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Advances in Surgical Treatment of Rhinitis

  • Otolaryngic Allergy (M Platt and C Brook, Section Editors)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Rhinitis is a heterogeneous diagnosis characterized by the presence of several nasal symptoms and it is only when pharmacotherapy fails that surgical treatment is considered. Over the years, multiple surgical techniques and approaches have been proposed to treat these patients. We aim to present a comprehensive literature review of the surgical management of rhinitis, including the most recent techniques and long-term outcome evaluations.

Recent Findings

Endoscopic techniques targeting the inferior turbinates, septum, and the parasympathetic neural supply to the nasal mucosa have evolved over the years to surgically address rhinitis; better understanding of rhinitis physiopathology has prompted the development of less invasive techniques with potentially similar outcomes and decreased morbidity.

Summary

For the management of allergic rhinitis, isolated outfracture of the inferior turbinate remains the least invasive technique and classical submucosal resection remains very much in favor among practitioners. A variety of methods to achieve adequate submucosal reduction of the inferior turbinate are also discussed, including the microdebrider, radiofrequency ablation, and coblation techniques. Regarding non allergic rhinitis, we assess both endoscopic vidian neurectomy and posterior nasal nerve neurectomy, two broadly effective, but elaborate, options necessitating general anesthesia and a visit to the operating room. We also discuss cryoablation of the posterior nasal nerve, which presents as a minimally invasive technique that can be performed as an in-office procedure.

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References

Papers of particular interest, published recently, have been highlighted as:

    • Of importance

    1. Wallace DV, Dykewicz MS, Bernstein DI, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(2 Suppl):S1-84.

      Article  Google Scholar 

    2. Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: a practice parameter update. J Allergy Clin Immunol. 2020;146(4):721–67.

      Article  CAS  Google Scholar 

    3. Bousquet J, Schünemann HJ, Togias A, et al. Next-generation allergic rhinitis and its impact on asthma (ARIA) guidelines for allergic rhinitis based on grading of recommendations assessment, development and evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2020;145(1):70-80.e73.

      Article  Google Scholar 

    4. Chhabra N, Houser SM. The surgical management of allergic rhinitis. Otolaryngol Clin North Am. 2011;44(3):779-95,xi.

      Article  Google Scholar 

    5. Soumya S, Adegboyega G, Elhassan H. Surgical approaches for allergic rhinitis: a systematic review protocol. Int J Surg Protoc. 2021;25(1):178–83.

      Article  PubMed Central  Google Scholar 

    6. Wu AW, Ting JY. Indications for surgery in refractory rhinitis. Curr Allergy Asthma Rep. 2014.

    7. Yan CH, Hwang PH. Surgical management of nonallergic rhinitis. Otolaryngol Clin North Am. 2018;51(5):945–55.

      Article  Google Scholar 

    8. Malcolmson KG. The vasomotor activities of the nasal mucous membrane. J Laryngol Otol. 1959;73:73–98.

      Article  Google Scholar 

    9. McCrory DC, Williams JW, Dolor RJ, et al. Management of allergic rhinitis in the working-age population. Evid Rep Technol Assess (Summ). 2003;67:1–4.

      Google Scholar 

    10. Bousquet J, Fokkens W, Burney P, et al. Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper. Allergy. 2008;63(7):842–53 Feb;14(2):414.

      Article  CAS  Google Scholar 

    11. Chhabra N, Houser SM. Surgery for allergic rhinitis. International forum of allergy & rhinology. 2014;4(Suppl 2):S79-83.

      Article  Google Scholar 

    12. Aksoy F, Yıldırım YS, Veyseller B, Ozturan O, Demirhan H. Midterm outcomes of outfracture of the inferior turbinate. Otolaryngol Head Neck Surg. 2010;143(4):579–84.

      Article  Google Scholar 

    13. Passàli D, Lauriello M, Anselmi M, Bellussi L. Treatment of hypertrophy of the inferior turbinate: long-term results in 382 patients randomly assigned to therapy. Ann Otol Rhinol Laryngol. 1999;108(6):569–75.

