Efficacy of various surgical methods in the treatment of allergic rhinitis: A network meta-analysis

Main Article Content

Qiwei Xie
Jiatian Yuan
Yaowen Wang


allergic rhinitis, network meta-analysis, surgical treatment


Objective: We often use surgery to treat allergic rhinitis (AR) patients who have failed drug treatment, but there is currently no clear gold standard for the treatment of allergic rhinitis. Using network meta-analysis, we evaluated the efficacy of different surgical methods in the treatment of AR.

Methods: PubMed, Embase, The Cochrane Library, Web of Science, CBM, Wan Fang Data, and CNKI databases were searched to collect clinical randomized controlled trials of AR with different surgical methods that met the inclusion criteria. After two investigators independently screened literature, extracted data, and assessed the risk of bias of included studies, R software was used to evaluate inconsistency using the node splitting method, and Stata15.1 was used to estimate the ranking probability of treatment.

Results: A total of 47 randomized control studies involving 17 surgical schemes and 4144 participants were included. The results showed that after excluding surgical methods that did not form a closed loop, in AR patients without chronic rhinosinusitis and nasal polyps, surgical efficiency and symptom score ranked the same, which were posterior nasal neurectomy (PNN), Vidian neurectomy (VN), anterior ethmoid neurectomy (AEN), nasal septal reconstruction (NSR), and bilateral inferior turbinoplasty (BIT). In AR patients with chronic rhinosinusitis with nasal polyps, the effective rate (OR = 5.06; 95% CI = 2.75–9.32) and symptom and sign scores (MD = -3.80; 95% CI = -6.50–1.09) of PNN + FESS (functional endoscopic sinusitis surgery) were higher than FESS, and there was a significant difference.

Conclusion: Our findings suggest that PNN is the best single operation for patients with AR and without chronic rhinosinusitis and nasal polyps, and the combination of multiple procedures may be better than a single operation. FESS + PNN is more effectual in AR patients with chronic rhinosinusitis with nasal polyps.

Abstract 106 | PDF Downloads 127 HTML Downloads 15 XML Downloads 5


1. Katelaris CH, Lee BW, Potter PC, Maspero JF, Cingi C, Lopatin A, et al. Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America. Clin Exp Allergy. 2012;42(2):186–207. 10.1111/j.1365-2222.2011.03891.x

2. Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020;146(4):721–67. 10.1016/j.jaci.2020.07.007

3. Zhang K, Li AR, Miglani A, Nguyen SA, Schlosser RJ. Effect of medical therapy in allergic rhinitis: A systematic review and meta-analysis. Am J Rhinol Allergy. 2022;36(2):269–80. 10.1177/19458924211041438

4. Tie K, Miller C, Zanation AM, Ebert CSJr,. Subcutaneous versus sublingual immunotherapy for adults with allergic rhinitis: A systematic review with meta-analyses. Laryngoscope. 2022;132(3):499–508. 10.1002/lary.29586

5. Konno A. Historical, pathophysiological, and therapeutic aspects of vidian neurectomy. Curr Allergy Asthma Rep. 2010;10(2):105–12. 10.1007/s11882-010-0093-3

6. Soumya S, Adegboyega G, Elhassan H. Surgical approaches for allergic rhinitis: A systematic review protocol. Int J Surg Protoc. 2021;25(1):178–83. 10.29337/ijsp.160

7. Abdullah B, Singh S. Surgical interventions for inferior turbinate hypertrophy: A comprehensive review of current techniques and technologies. Int J Environ Res Public Health. 2021;18(7):3441. 10.3390/ijerph18073441

8. Marshak T, Yun WK, Hazout C, Sacks R, Harvey RJ. A systematic review of the evidence base for vidian neurectomy in managing rhinitis. J Laryngol Otol. 2016;130 Suppl 4:S7–S28. 10.1017/S0022215116008008

9. Balai E, Gupta KK, Jolly K, Darr A. Posterior nasal nerve-neurectomy for the treatment of rhinitis: A systematic review and meta-analysis. Eur Ann Allergy Clin Immunol. 2022. 10.23822/EurAnnACI.1764-1489.268

10. Cheng L, Chen J, Fu Q, He S, Li H, Liu Z, et al. Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis. Allergy Asthma Immunol Res. 2018;10(4):300–53. 10.4168/aair.2018.10.4.300

11. [Chinese guideline for diagnosis and treatment of allergic rhinitis (2022, revision)]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022;57(2):106–29.

