ABSTRACT
Objectives: Rhinitis affects up to 40% of the population
worldwide and can significantly reduce quality of life. Some patients
remain symptomatic despite maximal medical therapy. In refractory cases,
posterior nasal neurectomy (PNN - the division of the intranasal nerve
branches containing postganglionic parasympathetic fibres) is postulated
to reduce symptom burden. The objectives of this paper were to review
the literature to establish whether the procedure is effective and safe
in the management of allergic and non-allergic rhinitis.
Design: A systematic review of Pubmed, EMBASE and MEDLINE was
undertaken. Studies were excluded if not available in English or
undertaken in non-human subjects.
Participants : Seventeen articles satisfied the inclusion
criteria studying in total 2029 patients. Sample size ranged from
8-1056.
Main Outcome Measures: Patient-reported objective and
subjective outcomes and post-operative complications were reviewed.
Results: There were two randomised controlled trials, two case
control studies, and the remaining thirteen were case series using both
objective and subjective outcome measures. All but one study found
improved patient reported outcomes following PNN. Complications were
reported in 10 studies - haemorrhage was the most common complication
and was observed in 28 patients (1.6% of subjects).
Conclusions: Endoscopic posterior nasal neurectomy is safe and
appears to be effective in the treatment of intractable rhinitis but the
level of the available evidence was generally poor. Larger,
well-designed studies are needed to clarify its role in the management
of difficult-to-treat rhinitis.
Keywords: rhinitis, parasympathetic fibres, endoscopy