Endoscopic posterior nasal neurectomy in persistent allergic rhinitis: a clinical study

Abstract

Background: In the last decades, incidence of allergic rhinitis (AR) showed steadily increase in developed and developing countries; with profound effects on patient life and overall health care system. In intractable AR, endoscopic neurectomy of posterior nasal nerve had been introduced as a curative alternative. However, its efficacy and safety not adequately addressed. Objective: The current study aimed to present our clinical experience with endoscopic posterior nasal neurectomy [safety and efficacy] and to address its effect on the patient quality of life. Methodology: A sixty-three patients with AR were included. Clinical symptoms of AR had been assessed before and at 3, 6 and 12 months after surgery using a numerical score. In addition, patients had been asked to fill a 28-items rhinoconjunctivitis quality of life (RQoL) questionnaire. Results: There was progressive and significant improvement of clinical symptoms and improvement of the RQoL scores after surgery when compared to preoperative values. All scores reduced significantly at 3 months with subsequent reduction at 6 months which become stable to the end of the first year, except quality of life which showed another significant reduction at the end of the first year when compared to values at the 6 th postoperative month. No major complications had been recorded, and the overall successful control on nasal symptoms had been recorded for 68.3%, 81.0%, 88.9% and 79.4% for sneezing, itching, rhinorrhea and nasal obstruction, respectively. Conclusion: Endoscopic posterior nasal neurectomy is an effective and safe surgical technique for treatment of AR resistant to medical therapy.

Posterior nasal neurectomy for intractable rhinitis: A systematic review of the literature

“…A total of 23 studies with 2282 subjects in total met the inclusion criteria and were included in this systematic review. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][25][26][27][28][29][30][31][32][33] This process is shown in Figure 1.…”

“…9,11,17,18,31 Two of the papers focused on surgical technique as opposed to assessing outcome and the results were not reported in sufficient detail. 10,16 Seven papers studied PNN as a single intervention and found a significant improvement in patient-reported symptoms 17,18,20,[30][31][32][33] (SNOT-22, RQLQ, and individual nasal symptom scores) with follow-up ranging from 6 to 12 months. The other case series looked at outcomes of PNN with turbinate reduction and/or septoplasty.…”

“…There were three case-control studies, two comparing outcomes of turbinate reduction with and without PNN, 14,25 one compared PNN against medical therapy. 29 The remaining 17 were case series; 9 prospective 11,17,18,21,26,[30][31][32][33] and 8 retrospective. 9,10,15,16,19,20,22,27 Ogi et al 19 published a case series and undertook a case-control sub-analysis on complications by sending questionnaires to patients who underwent endoscopic sinus surgery (without PNN) as a control.…”

“…Seven studies specified that there were no additional nasal interventions and PNN was studied as a single intervention. 17,18,20,[30][31][32][33] Eight studies, 11,13,15,16,21,22,26,27 examined PNN with concurrent turbinate and septal surgery and four examined PNN with concurrent turbinate reduction. 9,14,19,25 The procedure was performed under general anaesthesia in all studies but two where some patients had the procedure under local anaesthesia.…”

“…A total of 14 studies 9,[11][12][13][14]16,19,21,25,27,[29][30][31][32] recruited patients with allergic rhinitis. The study population was often not clearly described with most simply reporting moderate-to-severe allergic rhinitis (based on symptoms and/or positive blood or skin tests to house dust mite or pollen) resistant to medical treatment.…”