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Surgical Intervention in Allergic Rhinitis: Stuffy Versus Sneezy Runny Nose

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

To detect proportion and surgical outcome of adult patients with allergic rhinitis non-responsive to medical treatment. To identify clinical candidacy for submucous turbinoplasty of inferior turbinate resection or soft tissue reduction. A prospective descriptive study of adults with clinical allergic rhinitis was done. Non-responders to medical therapy were identified and outcome of surgical intervention analyzed. There were 393 patients. Eighty-one patients (21%) were refractory to medical therapy. Presenting symptoms were sneezing with watery rhinorrhea among 72% and nasal obstruction in 28% patients All patients in the latter group had hypertrophied inferior turbinates with associated deviated nasal septum in 36.6%. Bony and mucosal inferior turbinate hypertrophy among 73.3% and mucosal hypertrophy among 26.7% were identified by a negative or positive response to on-table local vasoconstrictor application respectively. Submucosal inferior turbinoplasty with turbinate resection in the former and soft tissue reduction in the latter group were done, along with septoplasty among 36%. All patients revealed significant reduction in postoperative SNOT score. Crusting was more during early postoperative period among those with soft tissue reduction and simultaneous septoplasty, necessitating meticulous endoscopic follow-up. Adult allergic rhinitis presenting predominantly with nasal obstruction (‘stuffy nose’), could be non-responsive to medical therapy unlike sneezy, runny nose, especially when obstructive symptoms are more than two years among older patients, suggesting presence of hypertrophied inferior turbinates. On-table response to vasoconstrictors is a reliable clinical indicator for submucous inferior turbinoplasty: negative and positive response suggesting turbinate resection among majority and soft tissue reduction among minority respectively.

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References

  1. Spector SL (1997) Overview of comorbid associations of allergic rhinitis. J Allergy Clin Immunol 99(2):S773–S780

    Article  CAS  PubMed  Google Scholar 

  2. Klimek LL, Bachert C, Pfaar O et al (2019) ARIA guideline: treatment of allergic rhinitis in the German health system. Allergol select J Int 28:255–276

    Article  Google Scholar 

  3. Courbis AL, Murray RB, Arnavielhe S, Caimmi D, Bedbrook A, Van Eerd M, De Vries G, Dray G, Agache I, Morais-Almeida M, Bachert C (2018) Electronic clinical decision support system for allergic rhinitis management: MASK e-CDSS. Clin Exp Allergy 48(12):1640–1653

    Article  PubMed  Google Scholar 

  4. Bousquet J, Schünemann HJ, Togias A, Bachert C, Erhola M, Hellings PW, Klimek L, Pfaar O, Wallace D, Ansotegui I, Agache I (2020) Next-generation allergic rhinitis and its impact on asthma (ARIA) guidelines for allergic rhinitis based on grading of recommendations assessment, development and evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol 145(1):70–80

    Article  PubMed  Google Scholar 

  5. Soe KK, Krikeerati T, Pheerapanyawaranun C, Niyomnaitham S, Phinyo P, Thongngarm T (2023) Comparative efficacy and acceptability of licensed dose intranasal corticosteroids for moderate-to-severe allergic rhinitis: a systematic review and network meta-analysis. Front Pharmacol 23(14):1184552

    Article  Google Scholar 

  6. Swift AC, Leong SC (2018) Management of enlarged turbinates. In: JhonWatkinson C (ed) Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery, 8th edn. CRC Press, London, pp 1157–1168

    Chapter  Google Scholar 

  7. Fairbanks DNF, Kaliner M (1998) Nonallergic rhinitis and infection. In: Cummings CW, Fredrickson JM, Harker AL, Krause CJ, Richardson MA (eds) Otolaryngology Head and Neck Surgery, 3rd edn. Mosby, St. Louis, pp 910–920

    Google Scholar 

  8. Yañez C, Mora N (2008) Inferior turbinate debriding technique: ten-year results. Otolaryngol Head Neck Surg 138:170–175

    Article  PubMed  Google Scholar 

  9. Lukka VK, Kurien R, Varghese L, Rupa V (2018) Endoscopic submucosal resection versus endoscopic submucosal diathermy for inferior turbinate hypertrophy. Indian J Otolaryngol Head Neck Surg 71(3):1885–1894

    PubMed  PubMed Central  Google Scholar 

  10. Zapanta PE, Devries Gm, Meyers AD Turbinectomy, Medscape march 01,2016 https://emedicine.medscape.com/article/2051775-technique

  11. Mahajan R, Nagaraj TM, Prashanth V (2019) A prospective study to compare the efficacy of powered turbinectomy versus submucous resection in the surgical management of inferior turbinate hypertrophy. Indian J Otolaryngol Head Neck Surg 71(Suppl 3):2203–2209

    Article  PubMed  PubMed Central  Google Scholar 

  12. Singh S, Ramli RR, Mohammad ZW, Abdullah B (2020) Coblation versus microdebrider-assisted turbinoplasty for endoscopic inferior turbinates reduction. Auris Nasus Larynx 47(4):593–601

    Article  PubMed  Google Scholar 

  13. Elshipli NA, El-Sisi HE, El-Fattah AMA, Al-Saddeik MAE (2021) Outcome comparison of submucous resection versus combined submucous diathermy and outfracture for treatment of inferior turbinate hypertrophy. Eur Arch Otorhinolaryngol 278(10):3827–3837