12. Li Q, Li X, Liu H. Observe the curative effect of the treatment of allergic rhinitis by cutting the wing tube nerve or stripping the inferior turbinate mucosa. J Hunan Normal Univ Med Sci. 2015;12(03):65–7.

13. Maimaitiaili G, Kahaer K, Tang L, Zhang J. The effect of-vidian neurectomy on pulmonary function in patients with allergic rhinitis and chronic rhinosinusitis with nasal polyps. Am J Med Sci. 2020;360(2):137–45. 10.1016/j.amjms.2020.04.024

14. Chen Q, Cao H. Analysis of operation treatment of nasal septum cleviatian complicated with allergic rhinitis. J Med Forum. 2014;35(03):18–19+23.

15. Nong Y. Clinical observation of three-line nasal septum correction combined with hypothermic plasma radiofrequency ablation in the treatment of moderate and severe perennial allergic rhinitis with nasal septum deviation. Mod Med Health Res. 2018;2(07):29–30.

16. Jiang T, Gui P, Da M, Wang L, Huang L. Endoscopic submucosal inferior turbinate partial excision combined with anterior ethmoidal nerve block for the treatment of allergic rhinitis. China Foreign Med Treat. 2018;37(21):63–5.

17. Zhang Z, Wang Q, Yuan Y, Long C, Rong Q. A comparative study of two surgical methods for allergic rhinitis with deviation of nasal septum. Hainan Med J. 2019;30(03):320–2.

18. Wang Z, Tang Z, Zhao H, Liu Z, Li D, Li S, et al. Clinical efficacy of endoscopic unilateral vidian main neurectomy under electromagnetic navigation guided on moderate to severe allergic rhinitis. Chinese Arch Otolaryngol Head Neck Surg. 2021;28(02):93–7.

19. Lin Q, Lin X. Clinical study of preethmoidal nerve block in the treatment of allergic rhinitis. Shenzhen J Integr Traditional Chinese Western Med. 2015;25(13):48–9.

20. Cao B, Wang X, Yang P, Zhang H, Zhang L, Liu J, et al. Long-term follow-up observation of plasma technique in treating AR with deviation of nasal septum. China Med Equip. 2020;17(03):113–6.

21. Liu Y, Zhao B, Tian S. Clinical research on recurrent allergic rhinitis by thermosetting both sphenopalatine and anterior ethmoidal nerves with microwave. J Chinese Pract Diagn Ther. 2002;(05): 337–338.

22. Zhou L. Analysis of the operation effect on 112 cases of perennial allergic rhinitis with septal deviation. Jinan University, 2002.

23. Cui T. Efficacy of nasal endoscope combined with plasma ablation in the treatment of nasal septum deviation with allergic rhinitis. Pract Clin J Integr Tradition Chinese West Med. 2021;21(23):59–60+98.

24. Yang W, Guo Q, Zhao H,Dong W, Liu L. Clinical study of endoscopic-assisted posterior nasal neurotomy for allergic rhinitis. Acta Acad Med Weifang. 2019;41(03):179–81.

25. Ren X. A study of the curative effect of endoscopic-assisted posterior nasal neurotomy on patients with refractory allergic rhinitis. Hebei Medical University, 2019.

26. Fang Z, Liu L, Dong W, Gao Y. Clinical observation of nasal endoscopic turbinate volume reduction combined with posterior rhinotomy in the treatment of allergic rhinitis with inferior turbinate hypertrophy. Acta Acad Med Weifang. 2021;43(03):200–2.