      Article  Google Scholar 

    14. Passàli D, Passàli FM, Damiani V, Passàli GC, Bellussi L. Treatment of inferior turbinate hypertrophy: a randomized clinical trial. Ann Otol Rhinol Laryngol. 2003;112(8):683–8.

      Article  Google Scholar 

    15. Kakarala K, Faquin WC, Cunningham MJ. Radiofrequency volumetric tissue reduction of the inferior turbinate in a sheep model. Laryngoscope. 2012;122(4):724–9.

      Article  Google Scholar 

    16. Safiruddin F, Vroegop AV, Ravesloot MJ, de Vries N. Long-term self-reported treatment effects and experience of radiofrequency-induced thermotherapy of the inferior turbinates performed under local anesthesia: a retrospective analysis. Eur Arch Otorhinolaryngol. 2013.

    17. Gunhan K, Unlu H, Yuceturk AV, Songu M. Intranasal steroids or radiofrequency turbinoplasty in persistent allergic rhinitis: effects on quality of life and objective parameters. Eur Arch Otorhinolaryngol. 2011;268:845–50.

      Article  Google Scholar 

    18. Lee JY, Lee JD. Comparative study on the long-term effectiveness between coblation- and microdebrider-assisted partial turbinoplasty. Laryngoscope. 2006;116(5):729–34.

      Article  Google Scholar 

    19. Mori S, Fujieda S, Igarashi M, et al. Submucous turbinectomy decreases not only nasal stiffness but also sneezing and rhinorrhea in patients with perennial allergic rhinitis. Clin Exp Allergy. 1999;29:1542–8.

      Article  CAS  Google Scholar 

    20. Mori S, Fujieda S, Yamada T, et al. Long-term effect of submucous turbinectomy in patients with perennial allergic rhinitis. Laryngoscope. 2002;112:865–9.

      Article  Google Scholar 

    21. Chen YL, Tan CT, Huang HM. Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis. Laryngoscope. 2008;118(7):1270–4.

      Article  Google Scholar 

    22. Liu CM, Tan CD, Lee FP, Lin KN, Huang HM. Microdebrider-assisted versus radiofrequency-assisted inferior turbinoplasty. Laryngoscope. 2009;119(2):414–8.

      Article  Google Scholar 

    23. Takahara D, Takeno S, Hamamoto T, Ishino T, Hirakawa K. Management of intractable nasal hyperreactivity by selective resection of posterior nasal nerve branches. Int J Otolaryngol. 2017;2017:1907862.

      Article  PubMed Central  Google Scholar 

    24. Golding-Wood PH. Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis. J Laryn- gol Otol. 1961;75:232–47.

      Article  CAS  Google Scholar 

    25. Kra**a Z. Critical review of Vidian neurectomy. Rhinology. 1989;27(4):271–6.

      CAS  PubMed  Google Scholar 

    26. Kamel R, Zaher S. Endoscopic transnasal vidian neurectomy. Laryngoscope. 1991;101:316–9.

      CAS  PubMed  Google Scholar 

    27. Robinson SR, Wormald PJ. Endoscopic vidian neurectomy. Am J Rhinol. 2006;20:197–202.

      Article  Google Scholar 

    28. Su WF, Liu SC, Chiu FS, Lee CH. Antegrade transsphenoidal vidian neurectomy: short-term surgical outcome analysis. Am J Rhi- nol Allergy. 2011;25:e217–20.

      Article  Google Scholar 

    29. Halderman A, Sindwani R. Surgical management of vasomotor rhinitis: a systematic review. Am J Rhinol Allergy. 2015;29:128–34.

      Article  Google Scholar 

    30. Lin PY, Cheng CY, Wu CC, Yen MY, Wang SJ, Liao KK, Lee SM. Bilateral neurotrophic keratopathy complicating Vidian neurectomy. Am J Ophthalmol. 2001;132(1):106–8.

      Article  CAS  Google Scholar 

    31. Bleier BS, Schlosser RJ. Endoscopic anatomy of the postganglionic pterygopalatine innervation of the posterolateral nasal mucosa. Int Forum Allergy Rhinol. 2011;1(2):113–7.

