1
|
Maniaci A, Calvo-Henriquez C, Cammaroto G, Garcia-Magan C, Garcia-Paz V, Iannella G, Jiménez-Huerta I, La Mantia I, Lechien JR, Leong SC, Lobo-Duro D, Maza-Solano J, Mitchell R, Otero-Alonso A, Peng Y, Radulesco T, Simon F, Teissier N, Cocuzza S, Saibene AM. Pediatric Inferior Turbinate Hypertrophy: Diagnosis and Management. A YO-IFOS Consensus Statement. Laryngoscope 2024; 134:1437-1444. [PMID: 37497872 DOI: 10.1002/lary.30907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies. METHODS A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available. RESULTS A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher-evidence items such as randomized-controlled trials, guidelines, and systematic reviews. A 34-statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus. CONCLUSIONS Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures. LEVEL OF EVIDENCE 5 Laryngoscope, 134:1437-1444, 2024.
Collapse
Affiliation(s)
- Antonino Maniaci
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Christian Calvo-Henriquez
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Service of Otolaryngology, Rhinology Unit, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Giovanni Cammaroto
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Carlos Garcia-Magan
- Department of Pediatrics, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanesa Garcia-Paz
- Allergy Department, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Giannicola Iannella
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otorhinolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Ignacio Jiménez-Huerta
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Service of Otolaryngology, Pediatric Otolaryngology Unit, Gregorio Marañon University Hospital, Madrid, Spain
| | - Ignazio La Mantia
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Jérome R Lechien
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Samuel C Leong
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- The Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - David Lobo-Duro
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Juan Maza-Solano
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Ron Mitchell
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Andrea Otero-Alonso
- Allergy Department, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - You Peng
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Thomas Radulesco
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, APHM, IUSTI, CNRS, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - François Simon
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Service, Université Paris Cité, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Natasha Teissier
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Pediatric Otolaryngology Department, Robert-Debré Hospital, Paris 7 Denis Diderot University, Paris, France
| | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alberto M Saibene
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Unit, ASST Santi Paolo E Carlo, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| |
Collapse
|
2
|
Trivedi B, Vyas P, Soni NK, Gupta P, Dabaria RK. Is Posterior Nasal Nerve Neurectomy Really a Ray of Hope for the Patients of Allergic Rhinitis. Indian J Otolaryngol Head Neck Surg 2022; 74:4713-4717. [PMID: 36742878 PMCID: PMC9895618 DOI: 10.1007/s12070-021-03031-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Allergic rhinitis significantly affects the quality of life, it contributes to missed or unproductive time at school or work, disturbed sleep pattern and day time somnolence. Rhinitis is defined clinically as having two or more symptoms of anterior or posterior rhinorrhoea, sneezing, nasal blockage and/or itching of the nose during two or more consecutive days for more than 1 h on most days (International rhinitis management working group, 1994). Allergic rhinitis is diagnosed when these symptoms are caused by allergen exposure leading to an IgE mediated reaction. Nerve irritation causes sneezing and itching, the loss of mucosal integrity causes causes rhinorrhoea and the vascular engrogment leads to nasal blockage. Medical modalities are symptomatically effective in mild cases, with temporary relief and addressable adverse effects. Prolonged treatment with allergy immunotherapy causes a sustainable financial burden while remaining inaccessible at smaller towns. Posterior nasal nerve neurectomy is short, easy and effective alternative. The basic procedure is to selectively cut nerve bundles at the level of the sphenopalatine foramen (SPF) with a trans nasal approach. By denervating the nasal mucosa one renders it unresponsive to any sorts of allergen or allergic reaction. The aim of the study was to evaluate the outcome of posterior nasal nerve neurectomy in cases of severe allergic rhinitis by assessing its impact on the total nasal symptom score. The study is a hospital based prospective study, conducted on 15 patients who presented to the ENT department of Mahatma Gandhi Hospital from march 2021 to October 2021 (6 months) suffering from allergic rhinitis and did not show any satisfactory improvement even after 1 year of medical treatment. Adult patients in the age group of 20-45 yrs. diagnosed with allergic rhinitis were enrolled into the study after obtaining a due written consent. These included patients having 2 or more symptoms of allergic rhinitis and refractoriness to medical therapy for > 1 year along with significantly affected quality of life and elevated IgE level. Patients with drug induced & hormonal causes of rhinitis, chronic rhinosinusitis and any anatomical feature which precipitates to rhinitis such as deviated nasal septum, hypertrophied turbinates, blocked osteomeatal unit, polypoidal nasal mucosa and sinonasal polyposis were excluded from the study. During our study period from march 2021-September 2021, 15 patients were enrolled in the study. All the patients were followed up at 2nd and 6th month postoperatively. Amongst these patients, there were 11 females (73.34%) and 4 were male (26.67%)The mean age of patients was 35.2 years. Subjective nasal symptoms of all 15 patients improved over the period of 6 months. The mean TNSS improved from 12.067 preoperatively to 8.66 at the end of 2nd month, i.e., 23.1% improvement. By the end of the 6th postoperative month there was a consistent reduction in the tnss, which further reduced to a mean of 3.4 (70.2% reduction) indicating a further improvement in symptoms with time. With the advancement & popularity of endoscopic sinus surgery in the past decade, endoscopic resection of the posterior nasal nerve is emerging as a safe and less invasive technique with long standing results. Medical treatment usually provides mild and symptomatic relief with long duration of treatment period. Thus, PNN is safer, economical & easier alternative to current trend of treatment of allergic rhinitis, proving to be highly efficient in cases of intractable allergic rhinitis.
