Preliminary Investigation Of Efficacy And Molecular Mechanism Of Vidian Neurectomy In The Management Of Allergic Rhinitis

Objective:To observe the therapeutic efficacy of vadian neurec-tomy in the management of allergic rhinitis.Method:Forty-nine patients with severe persistent allergic rhinitis were carried out endoscopic vadian neurectomy, and their quality of life before and 3-5-year after operation was assessed by "Lanzhou standard" and "rhinoconjunctivitis quality of life questionnaire (RQLQ)".Result: About the long-term efficacy of these 49 cases, complete response showed in 35 cases (71.4%), and partial response in 9 cases(18.4%), and ineffective in 5 cases (10.2%) according to the Lanzhou standard. Total effective rate was 89.8%. Meanwhile, the assessement by " RQLQ " showed that complete response was in 45 cases (91.8%), partial response in 2 cases(4.1%), and ineffective in 2 cases (4.1%). Total effective rate was 95.9%. The scores of nasocular and non-nasocular symptom, daily life and sleep quality, emotional state were significantly improved after operation (P<0.01), and the ability to solve actual problems also significantly increased(P<0.01).Conclution: Endoscopic vadian neurectomy is an effective and convenient technique in the management of severe persistent allergic rhinitis. Objective:To investigate the possible mechanism of vadian neurectomy in the management of allergic rhinitis.Method:Ten cases with severe persistent allergic rhinitis were carried out endoscopic vadian neuroctomy from Sep.2009 to Feb.2010. The quality of life was evaluated pre- and post-operation by "Lanzhou standard" and "rhinoconjunctivitis quality of life questionnaire (RQLQ) ". The quantity of eosinophile cells in nasal mucosa was observed by H/E histological techniques, and expression level of IL-4, IL-5, CGRP, SP and VIP was detected by immunohistochemistry before and 3 months after operation.Result:The observation of therapeutic efficacy showed that complete response in all 10 cases by "Lanzhou standard" and" RQLQ "3 months after operation.The number of Eos in nasal mucosa was 26.8±4.02/HP before operation and 9.8±4.18/HP 3 months after operation. The numbers of IL-5 and IL-4 positive cells in nasal mucosa were respectively 361.7±70.84,203.4±33.62 before operation, and were respectively 93.3±19.80,70.1±13.37 after operation. There was statistically significant difference between pre- and post-operation (P<0.01). The expression level of CGRP, SP and VIP in nasal mucosa were respectively 2329.05±272.63,2019.43±236.18,2465.96±358.63(IODM) before operation, and respectively 1753.32±289.99,1705.82±154.17,1755.74±360.27(IODM) after operation. The difference was also statistically significant (P<0.01).Conclusion:(1) Clinical effectiveness of endoscopic vadian neurectomy in the management of allergic rhinitis may be associated with the reduction of Eos and the decreased expression of IL-5, IL-4, CGRP, SP and VIP in nasal mucosa.(2) Clinical effectiveness of endoscopic vadian neurectomy in the management of severe persistent allergic rhinitis is not only associated with blocking parasympathetic function, but also with the recovering of unbanlanced immune response in local nasal mucosa.