Endoscopic Resection of Posterior Nasal Nerves in the Management of Chronic Allergic Rhinitis: Our Experience

To study the efficacy of endoscopic resection of posterior nasal nerves in the treatment of chronic Allergic rhinitis that has not benefitted from medical therapy. Ours was a prospective study that included 20 patients with diagnosed allergic rhinitis with unsatisfactory response to medical therapy who opted for surgical management. Pre-operatively Computed tomography of the nose and paranasal sinuses was done. Also, preoperative nasal symptom assessment was done using a 5-point visual analog scale (VAS) and Lund-Mackay score. Endoscopic resection of posterior nasal nerves under local anesthesia was done for all patients following which VAS and Lund-Mackay scores at 1 month, 3 months, 1 year, and 2 years postoperatively were recorded. The mean age in our study was 26.45 years with most of them being females. The VAS scores pre-operatively were higher (5.00 for nasal congestion, discharge, and sneezing, 4.00 for itching) with a drastic reduction at 1 month and 3 months post operatively (scores ranging from 0 to 1). However, at 1st and 2nd year of follow up there seemed to be a slight increase in the scores (average of 2.00) which was statistically significant (p < 0.001). Lund Mackay score from the pre-operative to post-operative period improved with a mean score of 1.50 to 1.00 at the end of 2 years (p = 0.022). Posterior nasal nerves resection in the management of chronic allergic rhinitis helps to alleviate symptoms. However, there is a need for long-term studies to site the persistence of the effects of this procedure. Treatment of chronic allergic rhinitis should include posterior nasal neurectomy in refractory cases.