Surgical Treatment Outcomes in the Management of Rhinitis: A Systematic Review and Meta-Analysis

Abstract

Background:

Rhinitis can present with symptoms including severe nasal obstruction, rhinorrhea, nasal itching, and sneezing. Surgical treatment options include inferior turbinate procedures, thought to target nasal congestion, and posterior nasal nerve (PNN) procedures, for relief of rhinorrhea. This review intends to quantify the degree of resolution of symptoms related to rhinitis from various procedures and guide clinical decision making.

Methods:

A literature search identified studies reporting rhinitis symptoms at baseline and following surgical treatment. Outcomes of interest were the 4-item Total Nasal Symptom Score (TNSS) and VAS equivalents for “rhinorrhea,” “nasal obstruction,” “nasal itching,” and “sneezing.” Postnasal drip (PND) scores were additionally collected when available.

Results:

A total of 20 studies (N = 1408) were analyzed. The TNSS fell by 50% (mean difference 3.86 points [95% CI 3.03-4.69]), with all 4 symptoms undergoing significant amelioration across all procedure types. Nasal congestion, rhinorrhea, and PND saw the largest improvement, with reductions ranging from 1.2 to 1.5 points. VAS scoring followed a similar pattern, with nasal obstruction and runny nose undergoing the largest changes. Turbinate and PNN procedures led to similar improvements in congestion and rhinorrhea, with average score reductions of 56.8% and 57.6% (P = 0.7168), respectively. Nasal itching and PND underwent differential improvement, with greatest improvements from PNN procedures (mean differences of 14.2% [95% CI: 4.7-23.4%] and 31.6% [95% CI: 21.2-40.6%], P < .0001).

Conclusion:

All surgical treatments for rhinitis improve patient symptom burden, having the most drastic effect on nasal congestion and rhinorrhea. PNN procedures result in greater improvements in nasal itching and PND but otherwise perform similarly to inferior turbinate surgeries.