, part or all of the turbinate is removed. This can be dangerous as the nose may not stop crusting and you may not feel air entering your nose termed “empty nose syndrome”. Dr. Bennett does not perform this technique.

6. A combination of any of the above may be used in certain situations to optimize breathing ability depending on your individual situation.