Skip to main content
Log in

Indications for Surgery in Refractory Rhinitis

  • RHINITIS (JJ OPPENHEIMER AND J CORREN, SECTION EDITORS)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Medical treatment of chronic rhinitis is successful in a majority of patients, but there is a still large population of patients who fail medical therapy. Surgical treatment for patients with severe persistent allergic rhinitis is not a new solution, but recent advancements in technology and surgical technique have made surgery safer and more effective. There is no gold standard of treatment in patients with refractory rhinitis, and surgeons may select a variety of procedures and techniques based on a patient’s anatomy, severity of disease, and comorbidities. Unfortunately, there are currently few large prospective, randomized controlled trials evaluating surgical treatments, and no study to date has compared immunotherapy to surgical intervention. Therefore, there is no hard and fast rule as to when to pursue surgical intervention after initial medical therapy has failed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nathan RA, Meltzer EO, Derebery J, et al. The prevalence of nasal symptoms attributed to allergies in the United States: findings from the burden of rhinitis in an America survey. Allergy Asthma Proc. 2008;29:600–8.

    Article  PubMed  Google Scholar 

  2. Bousquet PJ, Demoly P, Devillier P, et al. Impact of allergic rhinitis symptoms on quality of life in primary care. Int Arch Allergy Immunol. 2013;160:393–400.

    Article  PubMed  Google Scholar 

  3. Berger S, Gass S, Ophir D. The histopathology of the hypertrophic inferior turbinate. Arch Otolaryngol Head Neck Surg. 2006;132:588–94.

    Article  PubMed  Google Scholar 

  4. Aksoy F, Yıldırım YS, Veyseller B, et al. Midterm outcomes of outfracture of the inferior turbinate. Otolaryngol Head Neck Surg. 2010;143(4):579–84.

    Article  PubMed  Google Scholar 

  5. Passali D, Lauriello M, Anselmi M, et al. Treatment of hypertrophy of the inferior turbinate: long-term results in 382 patients randomly assigned to therapy. Ann Otol Rhinol Laryngol. 1999;108(6):569–75.

    CAS  PubMed  Google Scholar 

  6. Takeno S, Osada R, Ishino T, Yajin K. Laser surgery of the inferior turbinate for allergic rhinitis with seasonal exacerbation: an acoustic rhinometry study. Ann Otol Rhinol Laryngol. 2003;112:455–60.

    PubMed  Google Scholar 

  7. Caffier PP, Scherer H, Neumann K, Luck S, Enzmann H, Haisch A. Diode laser treatment in therapy-resistant allergic rhinitis: impact on nasal obstruction and associated symptoms. Lasers Med Sci. 2011;26:57–67.

    Article  PubMed  Google Scholar 

  8. Cakli H, Cingi C, Guven E, Gurbuz MK, Kaya E. Diode laser treatment of hypertrophic inferior turbinates and evaluation of the results with acoustic rhinometry. Eur Arch Otorhinolaryngol. 2012;269:2511–7.

    Article  PubMed  Google Scholar 

  9. Cassano M, Granieri C, Del Giudice AM, Mora F, et al. Restoration of nasal cytology after endoscopic turbinoplasty versus laser-assisted turbinoplasty. Am J Rhinol Allergy. 2010;24:310–4.

    Article  PubMed  Google Scholar 

  10. Sapci T, Sahin B, Karavus A, Akbulut UG. Comparison of the effects of radiofrequency tissue ablation, CO2 laser ablation, and partial turbinectomy applications on nasal mucociliary functions. Laryngoscope. 2003;113:514–9.

    Article  PubMed  Google Scholar 

  11. Kakarala K, Faquin WC, Cunningham MJ. Radiofrequency volumetric tissue reduction of the inferior turbinate in a sheep model. Laryngoscope. 2012;122:724–9.

    Article  PubMed  Google Scholar 

  12. Hytonen ML, Back LJ, Malmivaara AV, et al. Radiofrequency thermal ablation for patients with nasal symptoms: a systematic review of effectiveness and complications. Eur Arch Otorhinolaryngol. 2009;266(8):1257–66.

    Article  PubMed  Google Scholar 

  13. Powell NB, Zonato AI, Weaver EM, et al. Radiofrequency treatment of turbinate hypertrophy in subjects using continuous positive airway pressure: a randomized, double-blind, placebo-controlled clinical pilot trial. Laryngoscope. 2001;111:1783–90.

    Article  CAS  PubMed  Google Scholar 

  14. Safiruddin F, Vroegop AV, Ravesloot MJ, de Vries N. Long-term self-reported treatment effects and experience of radiofrequency-induced thermotherapy of the inferior turbinates performed under local anesthesia: a retrospective analysis. Eur Arch Otorhinolaryngol. 2013;270:1849–53. This article provides long-term questionnaire-based data on the effectiveness of radiofrequency inferior turbinate surgery..

    Article  CAS  PubMed  Google Scholar 

  15. Lin HC, Lin PW, Friedman M, Chang HW, et al. Long-term results of radiofrequency turbinoplasty for allergic rhinitis refractory to medical therapy. Arch Otolaryngol Head Neck Surg. 2010;136:892–5.

    Article  PubMed  Google Scholar 

  16. Gunhan K, Unlu H, Yuceturk AV, Songu M. Intranasal steroids or radiofrequency turbinoplasty in persistent allergic rhinitis: effects on quality of life and objective parameters. Eur Arch Otorhinolaryngol. 2011;268:845–50. This prospective randomized study compared conservative medical therapy to radiofrequency turbinoplasty and found that only RFA turbinate surgery improved nasal patency on objective measurements though both treatments improved quality of life significantly..

