Can You Remove Too Much Turbinate?

Nasal Breathing Clarity
Some patients who undergo aggressive nasal surgery have the persisting complaint of nasal blockage.  I see these people in consultation every week.  It will feel like they are still stuffy or blocked up.  However when the sniffing in, there is actually a hollow sound heard, and is quite clear that the patient is actually moving a large volume of air through the nose.  Many times these patients breathe better than the average patient.
It actually can be quite ironic and paradoxical that the patients with the largest nasal passages sometimes feel as though they cannot breathe as well.
There is a condition called empty nose syndrome that this is related to.  Essentially, her body has nasal turbinates for reason.  That reason is to humidify the air we breathe.  The turbinates are like little radiator coils sitting in the nasal passages.  When they are overly reduced we cannot humidify the air -and it becomes much like walking around with your mouth open.  You get throat irritation, postnasal drip, and throat scratchiness from having turbinates that are too small or overly reduced at surgery.
And a second thing happens, the nerve endings that help us detect nasal breathing and provide feedback to our brain are also trimmed down with turbinate reduction.  Because there is no turbulent airflow to stimulate nerve endings, plus the nerve sensors are reduced in number after surgery, we feel as though we are not breathing even though we are.  Again, quite ironic and paradoxic that patients who sometimes can breathe the best objectively feel as though her breathing the worst subjectively.
All of this means that we have to be a little bit judicious in turbinate reduction.  Living in the Southeast, we have plenty of humidified air around here, patients do often need a little bit more aggressive turbinate surgery then someone living in high-altitude mountainous regions.
In general, most patients benefit from removing 10 or 15% of the inferior turbinates at surgery.  There are techniques to remove more for select cases, and techniques to perform submucosal cauterization essentially removing less.  Every patient is different.  Every turbinate is different.  Every side of the nose is different.  This procedure should be somewhat customized to the patient and their individual issues.