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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2022; 26(02): e191-e198
DOI: 10.1055/s-0041-1730307
Original Article

The Effect of Turbinate Injection of Botulinum Toxin A on the Symptoms of Idiopathic Rhinitis

Thiago Carvalho 
1   Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
,
Daniel Calduro Salgado 
1   Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
,
Olavo de Godoy Mion 
1   Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
,
João Ferreira de Mello  Junior
1   Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
,
Richard Louis Voegels 
1   Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
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Abstract

Introduction Idiopathic rhinitis is a nonallergic and noninfectious rhinitis characterized mainly by nasal obstruction and rhinorrhea, resulting from an autonomic imbalance. Botulinum toxin type A (BTX-A) demonstrated its action in reducing rhinorrhea and nasal obstruction when injected into the nasal turbinates or septum.

Objective To analyze the effects of intranasal BTX-A injection to control the symptoms of idiopathic rhinitis and its possible adverse effects.

Method Patients with idiopathic rhinitis were divided into two groups. Group A had 15 participants (8 female and 6 male), of ages from 47 to 84 years (mean 66.57 years), and these received 60 U of Dysport (Ipsen Ltd, Maidenhead, Berkshire, UK) in each inferior nasal turbinate; group B had 12 participants (1 male and 11 female), of ages from 50 to 76 years (mean 60 years), and they received 1 ml of 0.9% saline. The individuals were reevaluated in the 1st, 2nd, 4th, 8th, and 12th weeks after injection by a questionnaire, accompanied by nasal inspiratory peak flow and acoustic rhinometry.

Results Group A showed significant improvement, mainly regarding the symptoms of sneezing/itching and nasal obstruction, over time and when compared to group B. Acoustic rhinometry confirmed the improvement in nasal obstruction. There was no relationship between the nasal peak flow data and the nasal obstruction score. No major adverse effects have been reported.

Conclusion The injection of botulinum toxin in the inferior nasal turbinates of patients with idiopathic rhinitis reduces the symptoms of sneezing, itching, nasal obstruction, and runny nose without significant adverse effects, suggesting that it is an option in the treatment of these patients.

Keywords

rhinitis - botulinum toxin - nasal obstruction - pruritus - acoustic rhinometry - therapeutics


