Efficacy of posterior nasal neurectomy for allergic rhinitis combined with chronic rhinosinusitis with nasal polyps

Abstract

Background: Allergic rhinitis combined with chronic rhinosinusitis with nasal polyps (ARwCRSwNP) is very common clinically. Conventionally, the treatment for these patients is surgical method for CRSwNP followed by treatment with a nasal steroid spray or other antiallergic drugs to control AR. In recent years, some rhinologists introduced vidian neurectomy (VN) or posterior nasal neurectomy (PNN) into endoscopy to treat refractory AR and reported an encouraging outcome. Furthermore, we explore the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP.

Objective: To investigate the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP.

Methods: Eighty-five patients with ARwCRSwNP who were admitted to our hospital from November 2016 to July 2018 were enrolled in two groups. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN; group B underwent conventional FESS alone. VAS, RQLQ, SNOT-22 and postoperative nasal endoscopy were used to evaluate the improvement in symptoms and the recurrence of nasal polyps.

Results: The experimental group had better control of sneezing (p < .05) and rhinorrhea (p < .01) than the control group. For those who underwent surgery more than 6 months prior in both groups, the recurrence rate was 29.6% (8/27) in the experimental group and 44.4% (8/18) in the control group, and there was no significant difference (χ² = .483, p = .487).

Conclusion: FESS combined with PNN can improve the symptoms of sneezing and rhinorrhea caused by ARwCRSwNP more obviously than FESS alone, but there is no clear statistical advantage of this procedure for improving the overall symptoms and controlling the recurrence of nasal polyps.

Chinese abstract

背景：过敏性鼻炎伴慢性鼻窦炎伴鼻息肉（ARwCRSwNP）在临床上很常见。传统上, 这些患者的治疗方法是治疗CRSwNP的手术法, 然后用鼻类固醇喷雾剂或其他抗过敏药物治疗来控制过敏性鼻炎。近年来, 一些鼻科医师将翼管神经切除术（VN）或后鼻神经切除术（PNN）引进内视镜治疗来医治难治性AR, 结果令人鼓舞。另外, 我们探讨了鼻息肉复发的控制及经鼻内镜下PNN治疗ARWCRSWnP后, 症状的改善。

目的：探讨鼻内镜下PNN治疗ARwCRSwNP后鼻息肉复发的控制及症状的改善。

方法：将2016年11月至2018年7月收治的85例ARwCRSwNP患者分为两组。A组接受常规功能性内镜鼻窦炎手术（FESS）并PNN手术；B组仅接受常规FESS。采用VAS、RQLQ、SNOT-22及术后鼻内窥镜检查来评价鼻息肉症状改善及复发情况。

结果：实验组对喷嚏（P<0.05）和鼻漏（P<0.01）的控制效果优于对照组。两组中6个多月以前接受手术者, 实验组复发率为29.6%（8/27）, 对照组复发率为44.4%（8/18）, 无显著性差异（χ² =0.483, P=0.487）。

结论：FESS联合PNN治疗方法对控制ARwCRSwNP所致的喷嚏、鼻漏症状明显优于单纯FESS治疗法, 但对改善鼻息肉的整体症状和控制鼻息肉复发无明显的统计学优势。

Keywords:

• Allergic rhinitis
• nasal polyps
• recurrence
• sneezing
• rhinorrhea

Acknowledgements

The authors thank the staff who took part in this study and the patients who were compliant with continuous follow-up.

Disclosure statement

No potential conflict of interest was reported by the authors.