Clin Exp Otorhinolaryngol.  2010 Dec;3(4):212-216. 10.3342/ceo.2010.3.4.212.

Long-Term Effectiveness and Safety of Endoscopic Vidian Neurectomy for the Treatment of Intractable Rhinitis

• Jang TY
• Kim YH
• Shin SH

• KMID: 2049054
• DOI: http://doi.org/10.3342/ceo.2010.3.4.212

Abstract

OBJECTIVES
Vidian neurectomy could be considered the treatment of choice for intractable rhinitis, because it is the only method that can permanently block the pathophysiological mechanism of rhinitis. The goal of this study was to evaluate the effect of vidian neurectomy on nasal symptoms and tear production, and to assess for possible complications.
METHODS
Six patients with intractable rhinitis who underwent endoscopic transnasal vidian neurectomy were enrolled. The degree of symptom improvement and complications were assessed through retrospective review of medical records prior to, and 1 year following surgery, and telephone survey after 6.9+/-2.1 years. Schirmer's test was performed before surgery, and these values were compared to postoperative results at 1 day, 1 month, and 2 months.
RESULTS
Changes in the visual analogue scale were significant in nasal obstruction (8.5+/-2.5 to 3.0+/-2.0, P<0.05) and rhinorrhea (9.0+/-2.2 to 2.0+/-1.6, P<0.05). Improvements persisted for up to 7 years after the primary surgery. Patients complained of mild dry eyes for 1 month after vidian neurectomy. However, five out of six reported marked improvement of xerophthalmia after 2 months. Aside from mild crusting of the nasal cavity and mild postoperative pain, there were no major complications. During the entire follow-up period, no patient needed additional treatment, such as antihistamines or corticosteroids.
CONCLUSION
Vidian neurectomy is effective in alleviating nasal symptoms in patients with intractable rhinitis refractory to other treatments. This effect is sustained for at least 7 years with minimal postoperative complications.

Keyword

Allergic rhinitis; Endoscopy; Vidian nerve; Schirmer's test

MeSH Terms

Endoscopy
Eye
Follow-Up Studies
Histamine Antagonists
Humans
Medical Records
Nasal Cavity
Nasal Obstruction
Pain, Postoperative
Postoperative Complications
Retrospective Studies
Rhinitis
Rhinitis, Allergic, Perennial
Tears
Telephone
Xerophthalmia
Histamine Antagonists

Figure

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  Fig. 1 The mean visual analogue scale (VAS) of nasal symptoms pre-surgery, 1 year, and 7 years after vidian neurectomy. 1, nasal obstruction; 2, rhinorrhea; 3, sneezing; and 4, itching. (Wilcoxon signed rank test, *P<0.05, **P<0.01). TNSS: total nasal symptom score.

• 

  Fig. 2 The results of the Schirmer's test before and after surgery (immediate postoperative period, 1 month, and 2 months after the operation) (Wilcoxon signed rank test, *P<0.05).

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  Fig. 3 Change in medication score after vidian neurectomy (Wilcoxon signed rank test, **P<0.01).

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