Efficacy Analysis Of Different Surgical Treatments For Moderate To Severe Allergic Rhinitis

Objective: The effectiveness and safety of neurological blockade(anterior ethmoidal nerve,nasal posterior neurotomy and vidian neurectomy)in the treatment of allergic rhinitis was analyzed by meta-analysis to determine the clinical application value of this type of surgery and provide relevant evidence-based evidence.Methods: The clinical researchs during when the datebase was built to March 2019 on the treatment of allergic rhinitis by posterior rhinotomy or anterior ethmoidal neurotomy,as well as case controlled trials of vidian neurotomy and drug therapy for allergic rhinitis were retrieved from Embase?Pubmed?Web of Science?Cochrane Library etc.After screening,quality evaluation and data extraction according to the exclusion criteria,Meta-analysis of the original data of the literature was performed using Revman 5.3 software.Results: 1.Analysis of the effectiveness of anterior ethmoidal nerve block in the treatment of allergic rhinitis A total of 14 clinical studies were included,including 1752 patients.Meta-analysis showed that anterior ethmoidal nerve block was very effective in the treatment of allergic rhinitis [RD=0.94,95% CI(0.92,0.96),P<0.001],and the results were statistically significant.2.Analysis of the efficacy and safety of nasal posterior neurotomy for allergic rhinitis.A total of 9 clinical studies were included,including 1343 patients.Meta-analysis showed that nasal endoscopic posterior neurotomy was effective in the treatment of allergic rhinitis [RD=0.89,95% CI(0.82,0.95),P<0.001],and the postoperative nasal ventilation resistance decreased[MD=0.33,95% CI(0.03,0.62),P=0.03],nasal congestion symptom score decreased[MD=3.30,95% CI(0.60,6.00),P=0.02],sneezing symptom score decreased[MD= 3.21,95% CI(1.80,4.62),P <0.001],salivation symptom score decreased[MD=3.33,95% CI(0.66,6.00),P=0.01],and the incidence of complications was very low [RD= 0.04,95% CI(0.01,0.08),P=0.03],the results were statistically significant.3.Analysis of the efficacy and safety of vidian neurectomy for moderate to severe allergic rhinitis.A total of 6 case-control studies were included,including 723 patients,consisting of 390 patients in the vidian neurectomy group and 333 in the drug-treated group.Meta-analysis showed that vidian neurectomy group resulted in smaller RQLQ scores [MD=-0.81,95%CI(-0.98,-0.63),P<0.001],lower incidence of complications [OR=0.34,95%CI(0.17,0.67),P=0.002],smaller VAS score [MD=-3.81,95%CI(-3.97,-3.65),P<0.001] and higher clinically effective ratio [OR=-3.70,95%CI(1.18,50.52),P=0.03] than conservative treatment group.The above results were statistically significant.Conclusion: 1.The efficiency of anterior ethmoidal nerve block for allergic rhinitis is about 94%.However,due to the lack of specific data on surgical complications,there is no evidence to support the safety of this procedure.2.The effective rate of posterior neurotomy for the treatment of allergic rhinitis is about 89%,postoperative nasal ventilation resistance and nasal congestion,sneezing,salivation and other symptoms are significantly relieved,and the incidence of postoperative complications is about 4%.Therefore,this procedure is an effective and feasible treatment for patients with moderate to severe allergic rhinitis who are ineffective in medical treatment.3.Compared with drug therapy,endoscopic vidian neurectomy for the treatment of moderate to severe allergic rhinitis has lower RQLQ score,less complication rate,lower VAS score,higher efficiency.So its efficacy is significantly better than drug treatment.