The outcome of posterior nasal nerve/vidian nerve neurectomy during FESS on patients of nasal polyposis associated with bronchial asthma

Abstract

Abstract Background Worldwide, bronchial asthma, allergic rhinitis, and chronic rhinosinusitis are highly prevalent conditions, and numerous researches have shown how they affect one another. Still, reports about surgical treatments remain limited. Aim To investigate the role of functional endoscopic sinus surgery (FESS) with posterior nasal nerve/vidian neurectomy, as a surgical protocol in the management of chronic rhinosinusitis with nasal polyposis (CRSwNP), and its effect on bronchial asthma (BA) patients’ quality of life and pulmonary function tests. Methods This study was a prospective observational study that involved 25 patients with BA and CRSwNP who underwent full-house FESS with bilateral posterior nasal nerve or vidian neurectomy in the Otorhinolaryngology-Head and Neck Surgery Department and were evaluated in the Chest Department, Zagazig University, from May 2022 to December 2023. All included patients were subjected to pre- and post-operative respiratory assessments including spirometry, Asthma Control Questionnaire (ACQ), and Asthma Quality of Life Questionnaire (AQLQ). Also, all patients were subjected to pre- and post-operative nasal assessment including visual analog scale (VAS), nasal endoscopic evaluation, and routine CT paranasal sinus. Results This study included 25 patients (11 men and 14 women; age range 18–57 years; mean ± SD of age 33.24 ± 11.3 years). There were statistically significant increases as regards forced vital capacity and forced expiratory volume in 1 s according to preoperative, 3 months, and 6 months postoperative values. As regards ACQ, AQLQ, and VAS scores, there were highly statistically significant improvements according to preoperative, 3 months, and 6 months postoperative follow-up scores. Asthma medication step-down was successful in 52% of patients after 6 months of follow-up. Conclusions The quality of life, pulmonary function, and nasal symptoms of people with bronchial asthma combined with CRSwNP can both be alleviated after posterior nasal nerve/vidian neurectomy beside FESS.

Keywords

• Bronchial asthma; Chronic rhinosinusitis with nasal polyposis; Functional endoscopic sinus surgery with neurectomy; Quality of life