The long-term outcomes of posterior nasal neurectomy with or without pharyngeal neurectomy in patients with allergic rhinitis: a randomized controlled trial

Hua, Hongting; Wang, Guo-Yuan; Zhao, Yi; Wang, Dong; Qiu, Zengyu; Fang, Ping

doi:10.1016/j.bjorl.2021.05.006

Cited by 6 publications

(40 citation statements)

References 19 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%

“…There are variations in the surgical technique of PNN but most authors describe raising a mucoperiosteal flap off the sphenopalatine foramen and SPA and identifying the nerve and any major branches. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] These are divided and partly excised. PNN is a relatively straightforward procedure, involves a less complicated dissection than vidian neurectomy, 10 and can be carried out as a day case procedure.…”

Section: Relevant Anatomy and Surgical Techniquementioning

confidence: 99%

“…These included three randomised controlled trials (RCTs). 12,13,28 Zhang 12 compared the outcomes of PNN (n = 32) against nasal corticosteroid and oral antihistamines (n = 31) and Hua et al 13 compared the outcomes of PNN alone (Continues)…”

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%

“…The entire neurovascular bundle containing the SPA and posterior nasal nerve and branches was divided/cauterised in five studies. 12,13,15,19,22 The main branch of the posterior nasal nerve was divided alone 14,17,18,21 or together with other nerve branches around the SPA. [9][10][11]16,20 One study did not report sufficient detail on the surgical technique used.…”

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: Relevant Anatomy and Surgical Techniquementioning

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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International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Wise

Damask

Roland

et al. 2023

Int Forum Allergy Rhinol

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Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR‐Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR‐Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence‐based findings and recommendation from the full document. Methods ICAR‐Allergic Rhinitis 2023 employed established evidence‐based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR‐Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR‐Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

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Endoscopic vidian and vidian‐branch neurectomy for refractory allergic rhinitis: A systematic review

Niu,

Chen,

Zhou

et al. 2023

Int Forum Allergy Rhinol

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BackgroundEndoscopic vidian neurectomy is expected to provide good therapeutic relief in patients with allergic rhinitis (AR) being refractory to medication therapy or conservative surgery. However, the evidence bases for its benefit remain debatable. In this study, we conducted a systematic review and meta‐analysis to clarify the therapeutic role of various forms of vidian neurectomy in refractory AR.MethodPreferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines were used to conduct a systematic review of primary studies that reported original patient data for endoscopic vidian neurectomy (EVN) and vidian‐branch neurectomy, which includes selective vidian neurectomy (SVN) and posterior nasal neurectomy (PNN). The primary outcome was patient‐reported outcome measures (PROMs), including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Visual Analog Scale (VAS), to assess an improvement in nasal symptom severity and quality of patient's life. The incidence of surgical complications and other objective outcomes were considered secondary outcomes.ResultsThis review included 24 clinical studies involving 1677 patients with refractory AR, of which 510 patients in six studies had combined chronic rhinosinusitis with nasal polyps (CRSwNP) and 95 patients in one study had combined asthma. Postoperative PROMs were significantly better than preoperatively in almost all patients who underwent vidianp (RQLQ: standardized mean difference [SMD] = 2.66, 95% confidence interval [CI] = 2.40–2.92, p < 0.001; VAS: SMD = 5.15, 95% CI = 4.29–6.02, p < 0.001) or vidian‐branch neurectomy (RQLQ in PNN: SMD = 3.29, 95% CI = 2.45–4.13, p < 0.001; VAS in PNN: SMD = 4.38, 95% CI = 3.41–5.34, p < 0.001), and were generally better than in the conservative treatment group. Dividing with 18 months as the cutoff point, a subgroup analysis of the follow‐up period was conducted, and the results showed that both long‐term and short‐term postoperative patients had considerably reduced symptoms compared to the preoperative period. The two surgical procedures, SVN and PNN, attributed to vidian‐branch neurectomy have extremely few complications. However, EVN is more likely to cause dry eyes and palatal numbness, with no other serious complications. In patients with AR and CRSwNP, vidian or selective vidian neurectomy combined with functional endoscopic sinus surgery (FESS) is more effective than conventional FESS (RQLQ: SMD = 2.17, 95% CI = 1.66–2.69, p < 0.001; VAS: SMD = 6.42, 95% CI = 4.78–8.06, p < 0.001). For patients who have both AR and asthma, SVN with pharyngeal branch excision is a potential treatment option.ConclusionEVN and vidian‐branch neurectomy (including SVN and PNN) are effective treatments, but the former has a higher risk of complications. Additionally, vidian‐branch neurectomy with FESS is beneficial for patients with mixed CRSwNP. SVN is a potential approach for patients with coexisting AR and asthma.

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The long-term outcomes of posterior nasal neurectomy with or without pharyngeal neurectomy in patients with allergic rhinitis: a randomized controlled trial

Cited by 6 publications

References 19 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

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Endoscopic vidian and vidian‐branch neurectomy for refractory allergic rhinitis: A systematic review

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