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Razmi SE, Dhanda AK, Shenoi J, Khan F, Takashima M, Ahmed OG. Predictors of Facial Pain and Headache Associated With Cryotherapy Ablation of the Posterior Nasal Nerve for the Treatment of Chronic Rhinitis. Cureus 2024; 16:e61749. [PMID: 38975475 PMCID: PMC11226239 DOI: 10.7759/cureus.61749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVE Cryotherapy ablation of the posterior nasal nerve (PNN) for treatment of patients with refractory chronic rhinitis (CR) is associated with postoperative facial pain and headache. This study sought to understand factors that may contribute to the development of this adverse effect. METHODS Patients undergoing PNN cryotherapy ablation for refractory CR at a single institution from January 2018 to August 2023 were included. Demographics and clinical characteristics were collected via chart review and interview. Student's T-test and Chi-square tests were used to assess the significance of quantitative and categorical data, respectively (alpha = 0.05). RESULTS Forty-eight patients underwent cryotherapy ablation. Twenty-eight patients (58%) reported having facial pain and headache (adverse effect group) immediately post-procedurally. The average age of the adverse effect group was 54.9 years (SD: 17.8 years) which was significantly lower (p=0.002) than the asymptomatic group (69.7 years, SD: 8.7 years). Female patients were significantly more likely to experience this adverse event than males (p=0.04). Moreover, Caucasian females were significantly more likely to experience this adverse effect when compared to all patients experiencing the adverse effect (n=15, p=0.04). Previous diagnosis of migraine disorder was more common in the adverse effect group (28%) compared to the asymptomatic group (15%) but not statistically significant (p=0.26). Previous migraine, trigeminal neuralgia, or headache disorder diagnoses were not significantly correlated with adverse effect prevalence (p = 0.26, 0.24, 0.15, respectively). CONCLUSION Given the relative immediacy and severity of this adverse effect, physicians should strongly consider these factors when counseling and selecting certain patient groups for this procedure.
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Affiliation(s)
- Samuel E Razmi
- School of Engineering Medicine, Texas A&M (Agricultural and Mechanical) College of Medicine, Houston, USA
| | - Aatin K Dhanda
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, USA
| | - Jason Shenoi
- School of Engineering Medicine, Texas A&M (Agricultural and Mechanical) College of Medicine, Houston, USA
| | - Faizaan Khan
- School of Engineering Medicine, Texas A&M (Agricultural and Mechanical) College of Medicine, Houston, USA
| | - Masayoshi Takashima
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, USA
| | - Omar G Ahmed
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, USA
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Virani FR, Wilson MD, Beliveau AM, Gill AS, Strong EB, Steele TO. The Impact of Surgical Posterior Nasal Nerve Cryoablation on Symptoms and Disease-Specific Quality of Life in Patients With Chronic Rhinitis. EAR, NOSE & THROAT JOURNAL 2023; 102:654-660. [PMID: 34128402 PMCID: PMC8958794 DOI: 10.1177/01455613211018576] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Preliminary data have demonstrated long-term efficacy of posterior nasal nerve (PNN) cryoablation in reducing rhinitis symptoms for patients with allergic rhinitis (AR) and nonallergic rhinitis (NAR). We sought to evaluate the impact of procedural cryoablation of the PNN on quality of life (QOL) in patients with AR and NAR. METHODS Adult patients undergoing PNN cryoablation for AR or NAR after appropriate medical therapy were included for analysis. Demographics, medical therapies, baseline rhinitis symptom (total nasal symptom score [TNSS]), and disease-specific QOL (mini-rhinoconjunctivitis quality of life questionnaire [mini-RQLQ]) were recorded. The Wilcoxon signed-rank test was used to test for significant changes in baseline test scores posttreatment. Absolute and relative improvement in outcomes was determined for each participant. Secondary outcomes were assessed with univariate and multivariate analyses. RESULTS Fourteen patients were enrolled with a mean follow-up of 16.5 weeks. The TNSS and mini-RQLQ scores significantly improved after PNN cryoablation (median δs [interquartile range]: -4 [3] and -1.61 [1.08], respectively; both P = .0002). The minimal clinically important difference for the TNSS and mini-RQLQ was obtained in 92.9% of patients in each category. Relative mean percentage (%) improvement after PNN cryoablation in the TNSS and mini-RQLQ was 40.7% and 40.5% (standard deviation = 24.9 and 29.5, respectively), respectively, for all patients. Patients with NAR (n = 10) reported mean improvement of 41.3% (29.1) as measured by the TNSS and 49.6% (25.9) by mini-RQLQ. Patients with AR reported mean percentage improvement in TNSS and mini-RQLQ scores of 39.5% (12.1) and 24.6% (28.5), respectively. Patients who had been prescribed a nasal anticholinergic for management prior to PNN cryoablation had statistically significantly increased improvement in mini-RQLQ scores from pre- to post-procedure (P = .0387). CONCLUSION Surgical cryoablation of the PNN significantly improves both symptoms and disease-specific QOL in majority of patients with AR and NAR.