Collapse
Affiliation(s)
- Bhargavi Trivedi
- Department of ENT, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Pratibha Vyas
- Department of ENT, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Nikhil Kumar Soni
- Department of ENT, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Priyanshi Gupta
- Department of ENT, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | |
Collapse
|
3
|
Joseph L, Prasad KC, Mohiyuddin SMA. A Comparative Study of Symptom Scores in Patients Undergoing Posterior Lateral Nasal Neurectomy with Medical Management for Allergic Rhinitis. Indian J Otolaryngol Head Neck Surg 2022; 74:402-408. [PMID: 36213484 PMCID: PMC9535045 DOI: 10.1007/s12070-021-02930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022] Open
Abstract
Allergic rhinitis is an IgE mediated reaction against inhaled allergens. Patients not responding to medical treatment require surgery. Most surgical procedures reduce erectile tissue of inferior turbinates. Vidian neurectomy reduces nasal hyperreactivity and secretions by reducing parasympathetic supply, but results in loss of lacrimation. Transnasal posterior nasal neurectomy is more selective denervation procedure which preserves lacrimation. There are few studies documenting the outcome of posterior lateral nasal neurectomy. Posterior lateral nasal neurectomy can be good treatment option for perennial allergic rhinitis. To assess and compare the symptom scores in patients undergoing posterior lateral nasal neurectomy and medical management for allergic rhinitis. This prospective study included 50 patients diagnosed as perennial allergic rhinitis as per the ARIA guidelines. 25 patients underwent posterior lateral nasal neurectomy and 25 patients underwent medical management using fluticasone nasal spray and Montelukast with Levocetirizine. Pre and post-treatment Total nasal symptom scores and mini rhinoconjunctivitis quality of life questionnaire scores were compared. Symptoms reduced significantly in both surgery and medical management group. However in surgery group, more patients showed more than 50% improvement in symptoms. Posterior lateral nasal neurectomy is minimally invasive treatment for patients with perennial allergic rhinitis not responding to or not complying with medical treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02930-0.
