Enlargement of the Bone Component in Different Parts of Compensatorily Hypertrophied Inferior Turbinate Lokman Uzun, M.D.,* Ahmet Savranlar, M.D.,# Levent Bekir Beder, M.D.,* Mehmet Birol Ugur, M.D.,* Fikret Cinar, M.D.,* Huseyin Ozdemir, M.D.,# and Sadi Gundogdu, M.D.# (Turkey) ABSTRACT Background: To evaluate the unilateral compensatorily hy- pertrophied inferior turbinate (CHIT) by computed tomogra- phy (CT) and determine the enlargement of the bone compo- nent in different parts of the CHIT. Methods: Patients were studied in three groups: those with a straight or nearly straight septum (n = 143), with mild devi- ation (n = 42), and with moderate to severe deviation (n = 99). The cross sectional area (CSA) of the inferior turbinate (IT) bone and the whole turbinate were measured at anterior, middle, and posterior thirds of the IT in coronal sections. The ratio of CSA of the IT bone on two sides of the septum (interturbinate ratio) and the ratio of the CSA of the overall turbinate to the IT bone (intraturbinate ratio) were calculated. Results: The interturbinate ratio of the bony turbinate CSA for the severe deviation group was significantly higher compared with other groups in anterior and middle segments (p  0.0001). The intraturbinate ratio was highest in the posterior segment and lowest in the middle segments in compensatorily hypertrophied sides for all groups (p  0.001). Conclusion: Skeletal enlargement is prominent in anterior and middle thirds of CHIT in patients with pronounced septal deviation. (American Journal of Rhinology 18, 405–410, 2004) U nilateral IT hypertrophy coexistent with septum devi- ation on the concave side is a frequently encountered sign in nasal examination. 1–3 It is assumed that this coun- terbalanced mechanism characterized by compensatory hy- pertrophy originates for protection of the more patent nasal side from excess airflow with its drying and crusting effects on nasal mucous membranes. 2 As a result, an increase in the volume of the erectile mucosa and/or skeleton of the turbi- nate may influence the nasal patency. 4 In patients with nasal obstruction and septum deviation, when septoplasty is performed as the only procedure, failure rate may reach 20–30%. 3,5 Untreated turbinate hypertrophy may be responsible for the high failure rates. 1,3,6–9 Follow- ing septal surgery without turbinate reduction, relocation of the septum will aggravate the obstruction on the nondevi- ated side of the nose. Common belief ascribes most of the enlargement of the inferior turbinate to mucosal (soft tissue) elements, 2 although the compensatory hypertrophy in these patients may involve both mucosa-submucosa and bone 1,10 However, Berger et al. had demonstrated that of all layers, bone of the inferior turbinate had undergone a twofold increase in thickness and manifested the most significant expansion in a histopathological study concerning compen- satorily hypertrophied inferior turbinates (CHIT). 2 From the *Department of Otorhinolaryngology, and #Depart- ment of Radiology, Karaelmas University, School of Medicine, Zonguldak, Turkey Address correspondence and reprint requests to Lokman Uzun, M.D., Karaelmas University, School of Medicine, Department of Otorhinolaryngology, 67600 Kozlu, Zonguldak, Turkey Copyright © 2004, OceanSide Publications, Inc., U.S.A. American Journal of Rhinology 405