What is a Concha Bullosa?

Before, we dig into what a concha bullosa is; let’s talk about normal anatomy of the nasal passages. When looking into the nasal passages, the structure and the midline is called septum. This typically should be more or less a straight bony and cartilaginous structure that is covered by membrane. On the side wall of the nose, we have three protrusions attached to the walls. These are called the turbinates. The biggest one is called the inferior turbinate and is the lower most. The middle turbinate is the medium size, and the superior turbinates is a very small one all the way up near the brain area. Each turbinate has a bony center with membrane covering it. The bone is usually solid and does not change with allergies. However, the membranes can swell from time-to-time due to having a cold or sinus infection or from allergy exacerbations.

Occasionally, the bony area of the middle turbinate can develop a pocket of air, otherwise known as concha bullosa. This is the same process of our sinuses growing from our childhood into our adulthood. If a concha bullosa is present, the volume of the air pocket creates additional obstructive issues for the nasal passages both in terms of breathing as well as the sinus drainage pathways. These patients may be predisposed to repeated sinus infections as well as sinus headaches.

A concha bullosa of the middle turbinate is considered to be an anatomical problem that does not respond to any type of medical therapy. In a patient with enough symptoms, removal of the concha bullosa as part of endoscopic sinus surgery is recommended. This is usually done in the operating room under anesthesia. Most surgeons prefer to remove the one side of the concha bullosa facing the sidewall of the nasal passages (lateral wall). This will create a large cavity adequate for breathing and sinus drainage where the sinus outflow happens. Please refer to the video above for demonstration of this technique.

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Posted in: Nose, Sinuses

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