Treatment strategy for patients with vasomotor rhinitis following laser coagulation of nasal turbinates

Abstract

Background: Laser coagulation of the nasal turbinates is a widely used procedure in the treatment of vasomotor rhinitis, with various wavelengths and techniques being employed. However, scientific sources on this subject rarely emphasizes postoperative nasal mucosa care. Authors either use various medications or limit postoperative care to nasal irrigation with saline solution. To date, no studies have been conducted comparing the effectiveness of different postoperative management methods following laser coagulation of the nasal turbinates.

Aim: To conduct a comparative assessment of the effectiveness of two intranasal therapy regimens in the early postoperative period following laser coagulation of the inferior nasal turbinates.

Methods: Superficial laser treatment was performed on the inferior nasal turbinates in 57 patients diagnosed with vasomotor rhinitis, using a 1.94 μm wavelength laser at 4 W power. During the seven-day postoperative period, patients were divided into two groups: Group 1 received irrigation therapy with isotonic saline, and Group 2 used a phenylephrine + cetirizine nasal spray. Symptom severity was assessed using the NOSE scale on postoperative day 1, day 7, and one month after surgery to evaluate symptom changes in two groups. Nasal endoscopy was also performed at the same time points.

Results: On postoperative day 1, a 10-point worsening on the NOSE scale due to nasal obstruction was recorded in Group 1 (isotonic saline irrigation), whereas no deterioration on the NOSE scale was noted in Group 2 (phenylephrine + cetirizine spray). By day 7, the difference between the groups remained 10 points, reflecting a moderate level of dissatisfaction. After one month, when postoperative conservative therapy was discontinued, no significant differences between the groups were found, and all patients reported satisfactory nasal breathing.

Conclusion: Local irrigation therapy, as well as phenylephrine combined with cetirizine in spray form, is justified during the postoperative period following laser coagulation of the inferior nasal turbinates.

Keywords

vasomotor rhinitis / superficial laser coagulation / 1.94 μm wavelength / NOSE scale

References

[1] Bernstein JA, Bernstein JS, Makol R, et al. Allergic rhinitis: a review. JAMA. 2024;331(10):866–877. doi: 10.1001/jama.2024.0530 EDN: APRVCZ

[2] Bernstein J.A., Bernstein J.S., Makol R., Ward S. Allergic rhinitis: a review // JAMA. 2024. Vol. 331, N 10. P. 866–877. doi: 10.1001/jama.2024.0530 EDN: APRVCZ

[3] Arefyeva NA, Vishnyakov VV, Karpishchenko SA, et al. Vasomotor rhinitis: pathogenesis, diagnosis and principles of treatment. (Klinical recommendations). Moscow. 2014. 25 p. EDN: SBUFCA

[4] Арефьева Н.А., Вишняков В.В., Карпищенко С.А., и др. Вазомоторный ринит: патогенез, диагностика и принципы лечения. Клинические рекомендации. 2014. 25 с. EDN: SBUFCA

[5] Nersesyan MV, Muntyan VV, Polev GA, et al. The use of laser in rhinosurgery. the curent state of the problem. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2022;28(2):20–30. EDN: DIZWMS

[6] Нерсесян М.В., Мунтян В.В., Полев Г.А., Попадюк В.А. Применение лазера в ринохирургии. Современное состояние проблемы // Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2022. Т. 28 № 2. C. 20–30. EDN: DIZWMS

[7] Green R, Banigo A, Hathorn I. Postoperative nasal debridement following functional endoscopic sinus surgery: a systematic review of the literature. Clin Otolaryngol. 2015;40(1):2–8. doi: 10.1111/COA.12330

[8] Green R., Banigo A., Hathorn I. Postoperative nasal debridement following functional endoscopic sinus surgery, a systematic review of the literature // Clin Otolaryngol. 2015. Vol. 40. N 1. P. 2–8. doi: 10.1111/COA.12330

[9] Lewis TA, Bayless L, Eckman JB, et al. 5-Lipoxygenase inhibitors with histamine H1 receptor antagonist activity. Bioorg Med Chem Lett. 2004;14(9):2265–2268. doi: 10.1016/j.bmcl.2004.02.005 EDN: KMTZOT

[10] Lewis T.A., Bayless L., Eckman J.B., et al. 5-Lipoxygenase inhibitors with histamine H1 receptor antagonist activity // Bioorg Med Chem Lett. 2004. Vol. 14, N 9. P. 2265–2268. doi: 10.1016/j.bmcl.2004.02.005 EDN: KMTZOT

[11] Korsgren M, Andersson M, Borgå O, et al. Clinical efficacy and pharmacokinetic profiles of intranasal and oral cetirizine in a repeated allergen challenge model of allergic rhinitis. Ann Allergy Asthma Immunol. 2007;98(4):316–321. doi: 10.1016/S1081-1206(10)60876-9

