Chronic Rhinitis Surgery: Association Between Preoperative Severity and Response Rate

Abstract

Background

The success rate of chronic rhinitis surgery varies depending on the patients’ factor and surgical method. While outcomes for nasal obstruction differ, the association between preoperative severity of other rhinitis symptoms, such as rhinorrhea, sneezing, and nasal itching, measured via the reflective total nasal symptom score (rTNSS) remains unevaluated.

Objective

To evaluate the association between the response rate to surgical treatment of chronic rhinitis and preoperative severity.

Methods

A retrospective cohort study was conducted among adult patients with chronic rhinitis symptoms refractory to medication and nasal spray for over 6 months and received radiofrequency ablation of inferior turbinates with posterior nasal nerve neurolysis. The primary endpoint was the change from baseline in 24-h rTNSS and nasal obstruction symptom evaluation (NOSE) scores. Postoperative surgery response rate, rTNSS score change, and score improvement ratios were also evaluated.

Results

A total of 183 patients (110 males, 60.1%) were included in this study. After 3-month follow-up, the preoperative rTNSS was 6.51 ± 2.74 change to 1.70 ± 1.43, and the NOSE score was 56.48 ± 19.90 change to 4.56 ± 7.74. Both scores and all sub-scores showed significant differences when comparing preoperative, 1-month, and 3-month results (P < 0.05-0.001). The response rate by rTNSS for whole cohort was 78.14 ± 41.44% and 93.99 ± 23.83% at 1- and 3-month follow-up. Subgroup analyses were performed according to individual rTNSS scores and 2 in 1 score groups (ie, 1-2, 3-4, etc) and their relationship to the surgery outcomes. Both preoperative individual score and score groups were significantly associated with all post-operation outcomes (P = 0.022 to <0.001) in linear regression analysis.

Conclusion

Patients with more severe preoperative rhinitis symptoms are associated with better response rate, post-operation symptom score changes, and score improvement ratio.

Keywords

preoperative severity radiofrequency rhinitis posterior nasal nerve neurolysis response rate

Get full access to this article

View all access options for this article.

References

Huang

Cheng

. Changes in nasal resistance and quality of life after endoscopic microdebridor-assisted inferior turbinoplasty in patients with perennial allergic rhinitis. Arch Otolaryngol Head Neck Surg. 2006;132(9):990–993.

Yoo

Choi

. Long-term efficacy of turbinoplasty compared with medical treatment in patients with allergic rhinitis. Acta Otolaryngol. 2022;142(5):431–437.

Lin

, et al. Radiofrequency for the treatment of allergic rhinitis refractory to medical therapy. Laryngoscope. 2003;113(4):673–678.

Park

Kim

Jun

, et al. Long-term outcomes of turbinate surgery in patients with allergic rhinitis: A systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2023;149(1):15–23.

Konno

Togawa

. Role of the vidian nerve in nasal allergy. Ann Otol Rhinol Laryngol. 1979;88(2 Pt 1):258–266.

Chang

Song

Hwang

. Cryosurgical ablation for treatment of rhinitis: A prospective multicenter study. Laryngoscope. 2020;130(8):1877–1884.

Kim

Kang

Kim

, et al. Effectiveness of the posterior nasal nerve cryoablation in allergic and non-allergic rhinitis. Laryngoscope. 2024;134(6):2502–2512.

Kobayashi

Hyodo

Nakamura

, et al. Resection of peripheral branches of the posterior nasal nerve compared to conventional posterior neurectomy in severe allergic rhinitis. Auris Nasus Larynx. 2012;39(6):593–596.

Takashima

Stolovitzky

, et al. Temperature-controlled radiofrequency neurolysis for treatment of chronic rhinitis: 12-month outcomes after treatment in a randomized controlled trial. Int Forum Allergy Rhinol. 2023;13(2):107–115.

10.

Takahara

Takeno

Hamamoto

, et al. Management of intractable nasal hyperreactivity by selective resection of posterior nasal nerve branches. Int J Otolaryngol. 2017;2017(1):1907862.

11.

Lee

Abbas

Charous

, et al. Clinical and quality of life outcomes following temperature-controlled radiofrequency neurolysis of the posterior nasal nerve (RhinAer) for treatment of chronic rhinitis. Am J Rhinol Allergy. 2022;36(6):747–754.

12.

Carrie

O’Hara

Fouweather

, et al. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: Multicentre, open label, randomised controlled trial. Br Med J. 2023;383:e075445.

13.

Pedersen

Schiöler

Finjan

, et al. Prognostic factors for outcome after septoplasty in 888 patients from the Swedish national septoplasty register. Eur Arch Otorhinolaryngol. 2019;276(8):2223–2228.

14.

American Academy of Otolaryngology Head and Neck Surgery. Position statement: PNN ablation for the treatment of chronic rhinitis. 2013. https://www.entnet.org/resource/position-statement-posterior-nasal-nerve/

15.

Krespi

Wilson

Kizhner

. Laser ablation of posterior nasal nerves for rhinitis. Am J Otolaryngol. 2020;41(3):102396.

16.

Ehmer

McDuffie

Scurry

Jr , et al. Temperature-controlled radiofrequency neurolysis for the treatment of rhinitis. Am J Rhinol Allergy 2022;36(1):149–156.

17.

Stolovitzky

Silvers

, et al. Effect of radiofrequency neurolysis on the symptoms of chronic rhinitis: a randomized controlled trial. OTO Open 2021;5(3):1–7.

18.

Lee

. Evaluation of nasal obstruction in medically treated patients with CNOSE, acoustic rhinometry and rhinomanometry. J Taiwan Otolaryngol-Head Neck Surg. 2019;54(1):1–9.

19.

Stewart

Witsell

Smith

, et al. Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004;130(2):157–163.

20.

Rennie

O’Hara

Rousseau

, et al. Nasal airway obstruction study (NAIROS): A phase III, open-label, mixed-methods, multicentre randomised controlled trial of septoplasty versus medical management of a septal deviation with nasal obstruction. Trials. 2020;21(1):179.

21.

Abdullah

Singh

. Surgical interventions for inferior turbinate hypertrophy: A comprehensive review of current techniques and technologies. Int J Environ Res Public Health. 2021;18(7):3441.

22.

Lin

Friedman

, et al. Long-term results of radiofrequency turbinoplasty for allergic rhinitis refractory to medical therapy. Arch Otolaryngol Head Neck Surg. 2010;136(9):892–895.

23.

Ehmer

McDuffie

McIntyre

, et al. Long-term outcomes following temperature-controlled radiofrequency neurolysis for the treatment of chronic rhinitis. Allergy Rhinol (Providence). 2022;13: 1–8.

24.

Pedersen

Dölvik

Holmberg

, et al. Surgery to relieve nasal obstruction: Outcome for 366 patients operated on by one senior surgeon. Eur Arch Otorhinolaryngol. 2021;278(10):3867–3875.

25.

Hussain

Ahmad

. Role of CO₂ laser in the management of symptomatic hypertrophy of inferior nasal turbinates. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 2):826–834.

26.

Ator

Coker

Jenkins

. Thermal injury to the intratemporal facial nerve following CO₂ laser application. Am J Otolaryngol. 1985;6(6):437–442.