Submucous diathermy to the inferior turbinates (SMD)

Before you agree to have diathermy nose surgery to reduce the lining of your nose, it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when dealing with diathermy, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your nose surgery treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

Your nose may feel blocked. Swelling of the lining of the turbinates inside your nose can cause this.

What are the turbinates?

A turbinate is a curved shelf of bone running along the inside of your nose. You have six turbinates, three on each side. These are called the superior, middle and inferior turbinates. The upper turbinate is the superior and the lower turbinate is the inferior. The inferior turbinates tend to be the ones that cause problems.

Between the turbinates are the openings from the sinuses into the nasal passages.

Your turbinates are covered in a special lining called mucosa. They increase the surface area of your nose lining. This helps to warm and moisten the air you breathe in through your nose.

What is diathermy?

Diathermy is the use of high frequency electrical currents, during surgery. The electric current produces heat. We use diathermy to stop bleeding and to cut tissue without causing bleeding. It can also destroy unwanted tissue. It is sometimes called cautery.

What has gone wrong?

The lining of the inside of your nose, especially over your turbinates, is very swollen. This has made the passage through your nose very narrow, causing a feeling of blockage. Your sinuses, which are hollow spaces in your facial bones, may become blocked, leading to sinus infection.

The aims

The aim of the operation is to shrink the mucosa lining your turbinates. If you only have swelling in one side of your nose then we only need to operate on this side. Usually, however, both sides need doing. The operation is carried out under a general anaesthetic, usually as a day case procedure. This means that you come into hospital on the day of your operation and go home the same day.

The benefits

Reducing the lining of your nose will remove the blockage and improve your nasal breathing. It may reduce your risks of developing sinus infections.

Are there any alternatives?

Nasal steroid drops or sprays may relieve blockages caused by a swelling of the nasal lining. However, long-term use of nasal decongestant drops or sprays can eventually damage your nasal lining and make the blockage worse.

What if you do nothing?

The swelling of the nasal lining over your turbinates will usually continue. Your nose will feel blocked. Sinus problems may develop or continue.

Who should have it done?

People who have swelling over their inferior turbinates, which causes nasal blockage or sinus problems, should have the operation.

Who should not have it done?

People who have other medical conditions that would make it unsafe for them to have a general anaesthetic should not have one.

Author: Mr Robert Ruckley MB. ChB.  F.R.C.S.  Consultant ENT surgeon.

© Dumas Ltd 2006

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