27. Li Z, Yu Y, Huang Y. Clinical analysis of endoscopic correction of nasal septum combined with plasma ablation of inferior turbinate in the treatment of allergic rhinitis. J Math Med. 2016;29(04):513–4.

28. Liu Z, Du H, Xue Y. The endoscopic nasal septum and inferior turbinate cavernous partial resection in the treatment of variability rhinitis with nasal septum deviation. Chinese J Otorhinolaryngol Integr Med. 2017;25(03):215–9.

29. Liu J. Clinical analysis of nasal branches of anterior ethmoidal nerve blocked by hypothermic plasma radiofrequency ablation under nasal endoscope in the treatment of allergic rhinitis. Int Infect Dis. 2019;8(03):59–60.

30. Liu F, Hu J, Xing X, Hang Z, Huang D, Li Shuo. Endoscopic highly selective vidian neurotomy for the treatment of allergic rhinitis. Chinese J Otorhinolaryngol Skull Base Surg. 2021; 27(04):403–7.

31. Lin Y, Huang Z. Study on the clinical of highly selective branches neurotomy of vidian verve with plasma radiofrequency ablation under endoscopy in treatment of allergic rhinitis. Med Forum. 2021;25(23):3264–6. 10.21608/smj.2020.43926.1199

32. Liang J. To study the effect of endoscopic nasal septum correction combined with inferior turbinate plasma ablation in the treatment of allergic rhinitis. Health Guide. 2020(42):35.

33. Zhang J. A comparative study of the short-term efficacy of vidian neurectomy and posterior nasal neurectomy under nasal endoscope in the treatment of refractory allergic rhinitis. Anhui Medical University, 2019.

34. Ren Y. Analysis of clinical efficacy of endoscopic pterygotomy combined with nasal septum deviation correction in the treatment of allergic rhinitis. Mod Diagn Treat. 2020;31(19):3129–31.

35. Yu S. Nasal endoscopic surgery combined with nasal peripheral nerve block in the treatment of allergic rhinitis. J Med Forum. 2012;33(04):94–5.

36. Yang P, Zhang T, Fan D, Liu T, Shi Q, Wang C. Combined application of nasal septum correction and etbmoidal nerve cauterization for septum deviation complicated with allergic rhinitis. J Clin Otorhinolaryngol Head Neck Surg. 1996;05 285–7.

37. Zhou L, Wang J. Nasal septum correction and anterior ethmoid neurotomy for perennial allergic rhinitis. Guangdong Med J. 2001;11:1035–6.

38. Gao J. Effects of septal correction combined with low temperature plasma radiofrequency ablation on inflammatory factors, immune function in patients with moderate to severe allergic rhinitis with septal deviation. Mod Med Health Res Electr J. 2020;4(07):1–4.

39. Zhu Z. The curative effect analysis of nasal septal reconstruction combined with nervus ethmoidalis anterior under radiofrequency ablation for allergic rhinitis patients with septal deviation. Anhui Medical University, 2019.

40. Cheng M, Yang L, Ye H, Hu Z. Clinical observation of septoplasty combined with radiofrequency ablation for nasal septum deviation accompanied with severe perennial allergic rhinitis patients. Chinese J Ophthalmol Otorhinolaryngol. 2017;17(01):43–45+54.

41. Gong X, Zheng P, Peng J. Efficacy observation of nasal septum correction combined with plasma ablation in the treatment of persistent allergic rhinitis. Guide China Med. 2012;10(32):181–2.

42. Xiong Y, Rowley Q. Effect of septoplasty alone and combined with inferior turbinate low-temperature plasma ablation on the prognosis of patients with allergic rhinitis. J Clin Pathol Res. 2020;40(07):1771–7.

43. Wu X. Analysis of surgical treatment of patients with deviated nasal septum complicated with allergic rhinitis. China Pract Med. 2013; 8(06):78–9.

