The Clinical Efficacy and Safety of Endoscopic Vidian-Branch Neurectomy in Intractable Allergic Rhinitis

Area of Science:

• Otolaryngology
• Allergy and Immunology
• Surgical Innovation

Background:

• Intractable allergic rhinitis (iAR) presents a significant clinical challenge, impacting patient quality of life.
• Current treatment options for iAR may be insufficient for some patients, necessitating alternative approaches.
• Vidian nerve neurectomy is a surgical option explored for managing severe allergic rhinitis symptoms.

Purpose of the Study:

• To evaluate the efficacy of endoscopic selective vidian branch neurectomy (EVBN) for treating intractable allergic rhinitis (iAR).
• To compare the safety and effectiveness of EVBN against endoscopic vidian neurectomy (EVN) and conservative treatment.
• To assess long-term outcomes, including symptom reduction and postoperative complications, over a 2-year follow-up period.

Main Methods:

• A prospective clinical study conducted at a tertiary referral center.
• 205 patients with iAR were divided into three groups: EVBN, EVN, and a control group receiving conservative treatment.
• Efficacy was assessed using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores at 6 months, 1 year, and 2 years post-treatment.

Main Results:

• Both EVBN and EVN groups showed significant improvements in RQLQ scores compared to baseline and the control group at all follow-up points.
• EVBN group reported significantly fewer instances of postoperative eye dryness (5.1%) compared to the EVN group (21.1%).
• Persistent eye dryness was noted in 8.5% of the EVN group patients, unresolved by the 2-year follow-up, whereas EVBN had minimal and transient side effects.

Conclusions:

• Endoscopic vidian-branch neurectomy (EVBN) and endoscopic vidian neurectomy (EVN) are effective treatments for intractable allergic rhinitis.
• EVBN is associated with a lower incidence of postoperative complications, particularly eye dryness, making it a potentially safer surgical option.
• The findings support EVBN as a favorable surgical intervention for patients with refractory iAR seeking improved quality of life with enhanced safety.