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<p>Allergic rhinitis (AR) is a prevalent chronic condition that significantly affects quality of life and daily functioning. Despite optimal medical management, a subset of patients with moderate-to-severe symptoms remains refractory to treatment. Posterior nasal nerve neurectomy (PNNN) has emerged as a promising surgical intervention in such cases, aiming to reduce nasal hyperreactivity by targeting parasympathetic innervation (1). To study the effect of bilateral posterior neurectomy in patients with moderate to severe intractable allergic rhinitis (2). To study pre-operative and post-operative mean subjective improvement in four nasal symptoms viz. Sneezing, rhinorrhoea, nasal blockage and post nasal drip along with total severity. (3) To note down any complications during or after the procedure. This prospective interventional study was conducted over 1.5 years in the ENT department of a tertiary care hospital. Ethical clearance was obtained from the Institutional Ethics Committee, and informed consent was collected from all participants in English, Hindi, or Marathi. Patients aged 18–60 years with a history of moderate-to-severe persistent or intermittent AR symptoms unresponsive to medical therapy for at least 3 years were included, as per ARIA 2019 guidelines. Exclusion criteria were systemic illnesses or refusal to consent. All patients underwent diagnostic nasal endoscopy, non-contrast CT scan of paranasal sinuses, serum IgE analysis, and were evaluated using validated symptom scoring questionnaires two weeks preoperatively and postoperatively at 1, 3, and 6 months. The study demonstrated significant improvement in symptoms post PNNN. Patients reported marked reductions in nasal obstruction, sneezing, itching, and rhinorrhoea. Subjective improvements were supported by consistently lower symptom scores at all follow-ups. No major intraoperative or postoperative complications were observed, and patient satisfaction was high. A decline in total IgE levels was also noted in some participants, reinforcing the potential systemic benefit. Posterior nasal nerve neurectomy is a safe and effective surgical option for patients with severe allergic rhinitis unresponsive to medical treatment. It provides sustained symptomatic relief and improves patient quality of life. However, further large-scale, multicentric studies with longer follow-up are warranted to validate and generalize these findings.</p>

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Efficacy of Endoscopic Posterior Nasal Nerve Neurectomy in Intractable Allergic Rhinitis Patients: A Prospective Interventional Study

  • 期刊论文

  • 发表日期：

    2025年10月18日

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  • Rushikesh Harkut,
  • Shashikant Mhashal,
  • Roshni Mohanty

摘要

Allergic rhinitis (AR) is a prevalent chronic condition that significantly affects quality of life and daily functioning. Despite optimal medical management, a subset of patients with moderate-to-severe symptoms remains refractory to treatment. Posterior nasal nerve neurectomy (PNNN) has emerged as a promising surgical intervention in such cases, aiming to reduce nasal hyperreactivity by targeting parasympathetic innervation (1). To study the effect of bilateral posterior neurectomy in patients with moderate to severe intractable allergic rhinitis (2). To study pre-operative and post-operative mean subjective improvement in four nasal symptoms viz. Sneezing, rhinorrhoea, nasal blockage and post nasal drip along with total severity. (3) To note down any complications during or after the procedure. This prospective interventional study was conducted over 1.5 years in the ENT department of a tertiary care hospital. Ethical clearance was obtained from the Institutional Ethics Committee, and informed consent was collected from all participants in English, Hindi, or Marathi. Patients aged 18–60 years with a history of moderate-to-severe persistent or intermittent AR symptoms unresponsive to medical therapy for at least 3 years were included, as per ARIA 2019 guidelines. Exclusion criteria were systemic illnesses or refusal to consent. All patients underwent diagnostic nasal endoscopy, non-contrast CT scan of paranasal sinuses, serum IgE analysis, and were evaluated using validated symptom scoring questionnaires two weeks preoperatively and postoperatively at 1, 3, and 6 months. The study demonstrated significant improvement in symptoms post PNNN. Patients reported marked reductions in nasal obstruction, sneezing, itching, and rhinorrhoea. Subjective improvements were supported by consistently lower symptom scores at all follow-ups. No major intraoperative or postoperative complications were observed, and patient satisfaction was high. A decline in total IgE levels was also noted in some participants, reinforcing the potential systemic benefit. Posterior nasal nerve neurectomy is a safe and effective surgical option for patients with severe allergic rhinitis unresponsive to medical treatment. It provides sustained symptomatic relief and improves patient quality of life. However, further large-scale, multicentric studies with longer follow-up are warranted to validate and generalize these findings.