Clinical Outcomes of Endoscopic Septoplasty with Posterior Nasal Neurectomy in Allergic Rhinitis Patients with Deviated Nasal Septum

Abstract

Background: Allergic rhinitis is a chronic immunoglobulin E-mediated inflammatory disorder of the nasal mucosa characterized by nasal obstruction, rhinorrhea, sneezing, and nasal itching. It significantly impairs sleep quality, work productivity, social functioning, and overall quality of life. Patients with coexisting deviated nasal septum frequently remain symptomatic despite optimal medical management. Surgical interventions such as endoscopic septoplasty combined with transnasal neurectomy have emerged as promising modalities targeting both anatomical obstruction and neural hyperresponsiveness associated with allergic rhinitis.^[1]

Methods: This prospective observational study was conducted in the Department of Otorhinolaryngology at Travancore Medical College Hospital, Kollam, from January 2023 to June 2024. Ninety-two patients diagnosed with moderate to severe persistent allergic rhinitis associated with deviated nasal septum were included. All patients underwent endoscopic septoplasty with bilateral transnasal neurectomy under general anesthesia. Symptom severity and quality of life were assessed preoperatively and two months postoperatively using the Nasal Obstruction Symptom Evaluation scale and Allergic Rhinitis Control Test questionnaire. Statistical analysis was performed using paired t-test, and a p-value less than 0.05 was considered statistically significant.

Results: Among the 92 participants, the majority belonged to the 30–40 years age group (65.2%), and males constituted 66.3% of the study population. Significant postoperative improvement was observed in nasal obstruction and allergic symptoms. The mean Nasal Obstruction Symptom Evaluation score decreased from 81.90 ± 10.24 preoperatively to 47.45 ± 8.31 postoperatively (p < 0.001). The mean Allergic Rhinitis Control Test score improved from 9.60 ± 2.01 to 15.97 ± 1.82 (p < 0.001). Intraoperative hemorrhage occurred in 6.5% of patients, while postoperative infection was noted in 5.4% of patients.

Conclusion: Endoscopic septoplasty combined with transnasal neurectomy is a safe and effective surgical modality for patients with moderate to severe persistent allergic rhinitis associated with deviated nasal septum. The procedure significantly improves nasal obstruction, allergic symptoms, and quality of life with minimal complications.