Endoscopic posterior nasal neurectomy for intractable rhinitis: a
systematic review of the literature Running Title: Endoscopic PNN: a
systematic review
Abstract
Objectives: Rhinitis affects up to 40% of the population worldwide and
can significantly reduce quality of life. Some patients remain
symptomatic despite maximal medical therapy. In refractory cases,
posterior nasal neurectomy (PNN - the division of the intranasal nerve
branches containing postganglionic parasympathetic fibres) is postulated
to reduce symptom burden. The objectives of this paper were to review
the literature to establish whether the procedure is effective and safe
in the management of allergic and non-allergic rhinitis. Design: A
systematic review of Pubmed, EMBASE and MEDLINE was undertaken. Studies
were excluded if not available in English or undertaken in non-human
subjects. Participants: Seventeen articles satisfied the inclusion
criteria studying in total 2029 patients. Sample size ranged from
8-1056. Main Outcome Measures: Patient-reported objective and subjective
outcomes and post-operative complications were reviewed Results: There
were two randomised controlled trials, two case control studies, and the
remaining thirteen were case series using both objective and subjective
outcome measures. All but one study found improved patient reported
outcomes following PNN. Complications were reported in 10 studies -
haemorrhage was the most common complication and was observed in 28
patients (1.6% of subjects). Conclusions: Endoscopic posterior nasal
neurectomy is safe and appears to be effective in the treatment of
intractable rhinitis but the level of the available evidence was
generally poor. Larger, well designed studies are needed to clarify its
role in the management of difficult-to-treat rhinitis.