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Affiliation(s)
- Farrukh R Virani
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
| | - Machelle D Wilson
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, CA, USA
| | - Angela M Beliveau
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
| | - Amarbir S Gill
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
| | - E Bradley Strong
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
| | - Toby O Steele
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
- VA Northern California Healthcare System, Sacramento, CA, USA
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Gorelik D, Choi A, Desisto N, Ordonez A, Takashima M, Rowan NR, Tang DM, Syed T, Yim MT, Ahmed OG. Indirect comparison of the efficacy of radiofrequency neurolysis and cryotherapy in the treatment of chronic rhinitis. Int Forum Allergy Rhinol 2023; 13:175-178. [PMID: 35924813 DOI: 10.1002/alr.23068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Daniel Gorelik
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology, Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Alexander Choi
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Nicole Desisto
- Texas A&M Health Sciences Center College of Medicine, Bryan, Texas, USA
| | - Adriana Ordonez
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA
| | - Masayoshi Takashima
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology, Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dennis M Tang
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tariq Syed
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology, Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael T Yim
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University in Shreveport, Shreveport, Louisiana, USA
| | - Omar G Ahmed
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology, Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
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Young K, Bulosan H, Kejriwal S, Liang J, Wu AW, Tang DM, Birkeland AC, Steele TO. Efficacy of Cryoablation on Chronic Rhinitis Management: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2023:19458924231152331. [PMID: 36691694 DOI: 10.1177/19458924231152331] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND ClariFix for posterior nasal nerve ablation has been approved for use since 2017, and this is the first study attempting to synthesize and assess the efficacy of this new device on the management of chronic rhinitis. OBJECTIVE The primary objective of this meta-analysis is to assess the efficacy of ClariFix in the symptomatic management of patients with chronic rhinitis. The main outcome measure is the mean difference in the reflective total nasal symptom score (rTNSS). METHODS A systematic search of Pubmed/Medline, Web of Science, and EBSCOhost was conducted from inception to May 2022. Peer-reviewed clinical trials reporting postcryotherapy rTNSS at both 1- and 3-month intervals for patients with chronic rhinitis were included. A random-effects model was utilized for meta-analysis. Study heterogeneity, bias, and overall quality were all assessed. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The primary outcome measures included mean differences in rTNSS from baseline to both 1- and 3-month postoperative time points. Secondary measures included other questionnaires including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS There were 5 studies that met the criteria (247 individuals). The pooled rTNSS mean difference from baseline to 1 and 3 months postoperatively was found to be -3.48 points (95% CI: -3.73 to -3.23, I2 = 0.13). and -3.50 (95% CI: -3.71 to -3.29, I2 = 0.00), respectively. The mean difference from baseline to 3 months postoperatively regarding the RQLQ was found to be -1.53 (95% CI: -1.74 to -1.31, I2 = 0.00). The most common adverse effects included facial or surgical site pain (40.4%), followed by headache (18.2%), oral numbness (11.1%), and sinusitis (4.0%). CONCLUSIONS The findings of this systematic review suggest that cryoablation with Clarifix is an effective treatment modality for chronic rhinitis. However, higher-quality randomized controlled trials will need to be performed to affirm the findings of this study.
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Affiliation(s)
- Kurtis Young
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Hannah Bulosan
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Sameer Kejriwal
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Northern California, Oakland, California, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dennis M Tang
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
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Lee JT, Abbas GM, Charous DD, Cuevas PDMM, Göktas PDMÖ, Loftus PA, Nachlas NE, Toskala EM, Watkins JP, Brehmer PDMD. 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; 36:747-754. [PMID: 35818709 PMCID: PMC9548948 DOI: 10.1177/19458924221109987] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Temperature-controlled radiofrequency (TCRF) neurolysis of the posterior
nasal nerve (PNN; RhinAer) is a minimally invasive treatment option for
patients with chronic rhinitis. Objective To determine clinical outcomes and quality of life (QoL) following TCRF
neurolysis of the PNN. Methods A prospective single-arm study of 129 patients with chronic rhinitis at 16
medical centers in the United States and Germany. Results The mean 24-h reflective total nasal symptom score (rTNSS) improved from 7.8
(95% CI, 7.5-8.1) at baseline to 3.6 (95% CI, 3.2-4.0) at 3 months and
continued to improve to 2.9 (95% CI, 2.5-3.3) at 6 months
(p < .001 comparing follow-up to baseline and
p = .002 comparing 3 and 6 months). This represents
53.8% improvement over baseline at 3 months and 62.8% improvement at 6
months. Rhinorrhea, congestion, sneezing, and itching subscores and
postnasal drip and cough scores were all significantly improved over
baseline at both timepoints. At 3 months, 76.2% (95% CI, 68.1%-82.8%) of
patients achieved a minimal clinically important difference of ≥30%
improvement in rTNSS over baseline and the percentage was higher at 6 months
(83.5% [95% CI, 75.8%-89.0%]). At 3 months, 80.3% (95% CI, 72.6%-86.3%)
reported a minimal clinically important difference of ≥0.4-point improvement
in the mini rhinoconjunctivitis quality of life questionnaire score, and the
percentage was higher at 6 months; 87.7% (95% CI, 80.7%-92.4%). There were
no serious adverse events with a relationship to the device/procedure
reported through 6 months. Conclusion In this large, multicenter study, TCRF neurolysis of the PNN was safe and
resulted in a significant reduction in rhinitis symptom burden at 3 months
that was sustained/improved through 6 months. The majority of patients
reported a clinically relevant improvement in QoL at 3 and 6 months
postprocedure.
