Efficacy of Posterior Nasal Neurectomy in Treatment of Central Compartment Atopic Disease: A Randomized Case Control Study

Background: Central compartment atopic disease (CCAD) is a recently described distinct phenotype of chronic rhinosinusitis with nasal polyps with high association with inhalant allergen deposition in the central compartment structures of the nose. The aim of this work was to assess the effect of posterior nasal neurectomy (PNN) on the quality of life and its clinical outcome in patients with CCAD resistant to standard medical treatment.Methods: This double-blind, randomized, prospective, case- control study was carried out on 50 patients with CCAD resistant to standard medical treatment. Patients were subdivided into two equal groups: Group A: Twenty five patients underwent endoscopic sinusitis surgery (ESS) and PNN and group B: Twenty five patients underwent ESS only.Results: Total Sino-nasal outcome test (SNOT)-22 score, and all its domains showed significant improvement between pre-operative and post-operative periods at 1 year landmark in both groups (P <0.001). Degree of change of total SNOT-22 score and its domains namely psychological manifestations domain, facial/ear symptoms, sleep score, extra rhinologic manifestations domain were insignificantly higher in follow up at 1 year in group A compared to group B (P >0.05), however, rhinologic manifestations domain showed significant improvement in group A than group B. Both groups had insignificant recurrence and revision rates and complications. (P >0.05).Conclusions: The use of endoscopic PNN in surgical treatment of CCAD patients resistant to medical treatment could be considered as an option especially in patients with high pre-operative rhinologic manifestations domain of SNOT-22 with low risk of complications.