THE ROLE OF POSTERIOR NASAL NERVE NEURECTOMY IN THE RELIEF OF INTRACTABLE ALLERGIC RHINITIS A RANDOMIZED CONTROL STUDY

Document Type : Preliminary preprint short reports of original research

Authors

1 Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University

2 Department of Otorhinolaryngology Faculty of Medicine, Alexandria University

Abstract

Introduction
Allergic rhinitis (AR) is a common chronic inflammatory disorder of the upper respiratory tract, mediated by IgE and triggered by allergens such as pollen, dust mites, and animal dander. Though not life-threatening, AR significantly affects quality of life by impairing sleep, concentration, and productivity. Classified by the ARIA guidelines into intermittent or persistent forms, AR is often associated with comorbidities like asthma and conjunctivitis, reflecting shared inflammatory pathways. While medical treatments such as antihistamines and corticosteroids offer relief for many, a subset of patients with intractable AR continue to suffer despite maximal therapy.
Surgical Management and Rationale
Vidian neurectomy was historically used for refractory AR but is associated with significant complications such as dry eye and palatal numbness. As a safer alternative, posterior nasal neurectomy (PNN) targets the posterior nasal nerve (a branch of the sphenopalatine nerve) and can be approached endoscopically. Techniques include cold steel dissection, bipolar cauterization, and submucosal coagulation within the inferior turbinate. Each method aims to reduce nasal hypersecretion and obstruction while minimizing risk to surrounding structures. However, there is a lack of high-quality comparative data on their outcomes and safety profiles.

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