Is Posterior Nasal Nerve Neurectomy Really a Ray of Hope for the Patients of Allergic Rhinitis

Trivedi, Bhargavi; Vyas, Pratibha; Soni, Nikhil Kumar; Gupta, Priyanshi; Dabaria, Rajendra Kumar

doi:10.1007/s12070-021-03031-8

Cited by 7 publications

(20 citation statements)

References 12 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…In the case series, only 5 of 17 papers defined their study population in sufficient detail. 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.…”

Section: Results Of Individual Studiesmentioning

confidence: 99%

“…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.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…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.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…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.…”

Section: Study Characteristicsmentioning

confidence: 99%

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

Lee

Chakravarty

Ellul

2022

Clinical Otolaryngology

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Background Rhinitis affects up to 40% of the population worldwide and can significantly reduce quality of life. Some patients remain symptomatic despite maximal medical therapy. In refractory cases, posterior nasal neurectomy (PNN—the endoscopic division of the intranasal nerve branches containing postganglionic parasympathetic fibres) is postulated to reduce symptom burden. Objectives of Review To establish whether PNN is effective and safe in the management of allergic and non‐allergic rhinitis. Type of Review Systematic review. Methods A comprehensive literature search was undertaken using PubMed, EMBASE, MEDLINE, and Cochrane. The inclusion criteria were: studies published in English, studies where PNN was performed either with or without additional procedures, and where measures of objective/subjective outcomes and/or complications were reported. Extracted data included study type, sample size, surgical technique, study population characteristics, follow‐up period, outcome measures, complications of surgery, and symptom outcomes. Results A total of 23 articles satisfied the inclusion criteria studying in total 2282 patients. Sample size ranged from 8 to 1056. There were 3 randomised controlled trials, 3 case‐control studies, and the remaining 17 were case series using both objective and subjective outcome measures. All but one study found improved patient‐reported outcomes following PNN. Complications were reported in 14 studies—epistaxis was the most common complication and was observed in 30 patients (1.5% of subjects). Conclusions PNN had a low rate of complications. Although most studies reported significant symptomatic improvement, their heterogeneity, level of evidence, study design, and/or quality was not sufficient to draw any firm conclusions on the effectiveness of the procedure. Larger, well‐designed studies are needed to clarify its role in the management of difficult‐to‐treat rhinitis.

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Section: Resultsmentioning

confidence: 99%

Section: Results Of Individual Studiesmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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

Lee

Chakravarty

Ellul

2022

Clinical Otolaryngology

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Temperature‐controlled radiofrequency ablation for the treatment of chronic rhinitis: Two‐year outcomes from a prospective multicenter trial

Takashima,

Stolovitzky,

et al. 2024

Int Forum Allergy Rhinol

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BackgroundMinimally invasive temperature‐controlled radiofrequency (TCRF) ablation of the posterior nasal nerve (PNN) demonstrated a significant larger treatment effect on the symptom burden of chronic rhinitis patients than a sham control (no energy delivery) at the 3‐month primary endpoint of this trial.MethodsTwo‐year posttreatment outcomes for patients treated in a prospective, multicenter, patient‐blinded randomized controlled trial were determined by combining the index active treatment‐arm and index control‐arm crossover patients into a single group (after the primary endpoint) to evaluate the treatment effect durability and long‐term effects on concomitant chronic rhinitis medication usage.ResultsThe mean baseline reflective total nasal symptom score (rTNSS) was 8.2 (95% confidence interval [CI], 7.9–8.6; N = 104). At 2 years (N = 79), the mean change in rTNSS was −5.3 (95% CI, −5.8 to −4.8; p < 0.001; 64.6% improvement). The 2‐year responder rate (≥30% improvement in rTNSS) was 87.3% (95% CI, 78.0–93.8). All four components of the rTNSS (rhinorrhea, congestion, sneezing, and nasal itching) showed significant improvement over baseline, with rhinorrhea and congestion showing the most improvement. Postnasal drip and cough symptoms were also significantly improved. At 2 years, 81.0% (95% CI, 70.6–89.0) reported a minimal clinically important difference of ≥0.4‐point improvement in the mini‐rhinoconjunctivitis quality of life questionnaire score. Of 56 patients using chronic rhinitis medications at baseline, 25 of 56 (44.6%) either stopped all medication use (7/56 [12.5%]) or stopped/decreased (18/56 [32.1%]) use of ≥1 medication class at 2 years. No serious adverse events related to the device/procedure were reported over 2 years.To determine the potential effect of patients who left the trial over 2 years on the responder rate, the responder statuses of the 14 patients with follow‐up data who were lost to follow‐up/withdrew/died were imputed by the last observation carried forward and the responder statuses of all nine patients who had an additional nasal procedure were imputed to nonresponder, resulting in a 2‐year responder rate of 79.4% (95% CI, 70.3–86.8).ConclusionTCRF ablation of the PNN is safe and resulted in a significant and sustained reduction in chronic rhinitis symptom burden through 2 years and a substantial reduction in concomitant medication burden.

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Two‐Year Outcomes After Radiofrequency Neurolysis of Posterior Nasal Nerve in Chronic Rhinitis

Lee,

Abbas,

Charous

et al. 2023

The Laryngoscope

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ObjectiveTo assess the long‐term safety and effectiveness of temperature‐controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN), a minimally invasive treatment for chronic rhinitis.MethodsA prospective, single‐arm study of 129 patients at 16 centers (United States, Germany) was conducted. Patient‐reported outcome measures were the 24‐h reflective total nasal symptom score (rTNSS) and mini rhinoconjunctivitis quality of life questionnaire (MiniRQLQ). Postnasal drip and cough symptoms were assessed using a 4‐point scale.ResultsThe mean pretreatment rTNSS was 7.8 (95% CI, 7.5–8.1). The significant rTNSS treatment effect at 3 months (−4.2 [95% CI, −4.6 to −3.8]; p < 0.001) was sustained through 2 years (−4.5 [95% CI, −5.0 to −3.9]; p < 0.001), a 57.7% improvement. At 2 years, the proportion of patients with a minimal clinically important difference (MCID) of ≥30% improvement in rTNSS from baseline was 80.0% (95% CI, 71.4%–86.5%). Individual postnasal drip and cough symptom scores were significantly improved from baseline through 2 years. The proportion of patients who reached the MCID for the MiniRQLQ (≥0.4‐point improvement) at 2 years was 77.4% (95% CI, 68.5%–84.3%). Of 81 patients using chronic rhinitis medications at baseline, 61.7% either stopped all medication use (28.4%) or stopped or decreased (33.3%) use of ≥1 medication class at 2 years. No device/procedure‐related serious adverse events were reported throughout 2 years.ConclusionTCRF neurolysis of the PNN resulted in sustained improvements in chronic rhinitis symptom burden and quality of life through 2 years, accompanied by a substantial decrease in medication burden.Level of Evidence4 Laryngoscope, 2023

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Is Posterior Nasal Nerve Neurectomy Really a Ray of Hope for the Patients of Allergic Rhinitis

Cited by 7 publications

References 12 publications

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

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

Temperature‐controlled radiofrequency ablation for the treatment of chronic rhinitis: Two‐year outcomes from a prospective multicenter trial

Two‐Year Outcomes After Radiofrequency Neurolysis of Posterior Nasal Nerve in Chronic Rhinitis

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