Posterior nasal nerve neurectomy for the treatment of rhinitis: a systematic review and meta-analysis

Abstract

BackgroundPosterior nasal nerve neurectomy (PNNN) is a surgical option for the treatment of refractory chronic rhinitis. It can be performed by surgical dissection, cryotherapy, or laser ablation. ObjectiveThis systematic review aimed to assess the effect of PNNN on Total Nasal Symptom Score (TNSS) in adults with chronic rhinitis. MethodsA systematic review of EMBASE, MEDLINE, PubMed and ClinicalKey databases was conducted in November 2021. Studies reporting PNNN performed as a single procedure in adult patients with allergic, non-allergic or mixed chronic rhinitis, and TNSS as the outcome measure, were included. M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n ResultsDatabase search identified 39 articles, of which 8 (463 patients) were included in the review. Two were randomised sham-controlled trials and six were prospective singlearm, unblinded and uncontrolled studies. Pooled analysis of data from the two randomized controlled trials found active treatment was associated with a significantly greater responder (≥30% reduction in TNSS from baseline) rate (OR 3.85, 95% CI 2.23 -6.64, p<0.00001). ConclusionsThis systematic review identified there is some limited evidence to suggest cryotherapy or radiofrequency ablation of the posterior nasal nerve can improve TNSS in adult patients. However, this is from a limited number of trials with short follow-up. Future research should focus on prospective randomised controlled trials with larger numbers of participants and medium to long term follow up in order to help draw more valid conclusions regarding the true effectiveness of PNNN in this patient cohort.

Efficacy of various surgical methods in the treatment of allergic rhinitis: A network meta-analysis

“…60,61 Studies, such as that PNN requires us to find and separate the posterior nasal neurovascular bundle at the posterior end of the middle turbinate, and then use bipolar electrocoagulation or plasma knife to coagulate and cut off the posterior nasal nerve. 9 The posterior nasal nerve is mainly composed of sensory fibers of the maxillary nerve and post-pterygonomic fibers of the sphenopalatine ganglion, which contain sympathetic and parasympathetic components. PNN simultaneously cuts off the branches of the sympathetic, parasympathetic, The anterior ethmoid nerve is derived from the ophthalmic nerve, 62 which is a mixed nerve of sensory and parasympathetic nerve, and its main branches innervate the anterior nasal cavity and sinus mucosa.…”

“…PNN selectively cuts off the nerve branches distributed in the nasal cavity, so the postoperative pain response is smaller and the surgical complications are less. 9 At present, a large number of experiments have shown that the above surgical methods can improve AR, 10 but there is no gold standard procedure for the treatment of allergic rhinitis. 11 In this study, network meta-analysis was used to study the differences in the efficacy of different surgical methods and to evaluate them, so as to provide a reference for clinicians in the choice of surgical methods for allergic rhinitis.…”

Radiofrequency Neurolysis of the Posterior Nasal Nerve: A Systematic Review and Meta‐Analysis

“…A previous systematic review by Balai et al, which evaluated the efficacy of these minimally invasive procedures, showed that these treatments improved chronic rhinitis symptoms. 6 However, only one of their eight studies examined the effects of radiofrequency ablation of the PNN. Since the publication of this systematic review, neurolysis of the PNN with temperature-controlled radiofrequency has been gaining more interest.…”

“…A previous systematic review by Balai et al, which evaluated the efficacy of these minimally invasive procedures, showed that these treatments improved chronic rhinitis symptoms 6 . However, only one of their eight studies examined the effects of radiofrequency ablation of the PNN.…”

Highlights of the treatment of allergic rhinitis according to Chinese guidelines

“…The newly updated Chinese guidelines of allergic rhinitis [1,2] have introduced that type 2 innate lymphoid cells (ILC2) function in type 2 immune responses during early allergic rhinitis and highlighted the crucial regulatory roles played by type 2 follicular helper T cells (Tfh) and follicular regulatory T cells (Tfr) in the production of IgE and the pathogenesis of allergic rhinitis, reflecting an innovative understanding of the mechanism of allergic rhinitis driven by basic immunological findings and providing a theoretical basis for further research. Additionally, the newly updated guidelines have stressed that substance P and calcitonin gene-related peptides (CGRP), which are secreted by nerve fibers around the nasal mucosal glands, increase significantly during allergic rhinitis and are closely involved in airway hyperresponsiveness [9,10], providing a theoretical justification for the clinical treatment of allergic rhinitis through parasympathetic nerve dissection using a minimally invasive endoscopic approaches [11,12].…”