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Volume 4, Issue 2, December 2018, Page: 39-45
Comparison of Three Techniques for the Management of Concha Bullosa on Nasal and Olfactory Functions
Deniz Hanci, ENT Clinic, Okmeydani Education and Research Hospital, Istanbul, Turkey
Huseyin Altun, ENT Clinic, Yunus Emre Hospital, Istanbul, Turkey
Received: Aug. 20, 2018;       Accepted: Sep. 7, 2018;       Published: Oct. 8, 2018
DOI: 10.11648/j.ijo.20180402.12      View  433      Downloads  41
Background: Different techniques were described for the management of concha bullosa. However there is still no consensus on which technique should be preferred. Objective: To evaluate the most effective technique for the management of concha bullosa in terms of improvement in nasal and olfactory functions. Study Design: Prospective, randomized controlled trial. Methods: A total of 95 patients were randomly divided into three groups; medial laminectomy (n = 31), lateral laminectomy (n = 32), and crushing of the middle turbinate (n = 32). Patients were evaluated using visual analogue score (VAS), sinonasal outcome test-22 (SNOT-22), peak inspiratory flow (PNIF), and Sniffin’ Sticks Extended Test preoperatively and 3 months postoperatively. Results: The age range of the study patients was 18 and 56 years (mean age 35.2±9.4 years). There was no statistically significant difference between the baseline characteristics of the patients including age and gender. There was a statistically significant improvement in headache, obstruction, PNIF, SNOT-22 scores and olfactory performances of the patients 3 months after the surgery (P < 0.05 for all). All the groups were comparable in improvement of nasal and olfactory functions after surgical management of concha bullosa. However, the crushing of the middle turbinate was less effective, and, medial laminectomy resulted in better improvement in PNIF score compared to lateral laminectomy (P = 0.011). In addition, there was a significant improvement in odor discrimination in medial laminectomy group when compared to crushing of middle turbinate (P = 0.011). Conclusions: Although all three techniques are comparable with respect to improvement in nasal and olfactory functions, we recommend medial laminectomy as the surgical technique for the management of concha bullosa.
Middle Turbinate Surgery, Obstruction, PNIF, SNOT-22, Extended Sniffin’ Test
To cite this article
Deniz Hanci, Huseyin Altun, Comparison of Three Techniques for the Management of Concha Bullosa on Nasal and Olfactory Functions, International Journal of Otorhinolaryngology. Vol. 4, No. 2, 2018, pp. 39-45. doi: 10.11648/j.ijo.20180402.12
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Unlü HH, Akyar S, Caylan R, Nalça Y. Concha bullosa. J Otolaryngol 1994; 23:23–27.
Subramanian S, Lekhraj Rampal GR, Wong EF, Mastura S, Razi A. Concha bullosa in chronic sinusitis. Med J Malaysia 2005; 60:535–539.
Badran HS. Role of surgery in isolated concha bullosa. Clin Med Insights Ear Nose Throat 2011; 4:13–19.
Mehta R, Kaluskar SK. Endoscopic turbinoplasty of concha bullosa: long term results. Indian J Otolaryngol Head Neck Surg 2013; 65:251–254.
San T, San S, Gürkan E, Erdoğan B. The role of septated concha bullosa on sinonasal pathologies. Eur Arch Otorhinolaryngol 2015; 272:1417–1421.
Belli E, Rendine G, Mazzone N. Concha bullosa: endoscopic treatment. J Craniofac Surg 2009; 20:1165–1168.
Maru YK, Gupta Y. Concha bullosa: Frequency and appearances on sinonasal CT. Indian J Otolaryngol Head Neck Surg 1999; 52:40–44.
Toplu Y, Bayindir T, Karatas E, Akarcay M. All concha bullosa: an undefined abnormality of the lateral nasal wall. Indian J Otolaryngol Head Neck Surg 2013; 65:86–88.
Kumral TL, Yıldırım G, Çakır O, Ataç E, Berkiten G, Saltürk Z, Uyar Y. Comparison of two partial middle turbinectomy techniques for the treatment of a concha bullosa. Laryngoscope 2015; 125:1062–1066.
Cannon CR. Endoscopic management of concha bullosa. Otolaryngol Head Neck Surg 1994; 110:449–454.