[12] Korsgren M., Andersson M., Borgå O., et al. Clinical efficacy and pharmacokinetic profiles of intranasal and oral cetirizine in a repeated allergen challenge model of allergic rhinitis // Ann Allergy Asthma Immunol. 2007. Vol. 98, N 4. P. 316–321. doi: 10.1016/S1081-1206(10)60876-9

[13] Horak F, Zieglmayer UP, Zieglmayer R, et al. Azelastine nasal spray and desloratadine tablets in pollen-induced seasonal allergic rhinitis: a pharmacodynamic study of onset of action and efficacy. Curr Med Res Opin. 2006;22(1):151–157. doi: 10.1185/030079906X80305

[14] Horak F., Zieglmayer U.P., Zieglmayer R., et al. Azelastine nasal spray and desloratadine tablets in pollen-induced seasonal allergic rhinitis: a pharmacodynamic study of onset of action and efficacy // Curr Med Res Opin. 2006. Vol. 22, N 1. P. 151–157. doi: 10.1185/030079906X80305

[15] Ryazantsev SV. Modern decongestants in the complex therapy of acute and chronic diseases of the ent organs. Russian Otorhinolaryngology. 2005;(6):71–74. EDN: YLOSBF

[16] Рязанцев С.В. Современные деконгестанты в комплексной терапии острых и хронических заболеваний ЛОР-органов // Российская оториноларингология. 2005;(6):71–74. EDN: YLOSBF

[17] Svistushkin VM, Nikiforova GN, Shevchik EA, et al. Intranasal drugs possibilities in the treatment of patients with rhinitis medicamentosa. Medical Council. 2023;17(7):152–159. doi: 10.21518/ms2023-117 EDN: IMEIPV

[18] Свистушкин В.М., Никифорова Г.Н., Шевчик Е.А., и др. Возможности интраназальных препаратов в лечении больных медикаментозным ринитом // Медицинский совет. 2023. Т. 17, № 7. С. 152–159. doi: 10.21518/ms2023-117 EDN: IMEIPV

[19] Fluhr JW, Darlenski R, Surber C. Glycerol and the skin: holistic approach to its origin and functions. Br J Dermatol. 2008;159(1):23–34. doi: 10.1111/j.1365-2133.2008.08643.x

[20] Fluhr J.W., Darlenski R., Surber C. Glycerol and the skin: holistic approach to its origin and functions // Br J Dermatol. 2008. Vol. 159, N 1. P. 23–34. doi: 10.1111/j.1365-2133.2008.08643.x

[21] Elwany S, Atef A, Ismail AS, et al. Arabic translation and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Egyptian Journal of Otolaryngology. 2021;37(1):92. doi: 10.1186/s43163-021-00156-z EDN: LQOSNG

[22] Elwany S., Atef A., Ismail A.S., et al. Arabic translation and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale // Egyptian Journal of Otolaryngology. 2021. Vol. 37, N 1. P. 92. doi: 10.1186/s43163-021-00156-z EDN: LQOSNG

[23] Karpishchenko SA, Ushakova SE, Fridman IL, et al. Results of an open, randomized, actively controlled study of the efficacy and safety of the new drug freinozole nasal spray (phenylephrine + cetyrizine) in patients with acute respiratory infection. Russian Bulletin of Otorhinolaryngology. 2019;84(5):61–67. doi: 10.17116/otorino20198405161 EDN: BCDZMW

[24] Карпищенко С.А., Ушакова С.Е., Фридман И.Л., и др. Результаты открытого, рандомизированного, активно-контролируемого исследования эффективности и безопасности нового лекарственного препарата Фринозол спрей назальный (Фенилэфрин + Цетиризин) у пациентов с острой респираторной инфекцией // Вестник оториноларингологии. 2019. Т. 84, № 5. С. 61–67. doi: 10.17116/otorino20198405161 EDN: BCDZMW

[25] Gurov AV, Muzhichkova AV, Yushkina MA. Pathogenetic approach in the treatment of inflammatory diseases of the nose and paranasal sinuses. Russian Bulletin of Otorhinolaryngology. 2023;88(5):91–96. doi: 10.17116/otorino20238805191 EDN: DYVAQH

[26] Гуров А.В., Мужичкова А.В., Юшкина М.А. Патогенетический подход в терапии воспалительных заболеваний носа и околоносовых пазух // Вестник оториноларингологии. 2023. Т. 88, № 5. С. 91–96. doi: 10.17116/otorino20238805191 EDN: DYVAQH

RIGHTS & PERMISSIONS

Eco-Vector