I have experienced complications from a partial inferior turbinectomy ever since I had the surgery 10 years ago. The side of the nose that I was breathing the most freely through before the surgery is now dry, painful and bleeding, as if the turbinates no longer function to lubricate, warm and filter air. Do you know of a procedure that can correct this now?

D.S.

The turbinates are sausage-like structures that are composed of a skeleton of flimsy bone, lined with a very plump layer of mucosa (mucous membrane). As you have correctly stated, the turbinates warm, filter and humidify the air we breathe. Without turbinates, the air we breathe in could, depending upon the local environment, be cold and dry and laden with pollen, dust, dirt and other particulate matter. The turbinates play a crucial role in maintaining nasal health, and good health in general.

"Partial inferior turbinectomy" refers to a procedure in which a portion of the inferior turbinate is surgically excised. This is done to enlarge the airway. The turbinates are, after all, very bulky structures that occupy a large volume within the nasal cavity. What better way to solve someone's nasal airway obstruction than to partially remove the main organ that blocks the airway?

But life and nasal physiology are not that simple. If the surgeon radically changes the shape of the nasal cavity, he/she may permanently alter the pattern of airflow through this cavity. Under normal circumstances, this airflow is laminar -- meaning the air flows in straight lines. If the shape of the cavity changes radically, airflow may become turbulent -- meaning the air tends to form eddies and does not flow in straight lines. Turbulent airflow is more sluggish than laminar flow. Thus, one can have an amazingly open nasal passage that nevertheless feels congested.

The problem you have, atrophic rhinitis, is very difficult to treat. Daily irrigation with a saline and bicarbonate mixture may give you some relief. Daily use of an estrogen-containing cream may also be helpful, although estrogen is not without risk. (Regular use of an estrogen-containing cream may cause breast swelling and tenderness. Also, women with a family history or personal history of breast cancer or other reproductive tract cancer should talk with a doctor about the risks of using estrogen.)

Further surgery is NOT the answer to your problem. You need to find an ENT (ear, nose and throat doctor) who will try to treat your problem by nonsurgical means.

By the way, I am NOT saying that partial inferior turbinectomy is a doomed operation, merely that it incurs the risks of atrophic rhinitis and paradoxical nasal airway obstruction. There are methods of improving a nasal airway that have less risk of these complications, and these are the methods that I prefer, but these methods have a higher risk of not relieving the patient's airway obstruction. Put simply, I would rather under-treat than over-treat my patients.