role of minimally invasive surgery in treating nasal symptoms in patients with long lasting allergic rhinitis

ABSTRACT

Allergic rhinitis is a common condition, affecting about 10-20% of the population. The main symptoms are nasal obstruction, rhinorhea and hyposmia. The treatment is mainly conservative and consists of use of antihistamins, nasal corticosteroid or both. Despite the effectiveness of the medical treatment, permanent nasal changes like mucosal hypetrohy of the inferior turbinates and nasal polyposis occur in many patients with time. In such cases surgery, in addition to the medical treatment, is indicated. The role of the surgery is 1/ to reduce the volume of the inferior turbinates 2/to remove nasal polyposis 3/ to facilitate the ventilation of the paranasal sinuses by enlarging their openings and 4/ to create better conditions for penetration of local steroids into the nasal mucosa. Minimally invasive surgery was performed in 65 patients with allergic rhiniris. Thirty seven of them were male and 28 female, aged from 15 to 64 years. All the patients underwent nasal endoscopy and the pathological changes were classified into 3 groups 1/mucosal hypertrophy in 45 cases; 2/nasal polyosis in 8 cases or 3/ both in 12 cases. The preoperative and postoperative assessment of nasal function was measured by 1/visual analog scale [VAS]; 2/ acoustic rhinometry; 3/ rhinomanometry. Surgery consisted of 1/endoscopic turbinoplasty in 57 case; 2/ polypectomy alone in 7 cases or 3/ polypectomy, combined with infundibulotomy, anterior ethmoidectomy and middle meatus antrostomy in 13 cases. In addition, in cases with marked septal deviations, 7 septoplasties were done. The results of the surgery were evaluated 6 months to ' year after the operation and show marked improvement of the main complains obstruction, rhinorhea and hyposmia. The following conclusions were made 1/Minimally invasive nasal surgery is effective in treating the main symptoms of allergic rhinitis. It brings long lasting relieve from the nasal obstruction, nasal secretion and anosmia, 2/By destructing the submucosal blood vessels and hypertrophic glands and maintining the patency and the ventilation of the paranasal sinuses, minimally invasive surgery acts as pathogenic treatment of allergic rhinitis. 3/The use of endoscopes, operating microscope and powered instruments, enhance the results of the surgery. 4/Minimally invasive surgery is a complementary treatment of allergic rhinitis and does not substitute the medical treatment