Posterior Nasal Neurectomy for Eosinophilic Chronic Rhinosinusitis With Allergic Rhinitis: Efficacy Study.

Abstract

To evaluate the efficacy of posterior nasal neurectomy (PNN) in patients with eosinophilic chronic rhinosinusitis (eCRS) and moderate to severe persistent allergic rhinitis (AR). A total of 42 patients with eCRS and AR were recruited from the Otorhinolaryngology Department of Qingdao University Affiliated Hospital between December 1, 2022, and January 1, 2024. All patients underwent functional endoscopic sinus surgery (FESS), with 20 receiving additional PNN (intervention group) and 22 undergoing FESS alone (control group). Subjective symptoms were assessed using the visual analog scale (VAS), sino-nasal outcome test-22 (SNOT-22), and rhinoconjunctivitis quality of life questionnaire (RQLQ). Objective assessments included the modified Lund-Kennedy endoscopic score and Lund-Mackay CT score. Postoperative nasal secretions were collected for cytokine analysis using enzyme-linked immunosorbent assay (ELISA). Preoperatively, the intervention group exhibited higher rates of excessive sneezing and emotional impact on RQLQ scores (p < 0.05). At 6-month follow-up, the intervention group showed significantly reduced subjective symptom scores (SNOT-22, p = 0.003; RQLQ activity, p < 0.001; nasal symptoms, p = 0.003; eye symptoms, p = 0.002; total RQLQ score, p = 0.007) and improved objective symptoms (Lund-Kennedy score, p < 0.001) compared to the control group. Greater reductions (Δ) were observed in eye symptoms (p = 0.002), emotional (p = 0.002), and Modified Lund-Kennedy score (p < 0.001). Postoperative IL-5 concentrations were lower in the intervention group (p = 0.023). Concurrent PNN with FESS is both safe and effective, leading to significant improvements in both subjective and objective symptoms in eCRS patients with AR. Cytokine analysis further supports the therapeutic benefits of this combined approach.