Should I have Concha Bullosa Surgery along with my Tonsil and Adenoid removal to breathe better and reduce allergies? (Photo)

Question

I am 38 yo female and Have major sinus nasal allergies. ENT said I need my tonsils + Adenoids taken out to help with allergies. I had an MRI scan for something not related but I noticed what looks like concha bullosa. When I called and mentioned that I may have this he was not interested in looking at the MRI and said we should just do the Tonsils and Adenoid surgery and not mess with the turbinates. What do you think, can you see anything on the MRI that may be causing this grief? Thank you!

William Portuese, MD · Answer

At age 38, adenoids are usually long since disappeared.  Most tonsils at that age are also very small and usually inconsequential.  It is rare to perform a tonsil and adenoidectomy on somebody at age 38.  Allergies in the nose are not treated with a tonsillectomy or an adenoidectomy.  Allergies are first treated with nasal sprays such as Flonase and Nasacort, decongestants and antihistamines.  Once she has failed medical therapy for allergies, consider allergy testing and environmental avoidance. if you her tested positive to loss of allergens, consider allergy shots or sublingual therapy.  A CAT scan of the sinuses was required to look for allergic nasal polyps located inside the sinus cavities creating chronic sinusitis.  Chronic  nasal polyps are treated with endoscopic sinus surgery.  Turbinate surgery is performed when the turbinates are significantly enlarged blocking airflow.  A concha bullosa  can sometimes cause facial headaches and nasal obstruction, and it is usually removed or opened at time of nasal surgery.  For more information about sinus surgery, and airflow management, please see the video and website link below

Fred J. Bressler, MD, FACS · Answer

Have you had a complete allergy and sinus evaluation? Typically, a patient would have a complete evaluation, CT sinuses, allergy testing, sinus endoscopy and a trial of appropriate medical therapy before considering surgery on the nose or sinuses. You do have a concha bullosa, but it does not appear to be contributing to nasal obstruction or sinus outflow track obstruction by MRI.  An office endoscopy and/or CT scan may be better to evaluate this however. Inferior nasal turbinates are often reduced for allergy patients who have persistent obstruction or nasal drainage despite medical/allergy therapy. Tonsillectomy and Adenoidectomy are usually offered for upper airway obstruction, recurrent pharyngitis, recurrent otitis media, sleep related breathing disorders or tumor evaluation for abnormal findings. Enlarged tonsils and adenoids are often found in patients with allergy and sinus issues, but removing them may not necessarily cure you of your allergy or sinus condition. Hope this brief reply helps.

Should I have Concha Bullosa Surgery along with my Tonsil and Adenoid removal to breathe better and reduce allergies? (Photo)

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Should I have Concha Bullosa Surgery along with my Tonsil and Adenoid removal to breathe better and reduce allergies? (Photo)

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Everything you need to know about Septoplasty

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