    Article  PubMed  Google Scholar 

  14. Xie Q, Yuan J, Wang Y (2023) Efficacy of various surgical methods in the treatment of allergic rhinitis: a network meta-analysis. Allergol Immunopathol (Madr) 51(2):137–147

    Article  PubMed  Google Scholar 

  15. Ghosh SK, Dutta M, Haldar D (2023) Role of bilateral inferior turbinoplasty as an adjunct to septoplasty in improving nasal obstruction and subjective performance in patients with deviated nasal septum associated with allergic rhinitis: an interventional. Prospect Study Ear Nose Throat J 102(7):445–452

    Article  Google Scholar 

  16. Ho YT, Lee TJ, Fu CH (2022) Association between clinical factors and surgical outcomes for patients with persistent allergic rhinitis. Ear Nose Throat J 19:1455613221091098. https://doi.org/10.1177/01455613221091098

    Article  Google Scholar 

  17. Gillman GS, Staltari GV, Chang YF, Mattos JL (2019) A prospective study of outcomes of septoplasty with turbinate reductions in patients with allergic rhinitis. Otolaryngol Head Neck Surg 160(6):1118–1123

    Article  PubMed  Google Scholar 

  18. Balai E, Gupta KK, Jolly K, Darr A (2023) Posterior nasal nerve neurectomy for the treatment of rhinitis: a systematic review and meta-analysis. Eur Ann Allergy Clin Immunol 55(3):101–114

    Article  CAS  PubMed  Google Scholar 

  19. de Oliveira GMM, CorreiaJúnior MAV, Costa EC, Lira GVAG, Rizzo JÂ, Hunter S, Gaua N, Sarinho ESC (2022) Accuracy of peak nasal flow to determine nasal obstruction in patients with allergic rhinitis. Acta Otorhinolaryngol Ital 42(2):155–161

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mullol J, Bachert C, Bousquet J (2005) Management of persistent allergic rhinitis: evidence-based treatment with levocetirizine. Ther Clin Risk Manag 1(4):265–71

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Farmer SE, Eccles R (2006) Chronic inferior turbinate enlargement and the implications for surgical intervention. Rhinology 44(4):234

    CAS  PubMed  Google Scholar 

  22. Seeger J, Zenev E, Gundlach P, Stein T, Müller G (2003) Bipolar radiofrequency-induced thermotherapy of turbinate hypertrophy: pilot study and 20 months’ follow-up. Laryngoscope 113(1):130–135

    Article  PubMed  Google Scholar 

  23. Caffier PP, Scherer H, Neumann K, Luck S (2011) Diode laser treatment in therapy-resistant allergic rhinitis: impact on nasal obstruction and associated symptoms. Lasers Med Sci 26(1):57–67

    Article  PubMed  Google Scholar 

  24. Allergies in America: A landmark survey of nasal allergy sufferers: executive summary. Available for URL: http://www.myallergiesinamerica.com].

  25. Jose J, Coatesworth AP. Inferior turbinate surgery for nasal obstruction in allergic rhinitis after failed medical treatment. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD005235

  26. Kang T, Sung CM, Yang HC (2019) Radiofrequency ablation of turbinates after septoplasty has no effect on allergic rhinitis symptoms other than nasal obstruction. Int Forum Allergy Rhinol 9(11):1257–1262

    Article  PubMed  Google Scholar 

  27. Chen YL, Tan CT, Huang HM (2008) Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis. Laryngoscope 118(7):1270–1274

    Article  PubMed  Google Scholar 

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The authors did not receive support from any funding agencies for the submitted work.

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Authors and Affiliations

  1. Department of ENT, Aarupadai Veedu Medical College, Puducherry, India

    D. Jayapriya & T. C. Vikram Raj Mohanam

  2. Department of ENT, Pondicherry Institute of Medical Sciences, Puducherry, India

    Mary Kurien, Rajarajeswari Nalamate, Sithananda Kumar Venkatesan & V. M. Lakshana Deve

  3. Department of Pathology, Aarupadai Veedu Medical College, Puducherry, India

    S. Kalaiarasan

  4. Department of ENT, Dr Moopen’s Medical College, Wayanad, India

    Nishanth Savery & Jishana Jamaldeen

Authors
  1. D. Jayapriya
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  2. T. C. Vikram Raj Mohanam
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  3. Mary Kurien
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  4. Nishanth Savery
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  5. Rajarajeswari Nalamate
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  6. S. Kalaiarasan
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  8. Sithananda Kumar Venkatesan
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  9. V. M. Lakshana Deve
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Contributions

Concept, design—Dr. JD, Dr. MK, Dr VRMTC, NS. Analysis and Interpretation of data—Dr. JD. Drafting of Manuscript—Dr. JD, Dr MK, Dr VRMTC. Critical revision of manuscript for important intellectual content—Dr MK, Dr VRMTC. Literature research and analysis- Dr MK, Dr VRMTC. Statistical analysis &editing- Dr. JD, Dr K. Study supervision- Dr MK, Dr VRMTC, NS, JJ, Dr RN, SKV, VMLD.

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Correspondence to T. C. Vikram Raj Mohanam.

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The authors declare that they have no competing interests.

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This study was conducted in accordance with the Declaration of Helsinki (revised 2013). Institutional Ethics Clearance: No: RC/18/92.

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Jayapriya, D., Vikram Raj Mohanam, T.C., Kurien, M. et al. Surgical Intervention in Allergic Rhinitis: Stuffy Versus Sneezy Runny Nose. Indian J Otolaryngol Head Neck Surg (2024). https://doi.org/10.1007/s12070-023-04404-x

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