Enlarged turbinates: symptoms, nighttime congestion and treatment options

Enlarged turbinates are one of the common reasons a nose stays blocked for weeks or months rather than days. The turbinates are ridges of tissue inside your nose that swell and shrink, and when they stay swollen they narrow the airway, which often feels worst when you lie down at night. Treatment usually starts with nasal sprays, and a small operation to reduce them is an option when sprays don't help.

What are turbinates?

Turbinates are small structures on the side walls inside your nose. Cleveland Clinic describes their job as cleaning, heating and humidifying the air as it passes through your nasal cavity on its way to your lungs. The lower pair, the inferior turbinates, are the ones most often involved in blockage.

They're built to change size. A 2021 review of turbinate surgery explains that the inferior turbinate contains a network of blood vessels that lets it expand, especially toward the front. That swelling is normal. Cleveland Clinic notes that the turbinates swell and shrink alternately on each side as part of the nasal cycle, so that one side of the nose becomes more congested every four to six hours while the other opens up. The nasal cycle explains this in more detail.

What causes turbinates to stay enlarged?

According to the 2021 review, allergy, infection and hormonal changes can all cause the turbinates to become engorged. Lasting enlargement, known as turbinate hypertrophy, happens with persistent and excessive stimulation. The review lists allergic rhinitis, vasomotor rhinitis and infectious rhinitis among the conditions in which it's seen.

Cleveland Clinic makes a similar point: the turbinates can become inflamed from irritation, allergies or infection, and most of the time this is temporary, but some people develop chronic swelling.

If you've been using a decongestant spray for more than a few days to get through the night, decongestant spray rebound explains why that can backfire.

What are the symptoms?

The main symptom of enlarged turbinates is a nose that feels blocked much of the time. Cleveland Clinic says turbinate reduction is usually considered when the blockage leads to congestion, post-nasal drip, sleep apnea or other breathing disorders.

Doctors can grade the size of the turbinates when they look inside the nose. One system described in the 2021 review uses three levels, running from mild enlargement with no obvious obstruction to complete blockage of the nasal cavity.

Why is it worse at night?

Turbinate hypertrophy feels worse at night because lying down narrows the nose further. Many people with nasal blockage notice it most after they go to bed, and the turbinates are a big part of the explanation. A 2022 meta-analysis in The Laryngoscope pooled nine studies and found that lying down increases nasal resistance and reduces nasal airflow, in healthy people and more so in people who snore.

A 2021 article from members of the same research group describes this postural effect as being explained by swelling of the inferior turbinates when you lie on your back. Exactly why it happens is still being studied. One idea is that blood pools in the veins of the nose when you're flat.

The same article explains why this matters so much for someone whose nose is already narrow. Airflow and resistance aren't related in a straight line, so in a nose at the borderline of normal, a small rise in resistance can cause a large drop in airflow. That can be enough to switch someone from breathing through their nose to breathing through their mouth during sleep. Why is my nose stuffy at night? covers the other reasons nighttime congestion builds up.

How is it diagnosed?

Cleveland Clinic says a doctor will examine your nose and may use nasal endoscopy, a thin camera, to confirm the diagnosis. The 2021 review stresses the importance of checking for related problems during this assessment, including a deviated septum, allergic rhinitis and enlargement on one side only, because these need to be dealt with at the same time for the best result. Our guide to deviated septum symptoms covers the most common of these.

How are enlarged turbinates treated without surgery?

Enlarged turbinates are treated with medicines first. Cleveland Clinic says doctors recommend steroid nasal sprays, antihistamines or both as a first line of treatment. The 2021 review lists antihistamines, topical decongestants and topical corticosteroids as the usual medical treatments, used mainly to reduce blockage and restore comfortable nasal breathing.

The same review is frank that not everyone responds. Some people improve slightly, and some don't improve at all and are left with ongoing blockage.

On the positional side, the 2021 article on nighttime congestion cites a study in which steroid nasal sprays brought lying-down congestion back to normal after two weeks in people with allergic rhinitis, and the authors describe these sprays as having a high safety profile. Ask a doctor or pharmacist which spray suits you and how long to use it.

What does turbinate reduction involve?

Turbinate reduction is surgery to shrink the turbinates when medicines don't work. Cleveland Clinic describes several techniques, including radiofrequency treatment and coblation, which use heat energy to shrink the tissue, and microdebrider resection, which removes tissue from inside the turbinate while leaving its outer lining in place. It's usually a same-day procedure, and some versions can be done under local anesthesia.

The 2021 review sorts these techniques into two groups. Mucosal-sparing techniques keep the lining of the turbinate, while older methods remove it. Removing more tissue relieves blockage well but brings more bleeding, crusting, pain and a longer recovery, so mucosal-sparing approaches are preferred.

The results are encouraging. A 2023 systematic review of 62 studies found that every technique it examined improved patient-reported nasal blockage. Radiofrequency and microdebrider techniques gave comparable results, and the benefit peaked within the first year and was sustained over the long term. Cleveland Clinic gives an overall success rate of about 82%, while noting that the tissue can eventually grow back.

What are the risks?

The risks of turbinate reduction include nosebleeds, chronic nasal dryness and empty nose syndrome, which Cleveland Clinic lists as possible downsides. Empty nose syndrome is very rare. It's a condition in which you can't feel air moving through your nose even though it's open.

Cleveland Clinic's page on atrophic rhinitis adds that nasal surgery, usually turbinate reduction, is the most common cause of the secondary form of that condition, in which the lining of the nose thins and becomes dry and crusted. It's rare, and symptoms can start months to years after surgery. This is part of why surgeons now try to preserve as much of the turbinate as they can. If dryness is a problem for you, why your nose dries out at night covers what helps.

Recovery is usually quick. Cleveland Clinic says you can return to normal routines in one day after an in-office procedure, or one week after surgery under general anesthesia, with full recovery taking up to six weeks. Crusting inside the nose can last up to three weeks, and saline spray or a cool mist humidifier can ease it.

Can you use mouth tape with enlarged turbinates?

You can use mouth tape with enlarged turbinates only if you can breathe comfortably through your nose with your mouth closed. If enlarged turbinates leave your nose blocked, especially when you lie down, keep your mouth free and focus on treating the blockage. Our two-minute nose test is a simple way to check, and the safety page explains who should avoid taping.

When should you see a doctor?

See a doctor if your nose has been blocked most of the time for weeks, if sprays from the pharmacy haven't helped or if you've been relying on decongestant sprays to breathe. A GP or family doctor can start treatment and refer you to an ear, nose and throat specialist if needed.

Cleveland Clinic advises calling your provider after turbinate surgery if you develop fever, bleeding, severe pain or difficulty breathing. Loud snoring with gasping or pauses in breathing needs a doctor in its own right, because it can be a sign of sleep apnea.

Read next

• Deviated septum: symptoms and when to see an ENT
• Why is my nose stuffy at night?
• Sinusitis and sleep

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.