Publikationsverlauf

Eingereicht: 06. August 2020

Angenommen: 29. Dezember 2020

Artikel online veröffentlicht:
13. August 2021

© 2021. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Bousquet J, Khaltaev N, Cruz AA. et al; World Health Organization, GA(2)LEN, AllerGen. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 (Suppl. 86) 8-160
    CrossrefPubMedSuche in Google Scholar
  • 2 Sakano E, Solé D, Cruz ÁA. et al. IV Consenso Brasileiro sobre Rinites 2017. Doc conjunto da Assoc Bras Alerg e Imunol Assoc Bras Otorrinolaringol e Cir Cérvico-Facial e Soc Bras Pediatr. 2017: 1-43 http://www.aborlccf.org.br/secao.asp?s=3
    PubMedSuche in Google Scholar
  • 3 Hellings PW, Klimek L, Cingi C. et al. Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology. Allergy 2017; 72 (11) 1657-1665
    CrossrefPubMedSuche in Google Scholar
  • 4 Fokkens W, Hellings P, Segboer C. Capsaicin for Rhinitis. Curr Allergy Asthma Rep 2016; 16 (08) 60
    CrossrefPubMedSuche in Google Scholar
  • 5 Bernstein JA, Singh U. Neural abnormalities in nonallergic rhinitis. Curr Allergy Asthma Rep 2015; 15 (04) 18
    CrossrefPubMedSuche in Google Scholar
  • 6 Baroody FM. Nonallergic Rhinitis: Mechanism of Action. Immunol Allergy Clin North Am 2016; 36 (02) 279-287
    CrossrefPubMedSuche in Google Scholar
  • 7 Segboer CL, Holland CT, Reinartz SM. et al. Nasal hyper-reactivity is a common feature in both allergic and nonallergic rhinitis. Allergy 2013; 68 (11) 1427-1434
    CrossrefPubMedSuche in Google Scholar
  • 8 Bernstein JA, Hastings L, Boespflug EL, Allendorfer JB, Lamy M, Eliassen JC. Alteration of brain activation patterns in nonallergic rhinitis patients using functional magnetic resonance imaging before and after treatment with intranasal azelastine. Ann Allergy Asthma Immunol 2011; 106 (06) 527-532
    CrossrefPubMedSuche in Google Scholar
  • 9 Gevorgyan A, Segboer C, Gorissen R, van Drunen CM, Fokkens W. Capsaicin for non-allergic rhinitis. Cochrane Database Syst Rev 2015; 2015 (07) CD010591
    CrossrefPubMedSuche in Google Scholar
  • 10 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. 04) S7-S28
    CrossrefPubMedSuche in Google Scholar
  • 11 Yiannakopoulou E. Serious and long-term adverse events associated with the therapeutic and cosmetic use of botulinum toxin. Pharmacology 2015; 95 (1-2): 65-69
    CrossrefPubMedSuche in Google Scholar
  • 12 Awan KH. The therapeutic usage of botulinum toxin (Botox) in non-cosmetic head and neck conditions - An evidence based review. Saudi Pharm J 2017; 25 (01) 18-24
    CrossrefPubMedSuche in Google Scholar
  • 13 Zhang EZ, Tan S, Loh I. Botolinum toxin in rhinitis: Literature review and posterior nasal injection in allergic rhinitis. Laryngoscope 2017; 127 (11) 2447-2454
    CrossrefPubMedSuche in Google Scholar
  • 14 Mello Jr JF, Mion O. Rinite Alérgica. In: Campos CAH, Costa HO de O. eds. Tratado de Otorrinolaringologia. Sociedade Brasileira de Otorrinolaringología, Vol. 3. 1st ed.. São Paulo: Roca; 2002: 68-87
    Suche in Google Scholar
  • 15 Clement PAR, Gordts F. Standardisation Committee on Objective Assessment of the Nasal Airway, IRS, and ERS. Consensus report on acoustic rhinometry and rhinomanometry. Rhinology 2005; 43 (03) 169-179 https://pubmed.ncbi.nlm.nih.gov/16218509/ . Accessed October 26, 2020
    PubMedSuche in Google Scholar
  • 16 Kim KS, Kim SS, Yoon JH, Han JW. The effect of botulinum toxin type A injection for intrinsic rhinitis. J Laryngol Otol 1998; 112 (03) 248-251
    CrossrefPubMedSuche in Google Scholar
  • 17 Augusto AGLBS, Bussolotti Filho I, Dolci JEL, König Júnior B. Structural and ultrastructural study of the anterior portion of the nasal septum and inferior nasal concha. Ear Nose Throat J 2001; 80 (05) 325-327, 333–338 http://www.ncbi.nlm.nih.gov/pubmed/11393913 . Accessed December 7, 2017
    CrossrefPubMedSuche in Google Scholar
  • 18 Abtahi SM, Hashemi SM, Abtahi SH, Bastani B. Septal injection in comparison with inferior turbinates injection of botulinum toxin A in patients with allergic rhinitis. J Res Med Sci 2013; 18 (05) 400-404
    PubMedSuche in Google Scholar
  • 19 Yang TY, Jung YG, Kim YH, Jang TY. A comparison of the effects of botulinum toxin A and steroid injection on nasal allergy. Otolaryngol Head Neck Surg 2008; 139 (03) 367-371
    CrossrefPubMedSuche in Google Scholar
  • 20 Rohrbach S, Junghans K, Köhler S, Laskawi R. Minimally invasive application of botulinum toxin A in patients with idiopathic rhinitis. Head Face Med 2009; 5 (01) 18
    CrossrefPubMedSuche in Google Scholar
  • 21 Rohrbach S, Laskawi R. Minimally invasive application of botulinum toxin type A in nasal hypersecretion. ORL J Otorhinolaryngol Relat Spec 2001; 63 (06) 382-384
    CrossrefPubMedSuche in Google Scholar
  • 22 Ünal M, Sevim S, Doğu O, Vayisoğlu Y, Kanik A. Effect of botulinum toxin type A on nasal symptoms in patients with allergic rhinitis: a double-blind, placebo-controlled clinical trial. Acta Otolaryngol 2003; 123 (09) 1060-1063
    CrossrefSuche in Google Scholar
  • 23 Özcan C, Vayisoglu Y, Doğu O, Görür K. The effect of intranasal injection of botulinum toxin A on the symptoms of vasomotor rhinitis. Am J Otolaryngol 2006; 27 (05) 314-318
    CrossrefPubMedSuche in Google Scholar
  • 24 Sapci T, Yazici S, Evcimik MF. et al. Investigation of the effects of intranasal botulinum toxin type A and ipratropium bromide nasal spray on nasal hypersecretion in idiopathic rhinitis without eosinophilia. Rhinology 2008; 46 (01) 45-51 http://www.ncbi.nlm.nih.gov/pubmed/18444492 Accessed December 7, 2017
    PubMedSuche in Google Scholar
  • 25 Hashemi SM, Okhovat A, Amini S, Pourghasemian M. Comparing the effects of Botulinum Toxin-A and cetirizine on the treatment of allergic rhinitis. Allergol Int 2013; 62 (02) 245-249
    CrossrefPubMedSuche in Google Scholar
  • 26 Rohrbach S, Olthoff A, Laskawi R, Giefer B, Götz W. Botulinum toxin type A induces apoptosis in nasal glands of guinea pigs. Ann Otol Rhinol Laryngol 2001; 110 (11) 1045-1050
    CrossrefPubMedSuche in Google Scholar
  • 27 Kim J, Shin W. How to do random allocation (randomization). Clin Orthop Surg 2014; 6 (01) 103-109
    CrossrefPubMedSuche in Google Scholar