What Is Concha Bullosa?

Man's lower part of face, side view, close-up
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What are Conchae?

Have you ever heard the phrase, "Breathe in through your nose, and out through your mouth"? This phrase is actually based on science. When you breath in through your nose, many things happen including, humidification of the air. Humidification occurs as the air travels across 3 to 4 conchae. The conchae were formerly called turbinates.

The conchae are shell-shaped bony structures on the opposite side your nasal septum, which separates the left and right sides of your nose.

Many tiny blood vessels within a mucus membrane covers the conchae. The lowest concha, or inferior concha, is an independent bony structure, while the middle and upper (superior) concha are actually part of the large ethmoid bone. These conchae form 3 nasal passages for air to flow through.

Each of these passageways, that are separated by conchae, have openings to your sinus cavities. Between the lower concha and the bottom of the nasal cavity is the nasolacrimal duct, or tear duct. In the middle passageway is the opening to both the maxillary and frontal sinuses. While the upper passageway has the opening to the sphenoidal sinus.

What is Concha Bullosa?

Concha bullosa is also known as pneumatization of the middle turbinate. This just means that there is an air pocket in the middle concha. Concha bullosa is a very common anatomical deviation. While it does not necessarily predispose you to sinus problems, persons with enlarged turbinates and concha bullosa may have a blockage which prevents their sinuses from draining properly, which may result in frequent sinus infections.

It is also suggested that concha bullosa may predispose you to having a deviated septum.

How is Concha Bullosa Diagnosed?

Concha Bullosa is best diagnosed with a CT scan and is estimated to be found in 16 to 53 out of 100 cases. The turbinates will normally show up as a light gray color, however in the case of concha bullosa, in the middle of the gray turbinates, will be a black pocket of air.

The views of the scan will also allow your physician to determine if the concha bullosa only occurs on one side of the nose or both sides. Your doctor will be able to estimate The CT scan could also be used to identify whether or not a deviated septum is present.

What are the Symptoms of Concha Bullosa?

Symptoms of concha bullosa are to the amount of air present in the middle turbinate. The larger the volume, the more likely you will be to have symptoms and the more severe the symptoms will be. Symptoms may include:

  • pain around the eyes that may last from several hours to several days
  • nasal obstruction

How is Concha Bullosa Treated?

The only treatment available for concha bullosa is surgery. While surgery is necessary to eliminate the air pocket, different methods exist to correct this problem. The three methods include: resection, turbinoplasty, and crushing.

Crushing is a commonly used method to treat concha bullosa. This is done under general anesthesia with an endoscope. Your physician will inject your concha with epinephrine to vasoconstrict, or the blood vessels smaller.

This will help to limit any inflammation and reduce bleeding. If sinus surgery is also needed, the sinuses will be operated on first. Once the sinus surgery is complete, forceps will be used to squeeze the concha bullosa from top to bottom and then squeezed toward the back to minimize damage to the turbinate. The crushing method has a very successful rate with minimal complications, though bleeding after the operation is possible. Crushing also carries the least risk for affecting your sense of smell.

Turbinate resection is the surgical removal of part of the concha or the complete removal of the concha. This allows for improved airflow and removes the concha bullosa. The remaining tissue is then cauterized and nasal packing inserted to reduce bleeding.

Turbinoplastyinvolves cutting open the turbinate and removing tissue and a small amount of bone. Once the tissue is sufficiently removed the incision is closed.

American Journal of Neuroradiology. The Incidence of Concha Bullosa and it's Relationship to Nasal Septal Deviation and Paranasal Sinus Disease. Accessed: August 12, 2010 from http://www.ajnr.org/cgi/content/abstract/25/9/1613

Hatipoğlu, H.G., Çetin, M.A. & Yüksel E. (2005). Concha bullosa types: their relationship with sinusitis, ostiomeatal and frontal recess disease. Diagn Intervent Radiol. 11:145-149

O'Rahilly, Müller, Carpenter & Swenson. (2008). Basic Human Anatomy - Chapter 52: The nose and paranasal sinuses. Accessed on 2/20/2016 from https://www.dartmouth.edu/~humananatomy/part_8/chapter_52.html

Tanyeri, H., Aksoy, E.A., Serin, G.M., Polat, S., Türk, A. & Ünal, O.F. (2012). Will a crushed concha bullosa form again? The Laryngoscope. 122(5). 956-960. DOI: 10.1002/lary.23234

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