44. Chang W, Qin J, Zhou H, Li J. Clinical observation of nasal septum deviation correction combined with radiofrequency plasma ablation in the treatment of allergic rhinitis. Chinese Remed Clin. 2020;20(07):1138–41.

45. Joshi SV, Rawool JS, Shaikh A, Telang RA, Sonawale S, Roy C, et al. Posterior nasal nerve resection—A novel and effective way to surgically treat refractory allergic and vasomotor rhinitis. Indian J Otolaryngol Head Neck Surg. 2021: 10.1007/s12070-021-02690-x

46. Ghosh SK, Dutta M, Haldar D. Role of bilateral inferior turbinoplasty as an adjunct to septoplasty in improving nasal obstruction and subjective performance in patients with deviated nasal septum associated with allergic rhinitis: An interventional, prospective study. Ear Nose Throat J. 2021: 10.1177/01455613211015440

47. Qi Y, Liu J, Peng S, Hou S, Zhang M, Wang Z. Efficacy of selective vidian neurectomy for allergic rhinitis combined with chronic rhinosinusitis. ORL J Otorhinolaryngol Relat Spec. 2021;83(5):327–34. 10.1159/000512083

48. Li S, Cheng J, Yang J, Zhao Y, Zhu Z, Zhao C, et al. Efficacy of posterior nasal neurectomy for allergic rhinitis combined with chronic rhinosinusitis with nasal polyps. Acta Otolaryngol. 2019; 139(10):890–4. 10.1080/00016489.2019.1654132

49. Suzuki M, Yokota M, Ozaki S, Murakami S. The effects of resection of the peripheral branches of the posterior nasal nerves in the inferior turbinate, with special focus on olfactory dys-function. J Laryngol Otol. 2019;133(12):1046–9. 10.1017/S0022215119002238

50. Kang T, Sung C M, Yang H C. Radiofrequency ablation of turbinates after septoplasty has no effect on allergic rhinitis symptoms other than nasal obstruction. Int Forum Allergy Rhinol. 2019;9(11):1257–62. 10.1002/alr.22420

51. Albu S, Trombitas V, Nagy A. Endoscopic microdebrider--assisted inferior turbinoplasty with and without posterior nasal neurectomy. Auris Nasus Larynx. 2014;41(3):273–7. 10.1016/j.anl.2013.10.018

52. He P. Study on the efficacy of wing tube neurectomy and inferior turbinate submucosal dissection under endoscopy in treatment of allergic rhinitis. J Clin Exp Med. 2016;15(23):2370–2.

53. Liu H, Ma R, Wen W. Clinical study on resection of the posterior nasal nerve in refractory hyperreactive rhinopathy. Ningxia Med J. 2014;36(10):882–4.

54. Tan D, Deng Z, Dong Y, et al. Clinical observation on treatment of allergic rhinitis complicated with nasal septum deviation combined with low-temperature plasma radiofrequency. Chinese J Otorhinolaryngol Skull Base Surg. 2010;16(06):446–9.

55. Wang D. Short-and medium-term follow-up study of 78 patients with allergic rhinitis treated by nasal peripheral nerve block combined with endoscopic surgery. J Math Med. 2020;33(03):378–9.

56. Yang Z. Clinical study on the treatment of allergic rhinitis by posterior nasal neurectomy combined with functional endoscopic sinus surgery. Hebei Medical University, 2020.

57. Tan G, Ma Y, Li H, Wang J. Long-term results of bilateral endoscopic vidian neurectomy in the management of moderate to severe persistent allergic rhinitis. Arch Otolaryngol Head Neck Surg. 2012;138(5):492–7. 10.1001/archoto.2012.284

58. Wang B, Li J, Liu W, Jiang X. Efficacy evaluation of highly selective pterygotomy in the treatment of allergic rhinitis. Contemp Med Symposium. 2018;16(04):94–5.