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Affiliation(s)
- Jivianne T Lee
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Daniel D Charous
- Arizona Desert Ear, Nose & Throat Specialists, Goodyear, AZ, USA
| | - Pd Dr Med Mandy Cuevas
- Department of Otorhinolaryngology, University Clinic Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | | | - Patricia A Loftus
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Elina M Toskala
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Prof Dr Med Detlef Brehmer
- Faculty of Medicine, University Witten/Herdecke, Witten, Germany.,Department of Electrical Engineering and Applied Natural Sciences, Westphalian University of Applied Sciences, Gelsenkirchen, Germany.,Department of Otorhinolaryngology, Private ENT Practice, Göttingen, Germany
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Brijmohan S, Barnes T. Post-procedure Rhinitis After Use of Sedatives and Supplemental Nasal Oxygen. Cureus 2022; 14:e23397. [PMID: 35481293 PMCID: PMC9033512 DOI: 10.7759/cureus.23397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/01/2022] Open
Abstract
Post-procedure rhinitis is a form of nonallergic rhinitis that is a common but underreported complication occurring after procedures requiring sedation and the use of supplemental oxygen via nasal cannula. Symptoms occur immediately after awakening from sedation and may be so unbearable, that it impairs work, daily functioning, sleep patterns, and quality of life. This case describes a 67-year-old male who developed these symptoms after esophagogastroduodenoscopy (EGD) under sedation with supplemental oxygen via nasal cannula. The proposed pathophysiology is thought to be due to the impingement of the cannula against mechanoreceptors in the nasal mucosal membrane causing parasympathetic overactivity. Based on this pathogenesis, the reported patient failed to show improvement with oral antihistamines but instead benefited from a topical anticholinergic agent. Patients at risk should be informed of the possibility of this adverse event and advised on proper treatment if it occurs.
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Miller N, Noller M, Yang A, McCoul ED, Tolisano AM, Riley CA. Lesser Known Uses of γ-Aminobutyric Acid Analogue Medications in Otolaryngology. Laryngoscope 2021; 132:954-964. [PMID: 34536232 DOI: 10.1002/lary.29855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/17/2021] [Accepted: 08/27/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS In otolaryngology, γ-aminobutyric acid (GABA) analogues have been previously analyzed for their roles in neuropathic pain, chronic cough, tinnitus, and perioperative analgesia. The primary aim of this study is to comprehensively summarize and synthesize the existing evidence for lesser known uses of gabapentin and pregabalin in otolaryngology. STUDY DESIGN A scoping review conducted of the available English-language literature was performed by two authors through April 1, 2021. METHODS The Preferred Reporting Items for Systematic Review and Meta-Analysis criteria were followed, and a quality assessment of included studies was performed using the Methodological Index for Non-Randomized Studies. RESULTS Ten studies met inclusion criteria. Three studies found that gabapentin may reduce gastrostomy tube usage and improve swallowing function in head and neck cancer patients undergoing radiation therapy (RT). Three studies suggested that gabapentin may help reduce opiate use when used as a primary analgesic in patients with radiation-induced mucositis. One study demonstrated that pregabalin-reduced trismus severity in patients with radiotherapy-induced trismus. One study demonstrated gabapentin may be useful in patients with phonasthenia. Two studies demonstrated that GABA analogues may be a useful adjunct in patients with globus pharyngeus in the context of likely laryngeal sensory neuropathy. CONCLUSIONS The most promising potential uses for GABA analogues identified in this review are for improving swallowing, trismus, and narcotic overuse after RT. The benefit of GABA analogues for improving nonorganic voice disorders is also promising while the benefit for globus pharyngeus when possibly related to laryngeal sensory neuropathy is inconclusive. Laryngoscope, 2021.
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Affiliation(s)
- Nathaniel Miller
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Michael Noller
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Alex Yang
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Edward D McCoul
- Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Clinic, New Orleans, Louisiana, U.S.A.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
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Kennedy DW. Management of the visual field in endoscopic sinus surgery. Int Forum Allergy Rhinol 2021; 10:139-140. [PMID: 32086999 DOI: 10.1002/alr.22527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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