Newer Surgical Options for Nasal Allergy

Abstract

Allergic rhinitis is a common disorder that affects several patients annually and the hallmark symptoms are nasal obstruction, rhinorrhea and sneezing which significantly impacts the quality of life. Many surgical options exist for the treatment of allergic rhinitis which is directed primarily addressing the nasal obstructive component. The purpose of this review article  is to highlight newer surgical options in the management of patients with nasal allergy. Surgical modalities such as endoscopic resection of the posterior nasal nerve and senior author’s own mini inferior turbinoplasty tunnelling technique for patients with nasal allergy is described here. Most of the literature has focused on medical management for patients with allergic rhinitis. Endoscopic Posterior Nasal neurectomy combined with mini inferior turbinoplasty has good overall significant improvement in nasal allergy symptom scores by 60–80%. Although no single modality has evolved as the gold standard for the surgical management of allergic rhinitis. The main stay of surgical intervention targets the inferior turbinate and posterior nasal nerve which is the parasympathetic supply to the nose causing rhinorrhea. This combined technique provides consistent, robust results with long-term relief of nasal symptoms due to allergic and vasomotor rhinitis without additional risk of complication.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Kizilkaya Z, Ceylan K, Emir H et al (2008) Comparison of radio-frequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy. Otolaryngol Head Neck Surg 138:176–181

    Article  Google Scholar 

  2. 2.

    Lee CF, Chen TA (2004) Power microdebrider-assisted modification of endoscopic inferior turbinoplasty: a preliminary report. Chang Gung Med J 27:359–365

    PubMed  Google Scholar 

  3. 3.

    Chen YL, Liu CM, Huang HM (2007) Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates. Int J Pediatr Otorhinolaryngol 71:921–927

    Article  Google Scholar 

  4. 4.

    Golding-Wood PH (1961) Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis. J Laryngol Otol 75:232–247

    CAS  Article  Google Scholar 

  5. 5.

    Kikawada T (2007) Endoscopic posterior nasal neurectomy: an alternative to vidian neurectomy. Oper Tech Otolaryngol 18(4):297–301. https://doi.org/10.1016/j.otot.2007.05.010

    Article  Google Scholar 

  6. 6.

    Kobayashi T, Hyodo M, Nakamura K, Komobuchi H, Honda N (2012) Resection of peripheral branches of the posterior nasal nerve compared to conventional posterior neurectomy in severe allergic rhinitis. Auris Nasus Larynx 39:593–596

    Article  Google Scholar 

  7. 7.

    Toma S, Hopkins C (2016) Stratification of SNOT-22 scores into mild, moderate or severe and relationship with other subjective instruments. Rhinology 54(2):129–133. https://doi.org/10.4193/Rhin15.072

    Article  PubMed  Google Scholar 

  8. 8.

    Abramson M, Harker LA (1973) Physiology of the nose. Otolaryngol Clin N Am 6:623–635

    CAS  Google Scholar 

  9. 9.

    Haight JS, Cole P (1983) The site and function of the nasal valve. Laryngoscope 93:49–55

    CAS  Article  Google Scholar 

  10. 10.

    Ogawa T, Takeno S, Ishino T, Hirakawa K (2007) Submucous turbinectomy combined with posterior nasal neurectomy in the management of severe allergic rhinitis: clinical outcomes and local cytokine changes. Auris Nasus Larynx 34:319–326

    Article  Google Scholar 

  11. 11.

    Malcomson KG (1959) The vasomotor activities of the nasal mucous membrane. J Laryngol Otol 73:73–98

    CAS  Article  Google Scholar 

Download references

Funding

No funding received.

Author information

Affiliations

Authors

Contributions

AN Performed surgery, own surgical technique and patient preoperative and postoperative management and follow up; RDN Preparation of the manuscript, literature review and review of manuscript.

Corresponding author

Correspondence to Rajendran Dinesh Kumar.

Ethics declarations

Conflict of interest

No potential conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (WMV 10400 kb)

Supplementary material 2 (WMV 19963 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nagalingeswaran, A., Kumar, R.D. Newer Surgical Options for Nasal Allergy. Indian J Otolaryngol Head Neck Surg 72, 133–139 (2020). https://doi.org/10.1007/s12070-019-01772-1

Download citation

Keywords

  • Nasal obstruction
  • Sneezing
  • Rhinorrhea
  • Inferior turbinate reduction
  • Tunneling
  • Microdebrider
  • Allergic rhinitis
  • Vasomotor rhinitis
  • Posterior nasal nerve
  •  Endoscopic Posterior Nasal Neurectomy