Diode laser treatment in therapy-resistant allergic rhinitis: impact on nasal obstruction and associated symptoms

The ideal treatment in severe obstructive allergic rhinitis unresponsive to standard therapy is lacking. This study aimed to evaluate the efficacy of endonasal corrective laser surgery in perennial (pAR) and seasonal (sAR) allergic rhinitis. Forty subjects (20 pAR, 20 sAR) underwent videoendoscopic diode laser surgery. Examinations were performed preoperatively and at follow-ups 1, 12, and 24 months after surgery, including objective parameters (rhinomanometry, videoendoscopy, allergy tests) and subjective visual analog scales (evaluation of surgery, satisfaction, allergic symptoms). Of all patients, 95% received inferior turbinate, 40% septal, and 15% middle turbinate surgery. Postoperatively, two subjects showed considerable residual symptomatology (95% response rate). Throughout follow-up, objective rhinomanometry and subjective scores for nasal obstruction, rhinorrhea, sneezing, itching, and overall satisfaction improved significantly with time (p < 0.0005). The improvement was greatest for nasal obstruction, initially higher in pAR but more sustained in sAR. After 2 years, 30% sAR and 40% pAR subjects had been receiving pharmacotherapy due to recurrent symptoms. The allergic condition remained unchanged (skin and in-vitro tests). Outpatient endonasal diode laser surgery appears to be effective, safe and well tolerated for treating otherwise therapy-resistant pAR and sAR, providing long-lasting symptom reduction with complete stop or decreased use of antiallergics.