The effect of botulinum toxin type A injection for intrinsic rhinitis

Abstract

Botulinum toxin type A (BTA) is known to inhibit the release of acetylcholine from cholinergic nerve endings. Owing to the characteristics of BTA, we thought that it could be used for the treatment of intrinsic rhinitis acting as an anticholinergic drug. In a double-blind placebo-controlled study four units of BTA were injected into the middle turbinate (two units) and inferior turbinate (two units) in each nasal cavity. Rhinorrhoea, nasal obstruction, and sneezing were recorded in a symptom diary on the basis of a scale of 5 and the number of paper tissues used per day was also recorded for 24 weeks. Rhinorrhoea was significantly diminished in severity (24.1–41.5 per cent reduction) and paper tissue use (54.3 per cent reduction) in the BTA group compared with the placebo group. This effect could be maintained for four weeks. Sneezing and nasal stuffiness were not affected by BTA. These results suggest that BTA can be used to treat rhinorrhoea in intrinsic rhinitis patients, however, the effective period is short.

Minimally Invasive Application of Botulinum Toxin Type A in Nasal Hypersecretion

“…In contrast to the study by Kim et al [2], our patient experienced an improvement of nasal congestion. In guinea pigs, we have seen apoptosis of nasal glands with degeneration and lysis [7].…”

“…Botulinum toxin has been injected into the turbinates of patients with intrinsic rhinitis, causing a significant reduction of nasal hypersecretion [2]; in dogs, a gauze soaked with the toxin and introduced into their nostrils was able to reduce rhinorrhea [6]. We have recently been able to demonstrate that botuli- Rohrbach/Laskawi num toxin type A induces apoptosis of nasal glands after local, noninvasive application with a sponge in guinea pigs [7].…”

“…ders of her nose or her maxillary sinuses and no infectious rhinitis. According to Kim et al [2] we handed out a so-called 'nose-diary' where she recorded the number of paper tissues she used every day (each tissue was used only once) and scored symptoms like nasal secretion, nasal congestion and sneezing on a four-point scale (0 = no, 1 = mild, 2 = moderate, 3 = moderate to severe, 4 = severe). Concomitant side effects such as dry nose, epistaxis and smelling disorders were also recorded daily.…”

“…Recently, Kim et al [2] reported on a significant reduction of rhinorrhea in patients with intrinsic rhinitis after injecting botulinum toxin type A into the middle and inferior turbinates. Here we report on the treatment of nasal hypersecretion in a female patient with intrinsic rhinitis using sponges for botulinum toxin application as a new minimally invasive option.…”

Neuronal Nitric Oxide Synthase-Immunoreactivity

“…These are probably independent of the terminal chemical denervation induced by the toxin. The fact that BTA is effective in decreasing nasal secretion was demonstrated earlier by experimental [29,30] and clinical studies [31,32]. We do not expect any NOS-related dysregulation with respect to basic functions particularly of the vascular or glandular compartment.…”