Collapse
Affiliation(s)
- Lini Joseph
- Department of ENT and HNS, Sri Devaraj URS Medical College and Research Centre, Tamaka, Kolar, Karnataka India
| | - K. C. Prasad
- Department of ENT and HNS, Sri Devaraj URS Medical College and Research Centre, Tamaka, Kolar, Karnataka India
| | - S. M. Azeem Mohiyuddin
- Department of ENT and HNS, Sri Devaraj URS Medical College and Research Centre, Tamaka, Kolar, Karnataka India
| |
Collapse
|
4
|
Senanayake P, Wong E, McBride K, Singh N. Efficacy of Vidian Neurectomy and Posterior Nasal Neurectomy in the Management of Nonallergic Rhinitis: A Systematic Review. Am J Rhinol Allergy 2022; 36:849-871. [PMID: 35695191 DOI: 10.1177/19458924221105933] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nonallergic rhinitis (NAR) is characterized by rhinorrhea, nasal obstruction, and sneezing, in the absence of systemic sensitization to allergens. For cases refractory to medical therapy and conservative surgical interventions, more targeted procedures, such as endoscopic vidian neurectomy (EVN) and posterior nasal neurectomy (PNN), including surgical (SPNN) and cryoablative (CPNN) methods, may reduce symptoms of NAR. OBJECTIVE The purpose of this study was to compare the efficacy, side effect profile, and complication rate between EVN and PNN for NAR. METHODS A systematic review of primary articles that reported original patient data for either EVN or PNN was conducted using Embase, Medline, PubMed, and Cochrane databases since 2006, according to PRISMA guidelines. The primary outcome of the study was an improvement in NAR symptom severity. Secondary outcomes included the incidence of postoperative side effects or complications. RESULTS In total, 58 articles met the search criteria with a total of 9 studies (including 2 RCTs) eligible for inclusion. There was a pooled sample of 229 NAR patients that underwent EVN (n = 65; 28.4%), SPNN (n = 50; 21.8%), or CPNN (n = 114; 49.8%). For all 3 techniques, there was a statistically significant improvement in nasal symptoms, particularly rhinorrhea, nasal congestion, and obstruction along with quality of life. Heterogeneity in outcome reporting prevented meta-analysis and direct comparison of efficacy. The pooled incidence of postoperative complications for EVN (n = 65), SPNN (n = 50), and CPNN (n = 70) was 30.8% versus 0% versus 2.9% for dry eye, 16.9% versus 0% versus 1.4% for palatal/cheek numbness, and 0% versus 6% versus 4.3% for bleeding. CONCLUSION EVN, SPNN, and CPNN are similarly efficacious for patients with NAR refractory to medical management. SPNN and CPNN are associated with lower rates of complications (dry eye and palatal/cheek numbness) compared with EVN.
Collapse
Affiliation(s)
- Praween Senanayake
- Department of Otolaryngology, Head and Neck Surgery, 8539Westmead Hospital, Sydney, NSW, Australia.,School of Medicine, 67422Western Sydney University, Campbelltown, NSW, Australia
| | - Eugene Wong
- Department of Otolaryngology, Head and Neck Surgery, 8539Westmead Hospital, Sydney, NSW, Australia
| | - Kate McBride
- School of Medicine, 67422Western Sydney University, Campbelltown, NSW, Australia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck Surgery, 8539Westmead Hospital, Sydney, NSW, Australia.,Sydney Medical School, 4334University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
5
|
Heffler E, Landi M, Caruso C, Fichera S, Gani F, Guida G, Liuzzo MT, Pistorio MP, Pizzimenti S, Riccio AM, Seccia V, Ferrando M, Malvezzi L, Passalacqua G, Gelardi M. Nasal cytology: Methodology with application to clinical practice and research. Clin Exp Allergy 2018; 48:1092-1106. [PMID: 29904978 DOI: 10.1111/cea.13207] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Nasal cytology is an easy, cheap, non-invasive and point-of-care method to assess nasal inflammation and disease-specific cellular features. By means of nasal cytology, it is possible to distinguish between different inflammatory patterns that are typically associated with specific diseases (ie, allergic and non-allergic rhinitis). Its use is particularly relevant when other clinical information, such as signs, symptoms, time-course and allergic sensitizations, is not enough to recognize which of the different rhinitis phenotypes is involved; for example, it is only by means of nasal cytology that it is possible to distinguish, among the non-allergic rhinitis, those characterized by eosinophilic (NARES), mast cellular (NARMA), mixed eosinophilic-mast cellular (NARESMA) or neutrophilic (NARNE) inflammation. Despite its clinical usefulness, cheapness, non-invasiveness and easiness, nasal cytology is still underused and this is at least partially due to the fact that, as far as now, there is not a consensus or an official recommendation on its methodological issues. We here review the scientific literature about nasal cytology, giving recommendations on how to perform and interpret nasal cytology.
