Efficacy of various surgical methods in the treatment of allergic rhinitis: A network meta-analysis

We often use surgery to treat allergic rhinitis (AR) patients who have failed drug treatment, but there is currently no clear gold standard for the treatment of allergic rhinitis. Using network meta-analysis, we evaluated the efficacy of different surgical methods in the treatment of AR.

PubMed, Embase, The Cochrane Library, Web of Science, CBM, Wan Fang Data, and CNKI databases were searched to collect clinical randomized controlled trials of AR with different surgical methods that met the inclusion criteria. After two investigators independently screened literature, extracted data, and assessed the risk of bias of included studies, R software was used to evaluate inconsistency using the node splitting method, and Stata15.1 was used to estimate the ranking probability of treatment.

A total of 47 randomized control studies involving 17 surgical schemes and 4144 participants were included. The results showed that after excluding surgical methods that did not form a closed loop, in AR patients without chronic rhinosinusitis and nasal polyps, surgical efficiency and symptom score ranked the same, which were posterior nasal neurectomy (PNN), Vidian neurectomy (VN), anterior ethmoid neurectomy (AEN), nasal septal reconstruction (NSR), and bilateral inferior turbinoplasty (BIT). In AR patients with chronic rhinosinusitis with nasal polyps, the effective rate (OR = 5.06; 95% CI = 2.75-9.32) and symptom and sign scores (MD = -3.80; 95% CI = -6.50-1.09) of PNN + FESS (functional endoscopic sinusitis surgery) were higher than FESS, and there was a significant difference.

Our findings suggest that PNN is the best single operation for patients with AR and without chronic rhinosinusitis and nasal polyps, and the combination of multiple procedures may be better than a single operation. FESS + PNN is more effectual in AR patients with chronic rhinosinusitis with nasal polyps.