The Effect of Vidian Neurectomy on Pulmonary Function in Patients with Allergic Rhinitis and Chronic Rhinosinusitis with Nasal Polyps

Gulibositan, Maimaitiaili; Kayisaier, Kahaer; Tang, Liang; Zhang, Jin

doi:10.1016/j.amjms.2020.04.024

Cited by 6 publications

(18 citation statements)

References 34 publications

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“…Observational studies and a non‐randomized controlled trial found that AR patients experienced improvements in sneezing, nasal discharge, obstruction, itching, and QOL 2375,2387–2390 . An RCT and another non‐randomized controlled trial of patients with both AR and CRSwNP found similar results, as well as improvement on pulmonary functions tests 2391,2392 . There remains some concern that symptom recurrence may be high based on earlier studies, 2393 especially with longer‐term follow up, though this remains in contention and recent series have reported durable outcomes.…”

Section: Managementmentioning

confidence: 97%

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Wise

Damask

Roland

et al. 2023

Int Forum Allergy Rhinol

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Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR‐Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR‐Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence‐based findings and recommendation from the full document. Methods ICAR‐Allergic Rhinitis 2023 employed established evidence‐based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR‐Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR‐Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

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Section: Managementmentioning

confidence: 97%

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Wise

Damask

Roland

et al. 2023

Int Forum Allergy Rhinol

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“…This study found that all the combined operation efficiency and symptom and sign score ranking were higher than those of FESS alone, and there was a statistical difference between PNN + FESS 71 and FESS. Therefore, when using FESS to treat patients with chronic rhinosinusitis and nasal polyps, the combination of PNN and VN 13 would be a better choice. Because the included literature is few and no closed loop is formed, more literature support and further discussion are needed as to which surgical method is better.…”

Section: Response Rate In Allergic Rhinitis Combined With Chronic Rhi...mentioning

confidence: 99%

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

Xie

Yuan²,

Wang³

2023

Allergol Immunopathol

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Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

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“…The year of publication of these studies ranged from 2011 30 to 2022. 31 Note that 14 30,[32][33][34][35][36][37][38][39][40][41][42][43][44] of the included studies were prospective cohort, nine 31,[45][46][47][48][49][50][51][52] were case series, and one 53 was a randomized controlled trial (RCT).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…In total, 1677 patients with AR were included, of whom a total of 510 patients had combined CRSwNP in six studies, 38,39,[42][43][44]52 and all patients in one study 41 had AR combined allergic asthma (95 patients). Note that 1193 (71.1%) of total patients were treated with nasal neurectomy, while 573 (34.2%) patients were treated with traditional treatment options such as conservative medication or other surgical treatment depending on their symptoms.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Seventy-four patients had a combined neurectomy, 44 of whom 35 underwent SVN with AEN, and 30 of whom 31 underwent both PNN and AEN. Another 338 patients from various studies were treated in the traditional way to cure AR, for instance, partial inferior turbinectomy and/or septoplasty as well as conservative medicines offered by Tan et al 30,32 Of the 510 patients from six studies 38,39,[42][43][44]52 diagnosed by AR combined with CRSwNP, 312 patients underwent neurectomy and FESS simultaneously to remove the nasal polyps, of which 56 patients 39 underwent bilateral vidian neurectomy, 38 patients 52 were amputated unilateral vidian nerve, 186 patients from three different studies 38,43,44 received SVN, and 70 patients 42 underwent PNN. These participants who received neurectomy and FESS together were typically contrasted with those who underwent FESS only.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Endoscopic vidian and vidian‐branch neurectomy for refractory allergic rhinitis: A systematic review

Niu,

Chen,

Zhou

et al. 2023

Int Forum Allergy Rhinol

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BackgroundEndoscopic vidian neurectomy is expected to provide good therapeutic relief in patients with allergic rhinitis (AR) being refractory to medication therapy or conservative surgery. However, the evidence bases for its benefit remain debatable. In this study, we conducted a systematic review and meta‐analysis to clarify the therapeutic role of various forms of vidian neurectomy in refractory AR.MethodPreferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines were used to conduct a systematic review of primary studies that reported original patient data for endoscopic vidian neurectomy (EVN) and vidian‐branch neurectomy, which includes selective vidian neurectomy (SVN) and posterior nasal neurectomy (PNN). The primary outcome was patient‐reported outcome measures (PROMs), including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Visual Analog Scale (VAS), to assess an improvement in nasal symptom severity and quality of patient's life. The incidence of surgical complications and other objective outcomes were considered secondary outcomes.ResultsThis review included 24 clinical studies involving 1677 patients with refractory AR, of which 510 patients in six studies had combined chronic rhinosinusitis with nasal polyps (CRSwNP) and 95 patients in one study had combined asthma. Postoperative PROMs were significantly better than preoperatively in almost all patients who underwent vidianp (RQLQ: standardized mean difference [SMD] = 2.66, 95% confidence interval [CI] = 2.40–2.92, p < 0.001; VAS: SMD = 5.15, 95% CI = 4.29–6.02, p < 0.001) or vidian‐branch neurectomy (RQLQ in PNN: SMD = 3.29, 95% CI = 2.45–4.13, p < 0.001; VAS in PNN: SMD = 4.38, 95% CI = 3.41–5.34, p < 0.001), and were generally better than in the conservative treatment group. Dividing with 18 months as the cutoff point, a subgroup analysis of the follow‐up period was conducted, and the results showed that both long‐term and short‐term postoperative patients had considerably reduced symptoms compared to the preoperative period. The two surgical procedures, SVN and PNN, attributed to vidian‐branch neurectomy have extremely few complications. However, EVN is more likely to cause dry eyes and palatal numbness, with no other serious complications. In patients with AR and CRSwNP, vidian or selective vidian neurectomy combined with functional endoscopic sinus surgery (FESS) is more effective than conventional FESS (RQLQ: SMD = 2.17, 95% CI = 1.66–2.69, p < 0.001; VAS: SMD = 6.42, 95% CI = 4.78–8.06, p < 0.001). For patients who have both AR and asthma, SVN with pharyngeal branch excision is a potential treatment option.ConclusionEVN and vidian‐branch neurectomy (including SVN and PNN) are effective treatments, but the former has a higher risk of complications. Additionally, vidian‐branch neurectomy with FESS is beneficial for patients with mixed CRSwNP. SVN is a potential approach for patients with coexisting AR and asthma.

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The Effect of Vidian Neurectomy on Pulmonary Function in Patients with Allergic Rhinitis and Chronic Rhinosinusitis with Nasal Polyps

Cited by 6 publications

References 34 publications

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

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

Endoscopic vidian and vidian‐branch neurectomy for refractory allergic rhinitis: A systematic review

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