59. Ahilasamy N, Rajendran DK. Endoscopic posterior nasal neurectomy. J Laryngol Otol. 2019;133(9):825–9. 10.1017/S002221511900166X

60. Ogawa T, Takeno S, Ishino T, Hirakawa K. Submucous turbinectomy combined with posterior nasal neurectomy in the management of severe allergic rhinitis: Clinical outcomes and local cytokine changes. Auris Nasus Larynx. 2007;34(3):319–26. 10.1016/j.anl.2007.01.008

61. Su WF, Liu SC, Chiu FS, Lee CH. Antegrade transsphenoidal vidian neurectomy: Short-term surgical outcome analysis. Am J Rhinol Allergy. 2011;25(6):e217–20. 10.2500/ajra.2011.25.3704

62. Takahashi Y, Kinoshita H, Nakano T, Asamoto K, Ichinose A, Kakizaki H. Anatomy of anterior ethmoidal foramen, medial canthal tendon, and lacrimal fossa for transcutaneous anterior ethmoidal nerve block in Japanese individuals. Ophthalmic Plast Reconstr Surg. 2014;30(5):431–3. 10.1097/IOP.0000000000000215

63. Garcia-Paz V, Chamorro-Petronacci C M, Painceira-Villar R, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Sarandeses-Garcia A, et al. Allergic rhinitis improvement after septorhinoplasty in a sample of allergic rhinitis patients with septal deviation: A quasi-experimental study. Sao Paulo Med J. 2022; 140(1):17–23. 10.1590/1516-3180.2021.0236.r1.03052021

64. Feng L, Yu L, Ying H, Guo Q, Tan C. The clinical and pathological changes following anterior-ethmoid neurotomy in treating perennial allergic rhinitis with plasma. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2003;17(2):97–9.

65. Zhang Y, Dai X, Zheng H, Feng Y. A comparison between anterior ethmoidal nerve block and selective pterygoid canal neurotomy in the treatment of moderate-to-severe allergic rhinitis. J Wenzhou Med Univ. 2021;51(03):230–3.

66. Sinno S, Mehta K, Lee ZH, Kidwai S, Saadeh PB, Lee MR. Inferior turbinate hypertrophy in rhinoplasty: Systematic review of surgical techniques. Plast Reconstr Surg. 2016;138(3):419.e–429e. 10.1097/PRS.0000000000002433

67. Whelan RL, Shaffer AD, Stapleton AL. Efficacy of inferior turbinate reduction in pediatric patients: A prospective analysis. Int Forum Allergy Rhinol. 2021;11(12):1654–62. 10.1002/alr.22849

68. Türk B. Results of radiofrequency ablation of inferior turbinate hypertrophy in allergic and non-allergic rhinitis patients. SiSli Etfal Hastanesi Tip Bulteni /Med Bull Sisli Hospital. 2018. 10.14744/SEMB.2018.77992

69. Garcia JPT, Moura BH, Rodrigues VH, Vivan MA, Azevedo SM, Dolci JEL, et al. Inferior turbinate reduction during rhinoplasty: Is there any effect on rhinitis symptoms?. Int Arch Otorhinolaryngol.2022;26(1):e111–e118. 10.1055/s-0041-1726046

70. Sonoda S, Murakami D, Saito Y, Miyamoto Y, Higuchi R, Kikuchi Y, et al. Long-term effectiveness, safety, and quality of life outcomes following endoscopic posterior nasal neurectomy with submucosal turbinectomy for the treatment of intractable severe chronic rhinitis. Auris Nasus Larynx. 2021;48(4):636–45. 10.1016/j.anl.2020.12.009

71. Cassano M, Marioni G, Russo L, Cassano P. Sphenopalatine artery ligation with nerve resection in patients with vasomotor rhinitis and polyposis: A prospective, randomized, double--blind investigation. Acta Otolaryngol. 2012;132(5):525–32. 10.3109/00016489.2011.648272