Assistant Professor Houston Methodist Academic Institute Houston Methodist Hospital Houston, Texas
INTRODUCTION: Vasomotor rhinitis (VR) is characterized by prolonged congestion and anterior/posterior rhinorrhea. Although in-office cryotherapy and radiofrequency treatment targeting the posterior nasal nerve (PNN) have minimized the morbidity and time commitment for controlling VR, up to 20-30% patients have limited responses. In this study, we examined the location of the sphenopalatine foramen (SPF), where PNN enters the nasal cavity, in relation to the middle turbinate (MT) attachment in order to predict response rates to in-office procedures for VR, which target the PNN anterior to the MT attachment. Our hypothesis is that patients with unfavorable MT attachment (axial CT: anterior to SPF) would have a higher chance of failing in-office VR treatment, in contrast to favorable MT attachment (axial CT: at or posterior to SPF).
METHODS:This was a retrospective case-control study to examine the potential correlation between MT attachment and failure rates of in-office procedures for VR.
RESULTS: Among 30 patients with VR treated with in-office procedures, 13 patients (43.3%) had no response. This failure cohort had a higher proportion of unfavorable MT attachments versus the success cohort (92.3% vs 58.8%, p<0.05) The odds ratio of patients failing their procedures due to unfavorable MT attachment on axial view was 8.4 (CI: 0.9-80.3, P=0.06). Four of the failed patients received vidian neurectomy, which completely resolved their symptoms.
CONCLUSION: A statistically higher proportion of patients with unfavorable MT attachment experiences ineffective in-office procedures for VR. Our results were limited by small sample size and continued investigations are required to solidify the correlation.