    Article  PubMed  Google Scholar 

  17. Di Rienzo Businco L, Di Rienzo Businco A, Lauriello M. Comparative study on the effectiveness of Coblation-assisted turbinoplasty in allergic rhinitis. Rhinology. 2010;48:174–8.

    PubMed  Google Scholar 

  18. Bhattacharyya N, Kepnes LJ. Clinical effectiveness of coblation inferior turbinate reduction. Otolaryngol Head Neck Surg. 2003;129:365–71.

    Article  PubMed  Google Scholar 

  19. Chen YL, Tan CT, Huang HM. Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis. Laryngoscope. 2008;118:1270–4.

    Article  PubMed  Google Scholar 

  20. Cingi C, Ure B, Cakli H, Ozudogru E. Microdebrider-assisted versus radiofrequency-assisted inferior turbinoplasty: a prospective study with objective and subjective outcome measures. Acta Otorhinolaryngol Ital. 2010;30:138–43.

    CAS  PubMed Central  PubMed  Google Scholar 

  21. Kassab AN, Rifaat M, Madian Y. Comparative study of management of inferior turbinate hypertrophy using turbinoplasty assisted by microdebrider or 980 nm diode laser. J Laryngol Otol. 2012;126:1231–7.

    Article  CAS  PubMed  Google Scholar 

  22. Liu CM, Tan CD, Lee FP, Lin KN, Huang HM. Microdebrider-assisted versus radiofrequncy-assisted inferior tubinoplasty. Laryngoscope. 2009;119:414–8.

    Article  PubMed  Google Scholar 

  23. Lee JY, Lee JD. Comparative study on the long-term effectiveness between coblation and microdebrider-assisted partial turbinoplasty. Laryngoscope. 2006;116:729–34.

    Article  PubMed  Google Scholar 

  24. Bhandarkar ND, Smith T. Outcomes of surgery for inferior turbinate hypertrophy. Curr Opin Otolaryngol Head Neck Surg. 2010;18:49–53.

    Article  PubMed  Google Scholar 

  25. Chhabra N, Houser SM. Surgical options for the allergic rhinitis patient. Curr Opin Otolaryngol Head Neck Surg. 2012;20:199–204.

    Article  PubMed  Google Scholar 

  26. Malcomson KG. The vasomotor activities of the nasal mucous membrane. J Laryngol Otol. 1959;73:733.

    Article  Google Scholar 

  27. Golding-Wood PH. Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis. J Laryngol Otol. 1961;75:232.

    Article  CAS  PubMed  Google Scholar 

  28. Krajina Z. Critical review of Vidian neurectomy. Rhinology. 1989;27(4):271–6.

    CAS  PubMed  Google Scholar 

  29. Kamel R, Zaher S. Endoscopic transnasal vidian neurectomy. Laryngoscope. 1991;101:316–9.

    CAS  PubMed  Google Scholar 

  30. Wentges RT. Surgical anatomy of the pterygopalatine fossa. J Laryngol Otol. 1975;89:35–45.

    Article  CAS  PubMed  Google Scholar 

  31. Yazar F, Cankal F, Haholu A, et al. CT evaluation of the vidian canal localization. Clin Anat. 2007;20:751–4.

    Article  PubMed  Google Scholar 

  32. Lee JC, Hsu CH, Kao CH, Lin YS. Endoscopic transsphenoidal vidian neurectomy. Eur Arch Otorhinolaryngol. 2011;268:851–6.

    Article  PubMed  Google Scholar 

  33. Robinson SR, Wormald PJ. Endoscopic vidian neurectomy. Am J Rhinol. 2006;20:197–202.

    PubMed  Google Scholar 

  34. Su W, Liu S, Chiu F, Lee C. Antegrade transsphenoidal vidian neurectomy: short-term surgical outcome analysis. Am J Rhinol Allergy. 2011;25(6):217–20.

    Article  Google Scholar 

  35. Tan G, Ma Y, Li H, Wang J. Long-term Results of Bilateral Endoscopic Vidian Neurectomy in the Management of Moderate to Severe Persistent Allergic Rhinitis. Arch Otolaryngol Head Neck Surg. 2012;138(5):492–7. This article is a large prospective non-randomized trial comparing continued medical therapy, septoplasty with turbinoplasty, and endoscopic vidian neurectomy in patients with severe persistent allergic rhinitis. While those patients who underwent septoplasty and turbinate surgery had significant improvements in quality of life and visual analog scale assessment of their symptoms, the endoscopic vidian neurectomy group had significantly better scores at all time points..

    Article  PubMed  Google Scholar 

  36. Bleier BS, Feldman R, Sadow PM, Wu AW, Ting J, Metson R. The accessory posterolateral nerve: an immunohistological analysis. Am J Rhinol Allergy. 2012;26(4):271–3.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Arthur W. Wu and Jonathan Y. Ting declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arthur W. Wu.

Additional information

This article is part of the Topical Collection on Rhinitis

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wu, A.W., Ting, J.Y. Indications for Surgery in Refractory Rhinitis. Curr Allergy Asthma Rep 14, 414 (2014). https://doi.org/10.1007/s11882-013-0414-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11882-013-0414-4

Keywords

Navigation