Posterior nasal nerve neurectomy for the treatment of rhinitis: a systematic review and meta-analysisEdward Balai email@example.com, Keshav Kumar Gupta2, Karan Jolly2, Adnan Darr3Show more: Authors information and Publication history
University Hospitals Coventry and Warwickshire NHS Trust, U.K.2
University Hospitals Birmingham NHS Foundation Trust, U.K.3
The Royal Wolverhampton Hospitals NHS Trust, U.K.
Published: 05 September 2022
Accepted: 05 September 2022
Received: 08 June 2022
Posterior nasal nerve neurectomy (PNNN) is a surgical option for the treatment of refractory chronic rhinitis. It can be performed by surgical dissection, cryotherapy, or laser ablation. This systematic review aimed to assess the effect of PNNN on Total Nasal Symptom Score (TNSS) in adults with chronic rhinitis. Methods.
A systematic review of EMBASE, MEDLINE, PubMed and ClinicalKey databases was conducted in November 2021. Studies reporting PNNN performed as a single procedure in adult patients with allergic, non-allergic or mixed chronic rhinitis, and TNSS as the outcome measure, were included. Results.
Database search identified 39 articles, of which 8 (463 patients) were included in the review. Two were randomised sham-controlled trials and six were prospective single-arm, unblinded and uncontrolled studies. Pooled analysis of data from the two randomized controlled trials found active treatment was associated with a significantly greater responder (≥ 30% reduction in TNSS from baseline) rate (OR 3.85, 95%CI 2.23-6.64, p < 0.00001). Conclusions.
This systematic review identified there is some limited evidence to suggest cryotherapy or radiofrequency ablation of the posterior nasal nerve can improve TNSS in adult patients. However, this is from a limited number of trials with short follow-up. Future research should focus on prospective randomised controlled trials with larger numbers of participants and medium to long term follow up in order to help draw more valid conclusions regarding the true effectiveness of PNNN in this patient cohort. Study registration.
The systematic review was registered prospectively on the PROSPERO database in July 2021 (ID: CRD42021270486).
Allergy; rhinology; chronic rhinitis; posterior nasal nerve; neurectomy.
Cite this article as:
Balai E, Gupta KK, Jolly K, Darr A. Posterior nasal nerve neurectomy for the treatment of rhinitis: a Systematic Review and Meta-Analysis. Eur Ann Allergy Clin Immunol. 2023;55(3):101-114. doi: 10.23822/EurAnnACI.1764-1489.268.