      Article  Google Scholar 

    32. Kikawada T. Endoscopic posterior nasal neurectomy: an alternative to vidian neurectomy. Oper Tech Otolayngol Head Neck Surg. 2007;18:297–301.

      Article  Google Scholar 

    33. Ruskell GL. Orbital passage of pterygopalatine ganglion efferents to paranasal sinuses and nasal mucosa in man. Cells Tissues Organs. 2003;175:223–8.

      Article  Google Scholar 

    34. Ruskell GL. Distribution of pterygopalatine ganglion efferents to the lacrimal gland in man. Exp Eye Res. 2004;78:329–35.

      Article  CAS  Google Scholar 

    35. Kobayashi T, Hyodo M, Nakamura K, Komobuchi H, Honda N. Resection of peripheral branches of the posterior nasal nerve compared to conventional posterior neurectomy in severe allergic rhinitis. Auris Nasus Larynx. 2012;39:593–6.

      Article  Google Scholar 

    36. Ikeda K, Yokoi H, Saito T, Kawano K, Yao T, Furukawa M. Effect of resection of the posterior nasal nerve on functional and morphological changes in the inferior turbinate mucosa. Acta Otolaryngol. 2008;128:1337–41.

      Article  Google Scholar 

    37. • Sonoda S, Murakami D, Saito Y, Miyamoto Y, Higuchi R, Kikuchi Y, Sawatsubashi M, Nakagawa T. Long-term effectiveness, safety, and quality of life outcomes following endoscopic posterior nasal neurectomy with submucosal turbinectomy for the treatment of intractable severe chronic rhinitis. Auris Nasus Larynx. 2021;48(4):636–45. Findings of this study suggest that patients with rhinitis who were treated with surgical posterior nasal neurectomy in combination with submucosal inferior turbinate reduction have significant improvement of rhinitis symptoms, quality of life, as well as decreased medication use for up to 8 years following their initial surgery.

      Article  Google Scholar 

    38. Albu S, Trombitas V, Nagy A. Endoscopic microdebrider-as- sisted inferior turbinoplasty with and without posterior nasal neurectomy. Auris Nasus Larynx. 2014;41:273–7.

      Article  Google Scholar 

    39. Ozenberger JM. Cryosurgery for the treatment of chronic rhinitis. Laryngoscope. 1973;83:508–16.

      Article  CAS  Google Scholar 

    40. Hwang PH, Lin B, Weiss R, Atkins J, Johnson J. Cryosurgical posterior nasal tissue ablation for the treatment of rhinitis. International forum of allergy & rhinology. 2017;7(10):952–6.

      Article  Google Scholar 

    41. Chang MT, Song S, Hwang PH. Cryosurgical ablation for treatment of rhinitis: a prospective multicenter study. Laryngoscope. 2020;130(8):1877–84.

      Article  Google Scholar 

    42. • Ow RA, O’Malley EM, Han JK, Lam KK, Yen DM. Cryosurgical ablation for treatment of rhinitis: two-year results of a prospective multicenter study. Laryngoscope. 2021;131(9):1952–7. Findings of this study suggests that patients who underwent transnasal application of cryotherapy to the posterior nasal nerve have significant improvement of rhinitis symptoms and quality of life for up to 2 years after initial treatment.

      Article  PubMed Central  Google Scholar 

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    Authors and Affiliations

    1. Department of Otolaryngology, Head & Neck Surgery, Boston University, 800 Harrison Ave. BCD Building, 5th floor, Boston, MA, 02118, USA

      Marianella Paz-Lansberg

    2. Department of Otolaryngology, Head and Neck Surgery, University of Chicago Medicine, Chicago, IL, USA

      Dara Adams

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    1. Marianella Paz-Lansberg
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    Correspondence to Marianella Paz-Lansberg.

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    Paz-Lansberg, M., Adams, D. Advances in Surgical Treatment of Rhinitis. Curr Otorhinolaryngol Rep 10, 172–178 (2022). https://doi.org/10.1007/s40136-022-00400-x

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