Selective Vidian Neurectomy Plus FESS Shows Long-Term Relief in Nasal Itching
Combining FESS with selective vidian neurectomy improved long-term nasal symptom control, especially nasal itching, in CRSwNP, allergic rhinitis, and asthma.
Credit: Adobe Stock/ eddows
A new study found that 3 years of functional endoscopic sinus surgery (FESS) combined with selective vidian neurectomy improved nasal symptoms in patients with allergic rhinitis, chronic rhinosinusitis with nasal polyps (CRSwNP), and asthma.1
“Both groups demonstrated significant symptom improvement and enhanced quality of life three years post-surgery,” wrote investigators, led by Chengxun Jin, from the department of otolaryngology, head and neck surgery at The Second Hospital of Jilin University, China. “However, patients treated with FESS plus selective vidian neurectomy reported greater relief from nasal itching and sneezing, particularly nasal itching, which showed statistically significant improvement.”
Patients with allergic rhinitis, CRSwNP, and asthma often face high recurrence rates after FESS, and several may require revision surgery. A previous study demonstrated the short-term efficacy of FESS combined with posterior nasal neurectomy in managing allergic rhinitis and CRSwNP, particularly for reducing rhinorrhea.
Moreover, reports have shown the effectiveness of selective vidian neurectomy for improving nasal symptoms by targeting parasympathetic innervation, reducing glandular secretion, and mucosal edema.2 In this study, investigators evaluated the long-term outcomes of combining FESS with selective vidian neurectomy in patients with allergic rhinitis, CRSwNP, and asthma, examining typical allergic symptoms—nasal blockage, itching, sneezing, and rhinorrhea—along with eye symptoms.1
The study sample included 56 patients with allergic rhinitis and CRSwNP, with 27 who had asthma. All participants, aged 24 – 68 years, had a history of nasal symptoms for > 3 months and were admitted to the department of otolaryngology-head and neck surgery at the Second Hospital of Jilin University from February 2017 to January 2019.
Participants were divided into 2 arms: group A received FESS with selective vidian neurectomy (n = 34), and group B (controls) only underwent FESS (n = 22). The follow-up period concluded in February 2022.
Investigators assessed disease severity, control, and outcomes using the Visual Analog Scale (VAS), the 22-item Sino-Nasal Outcome Test (SNOT-22), and the Lund-Kennedy score for nasal endoscopy. The team assessed the factors impacting disease severity and treatment outcomes by recording allergy assessments (on mites, mold, and pollens), preoperative blood eosinophilia, and tissue eosinophil levels from histopathological examination.
After 3 years, patients who had undergone FESS with or without selective vidian neurectomy had significantly improved nasal symptoms and quality of life compared to the preoperative period (P < .01).
Patients who received a combined treatment of FESS and selective vidian neurectomy had better outcomes for nasal itching (VAS difference, 4.5; IQR, 8.0 – 2.0 vs 2.0; 6.0 – 0.75; P = .04). Additionally, participants on combined FESS and selective vidian neurectomy also had better outcomes for sneezing (4.0 vs 2.0), nasal blockage (6.0 vs 5.5), and watery eyes (2.5 vs 1.5), but these findings were not significant (P = .28, P = .95, P = .91, respectively).
More participants on combined FESS and selective vidian neurectomy achieved CRS control than participants only on FESS (41.2% vs 27.3%), with mean Lund-Kennedy scores of 2.50 ± 2.345 and 1.79 ± 1.528, respectively. Those with CRS and high tissue eosinophilic inflammation had reduced disease control compared to individuals with controlled or partly controlled disease (P < .05).
CRS control was ultimately similar between arms, but among group A, patients with asthma demonstrated better CRS control (P < .05).
“Overall, our findings indicate that selective vidian neurectomy contributes to the sustained management of [allergic rhinitis] symptoms, particularly nasal itching, supporting its value in long-term CRS and [allergic rhinitis] control in patients with [allergic rhinitis and] CRSwNP,” investigators wrote.
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