Middle Turbinate Lateralization Under Local Anesthesia: A Simple Technique for Treatment of Middle Turbinate Headache Syndrome

Introduction: Middle turbinate headache syndrome is a rare, but not uncommon, treatable cause of headache. It is described as the compression of the middle turbinate against the septum or the lateral wall of the nose and it is characterized by intermittent, usually unilateral, periorbital pain. The clinical history, nasal endoscopic examination and coronal CT scan should point towards the diagnosis and a local anesthetic challenge test should confirm the diagnosis. Treat¬ment is by relieving the contact point by medical or surgical means.Objective: To study the effectiveness of a simple minimally invasive method for elimination of the symptoms of middle turbinate headache syndrome.Methods: A prospective study of 25 patients with chronic nasal or glabellar pain who endoscopically demonstrated a contact point between the middle turbinate and the nasal septum. All patients were treated by lateralization of the middle turbinate using a small metal instrument like a tongue depressor under 10% lidocaine HCL topical anesthesia.Results: Of the treated cohort: 23 (92%) of the patients had complete clinical symptom resolution after one treatment and 2 patients (8%) had resolution after two treatments sittings. Recurrence occurred in 1 patient (4%) after 7 months of follow up. There were no short or long-term adverse sequelae. The results persisted at a mean follow-up time of 30 months (range, 7-36 months).Conclusions: Middle turbinate lateralization under local anesthesia is a simple, safe and effective technique in eliminating the symptoms of rhinologic headache induced by a contact point between the middle turbinate and nasal septum.