Original study. Effectiveness of endoscopic posterior nasal neurectomy for the treatment of intractable rhinitis

Abstract

Effectiveness of endoscopic posterior nasal neurectomy for the treatment of intractable rhinitis INTRODUCTIONRhinitis is an inflammatory condition affecting the lining of the nose, characterized by nasal congestion, rhinorrhea, itching, sneezing and/or post-nasal discharge 1 . More than 20% of the population is affected by chronic rhinitis [2][3][4] . Depending on whether an allergic etiology is implicated, non-infectious rhinitis can be subdivided into allergic and non-allergic. With 600 million of world's population affected, allergic rhinitis is the most prevalent atopic disorder. The incidence of allergic rhinitis is on steady increase 5 . Various etiological factors have been postulated for chronic rhinitis -these include allergy, occupational exposures, hormonal changes, smoking, xylometazoline abuse, etc. The standard treatment strategy is medical (histamine antagonists, leukotriene receptor antagonists, intranasal corticosteroids, etc.) But many times, these therapies show limited effectiveness and cause substantial burden for treatment cost on the long term. In addition, the symptoms of intractable rhinitis can cause social embarrassment with a profound effect on patients' quality of life.Surgical management can be considered in such patients with intractable rhinitis. Various surgical techniques have been documented including Vidian neurectomy 6 , posterior nasal neurectomy, inferior turbinate reduction, with varying success rates [5][6][7][8] . In view of this, we are studying the effectiveness of posterior nasal neurectomy (PNN) in patients who have intractable rhinitis, refractory to maximum medical therapy. The outcome is assessed with patient's level of satisfac-ABSTRACT BACKGROUND. Chronic rhinitis is a clinical condition affecting more than 20% of the world population. The standard treat-

Endoscopic posterior nasal neurectomy for intractable rhinitis: a systematic review of the literature Running Title: Endoscopic PNN: a systematic review

“…In the case series analysis, three papers (23,24,26) studied PNN as a single intervention and found a significant improvement in patient reported symptoms (SNOT-22, RQLQ, and individual nasal symptom scores)with follow-up ranging from 6 to 12 months.…”

“…Ogi et al (25) 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. Five studies (12,15,(23)(24)26) examined PNN as a single intervention with no concomitant nasal surgery. Eight studies (9,13,(19)(20)(21)(22)(27)(28) examined PNN with concurrent turbinate and septal surgery and four (17)(18)21,25) examined PNN with concurrent turbinate reduction.…”

“…Ten studies(9,13,15-18,21-22,25,27) recruited patients with allergic rhinitis only and three studies (19,20,28) included both allergic and non-allergic patients. The allergy status was not recorded in 4 studies (12,(23)(24)26). Allergic rhinitis was defined by IgE or RAST testing in six studies (17,18,19,20,25,28), skin prick testing in one study (27), and diagnosis was confirmed by both in two studies (9,13).…”

“…The remaining studies did not define how allergic rhinitis was diagnosed in the study populations. Eleven studies (9,13,(15)(16)(18)(19)(22)(23)(24)(25)28) specified the treatments that had been used prior to PNN.…”

Anatomical relationship of pterygoid process pneumatization and vidian canal

“…10 Since this method is associated with less morbidity than the traditional transantral approach to vidian canal contents, it is the favoured surgical intervention for vasomotor rhinitis where nonsurgical medical line of management has consistently failed. 11 , 12 Also, to resect the tumors of the pterygopalatine fossa, understanding of the vidian canal location, variations and related structures like position and location of foramen rotundum in the posterior wall of pterygopalatine fossa is crucial. 13 …”