Apuhan T, Yildirim YS, Simşek T, Yilmaz F, Yilmaz F. Concha bullosa surgery and the distribution of human olfactory neuroepithelium. Eur Arch Otorhinolaryngol 2013; 270:953–957.
Hummel T, Sekinger B, Wolf S, Pauli E, Kobal G. 'Sniffin' Sticks': Olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold. Chem Senses 1997; 22:39–52.
Haehner A, Mayer AM, Landis BN, Pournaras I, Lill K, Gudziol V, Hummel T. High test-retest reliability of the extended version of the "Sniffin' Sticks" test. Chem Senses 2009; 34:705–711.
Ramadan HH, Allen GC. Complications of endoscopic sinus surgery in a residency training program. Laryngoscope 1995; 105:336–339.
Havas TE, Lowinger DS. Comparison of functional endonasal sinus surgery with and without partial middle turbinate resection. Ann Otol Rhinol Laryngol 2000; 109:634–640.
Dogru H, Tuz M, Uygur K, Cetin M. A new turbinoplasty technique for the management of concha bullosa: our short term outcomes. Laryngoscope 2001; 111:172–175.
Braun H, Stammberger H. Pneumatisation of turbinates. Laryngoscope 2003; 113:668–672.
Shih C, Chin G, Rice DH. Middle turbinate resection: Impact on outcomes in endoscopic sinus surgery. Ear Nose Throat J 2003; 82:796–797.
Dogru H, Uygur K, Tuz M. Concha bullosa squeezer for turbinoplasty (Doğru forceps). J Otolaryngol 2004; 33:111–113.
Kieff DA, Busaba NY. Reformation of concha bullosa following treatment by crushing surgical technique: implication for balloon sinuplasty. Laryngoscope 2009; 119:2454–2456.
Tanyeri H, Aksoy EA, Serin GM, Polat S, Türk A, Unal OF. Will a crushed concha bullosa form again? Laryngoscope 2012; 122:956–960.
Koçak İ, Gökler O, Doğan R. Is ıt affective to use the crushing technique inn all types of concha bullosa. Eur Arch Otorhinolaryngol. 2016; 273 (11):3775-3781.
Eren SB, Kocak I, Dogan R, Ozturan O, Yildirim YS, Tugrul S. A comparison of the long-term results of crushing and crushing with intrinsic stripping techniques in concha bullosa surgery. Int Forum Allergy Rhinol 2014; 4:753–758.
Morgenstein KM, Krieger MK, Hollywood EL. Experiences in middle turbinectomy. Laryngoscope 1980; 90:1596–1603.
Yarmohammadi ME, Ghasemi H, Pourfarzam S, Nadoushan MR, Majd SA. Effect of turbinoplasty in concha bullosa induced rhinogenic headache, a randomized clinical trial. J Res Med Sci 2012; 17:229–234.
Tsounis M, Swart KM, Georgalas C, Markou K, Menger DJ. The clinical value of peak nasal inspiratory flow, peak oral inspiratory flow, and the nasal patency index. Laryngoscope 2014; 124:2665–2669.
Teixeira RU, Zappelini CE, Alves FS, da Costa EA. Peak nasal inspiratory flow evaluation as an objective method of measuring nasal airflow. Braz J Otorhinolaryngol 2011; 77:473–480.
Rujanavej V, Snidvongs K, Chusakul S, Aeumjaturapat S. The validity of peak nasal inspiratory flow as a screening tool for nasal obstruction. J Med Assoc Thai 2012; 95:1205–1210.
Ottaviano G, Lund VJ, Nardello E, Scarpa B, Mylonakis I, Frasson G, Iacono V, Manzato E, Marioni G, Staffieri A. Peak nasal inspiratory flow: a useful and handy tool for the diagnosis of nasal obstruction in the elderly. Eur Arch Otorhinolaryngol 2014; 271:2427–2431.
Bathala S, Eccles R. Assessment of upper airway obstruction by measuring peak oral and nasal inspiratory flow. J Laryngol Otol 2015; 129:473–477.
Martins de Oliveira GM, Rizzo JA, Camargos PA, Sarinho ES. Are measurements of peak nasal flow useful for evaluating nasal obstruction in patients with allergic rhinitis? Rhinology 2015; 53:160–166.
Lane AP, Gomez G, Dankulich T, Wang H, Bolger WE, Rawson NE. The superior turbinate as a source of functional human olfactory receptor neurons. Laryngoscope 2002; 112:1183–1189.
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