Effect of vidian neurectomy combined with anterior ethmoidal neurotomy on olfaction and clinical efficacy in patients with chronic sinusitis complicated with allergic rhinitis

Ding Yueni; Li Peizhong

doi:10.3760/j.issn.1673-4777.2025.06.016

Abstract：Objective To investigate the effect of vidian neurectomy(VN)combined with anterior ethmoidal neurotomy(AEN)on olfaction and clinical efficacy in patients with chronic sinusitis complicated with allergic rhinitis(CRSwAR).Methods The medical records of 54 patients with moderate to severe CRSwAR with olfactory dysfunction who were treated in the Department of Otolaryngology,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from December 2022 to December 2023 were retrospectively collected.The patients were divided into observation group(26 cases)and control group(28 cases)according to the specific operation conditions.The control group was treated with functional endoscopic sinus surgery,while the observation group was treated with unilateral VN and bilateral AEN on the basis of the control group.The percentage of eosinophils in peripheral blood(EOS％),the total score of Sniffin' sticks olfactory test,subjective symptom score[sinonasal outcome test(SNOT-22),rhinoconjunctivitis quality of life questionnaire(RQLQ)score],Lund-Kennedy score of nasal endoscopy and Lund-Mackay score of nasal cavity and paranasal sinus CT were compared between the two groups before and after surgery,and the changes of olfactory and nasal symptoms before and after operation were evaluated and analyzed.The factors affecting the total score of Sniffin' sticks olfactory test were analyzed by generalized mixed linear model,and the postoperative recurrence rate was compared between the two groups.Results Both groups of EOS％decreased over time(Pwithin group＜0.01),but no significant interaction was observed(Pinteraction=0.33).The analysis of within subject effects showed that the total score of Sniffin'sticks olfactory test changed over time(Pwithin group＜0.01),and the observation group showed a faster increase in scores compared to the control group(Pinteraction＜0.01).Both SNOT-22 and RQLQ scores had a temporal trend and interactive effects,and there was a significant difference in the treatment effect between the two groups in terms of the above scores(both Pinter group＜0.05).One year after surgery,the Lund-Kennedy scores of nasal endoscopy and nasal sinus CT in both groups were lower than before surgery,and the observation group had lower Lund-Kennedy scores of nasal endoscopy than the control group[(3.3±0.3)vs(4.7±3.0)](both P＜0.05).The results of general-ized linear mixed model analysis showed that the Lund-Kennedy score of nasal endoscopy had an effect on the total score of Sniffin' sticks olfactory test(P=0.001).The recurrence rate of the observation group was lower than that of the control group[7.7％(2/26)vs 32.1％(9/28)](P=0.026).Conclusion VN and AEN combined with functional endoscopic sinus surgery is beneficial to restore the olfactory function and nasal mucosal function of CRSwAR patients,and reduce the postoperative recurrence rate.