Submucous turbinectomy combined with posterior nasal neurectomy in the management of severe allergic rhinitis: clinical outcomes and local cytokine changes

OBJECTIVES: Submucous resection of the inferior turbinate is one of the recommended methods to alleviate nasal symptoms in patients with severe allergic rhinitis patients in terms of postoperative results and preservation of nasal function. Posterior nasal neurectomy, recently developed by Kikawada, is a novel method to selectively cut the neural bundles out from the sphenopalatine foramen and to diminish the complaints of hypersecretion. This study was carried to examine the clinical effectiveness and changes in local cytokine levels of this combined surgical procedure. METHODS: Twenty-three patients with severe perennial allergic rhinitis underwent submucous turbinectomy combined with posterior nasal neurectomy under general anesthesia. The patients' subjective nasal symptoms were examined at each visit. The levels of interleukin-5 (IL-5), eotaxin and regulated on activation, normal T cell expressed and secreted (RANTES) in nasal lavages were measured before and 6 month after surgery. Nasal mucosa of the inferior turbinate was also obtained for histopathological examination in some cases. RESULTS: The mean symptom scores for sneeze, rhinorrhea, nasal obstruction, and total severity were all statistically decreased after surgery. Therapeutic effects continued to be apparent as long as 3 years after surgery. The mean levels of both IL-5 and eotaxin significantly decreased after surgery, but that of RANTES remained unchanged. Histopathological examination revealed that the number of inflammatory cells and nasal glands markedly reduced in lamina propria and the epithelial layer became covered with stratified columnar cells. CONCLUSION: Submucosal turbinectomy with posterior nasal neurectomy has remarkably improved subjective nasal symptoms in patients with severe allergic rhinitis on a long-term follow-up basis. The present study also demonstrates that the clinical effectiveness of the procedure is accompanied by decreases in local inflammatory cell infiltration and the related cytokine production.