Collapse
Affiliation(s)
- E Heffler
- Department of Biomedical Sciences, Humanitas University, Milano, Italy.,Personalized Medicine, Asthma and Allergy Unit, Humanitas Clinical and Research Center, Humanitas University, Milano, Italy
| | - M Landi
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Paediatric National Healthcare System, Torino, Italy
| | - C Caruso
- Allergy Unit, Fondazione Policlinico Gemelli, Presidio Columbus, Rome, Italy
| | - S Fichera
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - F Gani
- Respiratory Allergy, A.O.U. San Luigi, Orbassano, Torino, Italy
| | - G Guida
- Allergy and Lung Physiology, AO Santa Croce e Carle, Cuneo, Italy
| | - M T Liuzzo
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - M P Pistorio
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - S Pizzimenti
- Respiratory Medicine Unit, National Health System, ASL Città di Torino, Torino, Italy
| | - A M Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - V Seccia
- 1st Otorhinolaryngology Unit, Department of Medical and Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - M Ferrando
- Department of Biomedical Sciences, Humanitas University, Milano, Italy.,Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - L Malvezzi
- Department of Otolaryngology, Humanitas Clinical and Research Center, Milano, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| |
Collapse
|
6
|
Abstract
Nonallergic rhinitis (NAR) describes chronic symptoms of nasal congestion, obstruction, and rhinorrhea unrelated to a specific allergen based on skin or serum testing. Vasomotor rhinitis is the most frequent subtype of NAR. Although medical management is the first-line treatment of NAR, there is a role for surgical therapy when medications fail to improve symptoms. Surgical options for NAR include inferior turbinate reduction and botulinum toxin injection as well as more directed targeting of the autonomic nerve supply to the nasal cavity through vidian neurectomy, posterior nasal neurectomy, and cryoablation of the posterior nerve.
Collapse
Affiliation(s)
- Carol H Yan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
| |
Collapse
|
7
|
Management of Intractable Nasal Hyperreactivity by Selective Resection of Posterior Nasal Nerve Branches. Int J Otolaryngol 2017; 2017:1907862. [PMID: 29379524 PMCID: PMC5742896 DOI: 10.1155/2017/1907862] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/17/2017] [Accepted: 11/23/2017] [Indexed: 12/02/2022] Open
Abstract
The posterior nasal nerves emerge from the sphenopalatine foramen and contain sensory and autonomic nerve components. Posterior nasal neurectomy is an effective method to remove pathological neural networks surrounding the inferior turbinate that cause unregulated nasal hypersensitivity with excess secretion in patients with severe allergic rhinitis (AR). We describe the sophisticated endoscopic surgical procedure that allows feasible access to the confined area and selective resection of the nerve branches with the preservation of the sphenopalatine artery (SPA). We retrospectively analyzed the cases of 23 symptomatic severe AR patients who failed to respond to standard medical treatment and underwent surgery. There have been no major complications after surgery including nasal bleeding or transient numbness of the upper teeth. The mean total nasal symptom scores (TNSS) were decreased by 70.2% at 12 months after the procedure. Our comparison of the clinical effectiveness based on the number of severed nerve branches revealed that the improvement of the TNSS was significantly higher in patients with >2 branches. We conclude that this minimally invasive technique that preserves the SPA is clinically useful and decreases the rate of postoperative complications. This trial is registered with UMIN000029025.
Collapse
|
8
|
Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management? The Journal of Laryngology & Otology 2017; 131:290-297. [PMID: 28179040 DOI: 10.1017/s0022215117000214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. OBJECTIVES This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.
Collapse
|
9
|
|
10
|
Abstract
CONCLUSION Kinetic oscillation stimulation (KOS) of nasal mucosa at low frequency seems to be a possibly effective and safe short-term treatment of non-allergic nasal stuffiness. OBJECTIVE To assess the relief of rhinitis symptoms, especially stuffiness, by comparing active treatment, i.e. KOS at low frequency of the nasal mucosa, with placebo. METHODS Patients were randomized to active or placebo treatment in this double-blinded parallel design study. Treatment with an inflatable oscillating catheter was administered on day 0, and symptom scores (stuffiness, secretion, and itching) were graded daily until day 14. An overall grading of symptoms from 1 week before treatment and during 14 days thereafter was made at day 14. Eighty-six patients (52 with non-allergic perennial rhinitis, NAR; 34 with rhinitis medicamentosa, RM) were randomized, and 71 were evaluated (active treatment, n = 35; placebo, n = 36). RESULTS Patients with either NAR or RM who received active treatment reported reduced symptom scores by some measures, e.g. median RQSS stuffiness measure fell from 2 to 1 on a scale from 0 to 3 during the week following treatment. No significant effect was observed for patients treated with placebo. Mild side effects were reported.
Collapse
Affiliation(s)
- Jan-Erik Juto
- Division of ENT Department, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Axelsson
- Division of ENT Department, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
11
|
Singh U, Bernstein JA. Intranasal Capsaicin in Management of Nonallergic (Vasomotor) Rhinitis. CAPSAICIN AS A THERAPEUTIC MOLECULE 2014; 68:147-70. [PMID: 24941668 DOI: 10.1007/978-3-0348-0828-6_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|