Effectiveness of chemical cautery along with medical therapy versus medical therapy alone in treatment of Allergic rhinitis-a randomized controlled trial

Allergic Rhinitis is common in our country. Symptoms characteristics of allergic rhinitis can occur due to the hyperactivity of nasal mucosa to endogenous or exogenous stimulants8.

Rhinitis is defined as the presence of at least one of the following- nasal congestion, rhinorrhea, sneezing, nasal itching and nasal obstruction. Other reported symptoms include throat clearing, headache ,facial pain, ear pain, itchy throat and palates, ocular symptoms and sleep disturbance. Since allergic rhinitis is induced by specific allergen, it makes sense that avoiding those triggers would be an effective treatment. However this is not always possible.10

Common treatment options include Antihistamines, Decongestants, corticosteroids [topical or systemic], mast cell stabilizers, Immunotherapy or surgical treatment like surface or submucosal cautery, different forms of laser cautery, cryosurgery, turbinectomy. Chemical used for chemical cautery is 15% Silver nitrate which is considered safe by carcinogenic potency database and is widely used on skin or mucosa by various medical specialties.9

In this method we actually cauterize the Trigger area. This area is very sensitive to allergens whose stimulation may lead to attack of allergic rhinitis. This area include anterior part of inferior turbinate and corresponding adjacent part of septum which is the first area to be exposed to allergen on inhalation.1

This study aims at comparing the efficacy of combined treatment with medical therapy and 15 % silver nitrate cauterization against medical therapy alone in the treatment of allergic rhinitis.

INCLUSION CRITERIA:

1. All the patient between age group 15-75years with complaints of sneezing, rhinorrhea, headache, nasal block with or without inferior turbinate hypertrophy

2.Patient giving consent for the study

EXCLUSION CRITERIA:

1.Smokers

2.Pregnant women

3.Patients with age less than 15 years or more than 75 years

4.Anatomic defect of nose like marked Deviation of nasal septum

5.Chronic respiratory illness

6. Nasal polyps

7. Foreign body in nose

8.Adenoid hypertrophy

9.Synechiae

10.Recent nasal surgeries history

11.Nasal mass

12.Patients not giving consent for the study.

METHODOLOGY:

It is a Hospital based Randomized control prospective study on 60 patients clinically diagnosed with allergic rhinitis will be conducted on the patients attending the OPD of Department of ENT, at SNMC and HSK Hospital & RC, Bagalkot after receiving ethical clearance certificate. Detailed history from the selected patients will be taken particularly in relation to duration of disease, previous medications, and extent of relief with previous treatment and complete ENT examination will be done. Diagnostic nasal endoscopy will be done to confirm findings and rule out other causes like nasal block with DNS, nasal polyposis, foreign body, synechiae, mass. Routine investigations will be done . SNOTT 22 Questionnaire will be given to patients and score will be evaluated.

Patients will be divided randomly into two groups based on computer generated randomization table. First group will undergo chemical cautery with 15% silver nitrate which will be done in anterior part of inferior turbinate and corresponding part septum after 4 percent xylocaine nasal packing along with it they will be receiving medical therapy and other group will be receiving only medical therapy

Patients from both group will be called for follow after 8 to 12 days . chemical cauterization will be repeated in 1st group and SNOTT 22 questionnaire will be given to patients both groups. Results were compared . Patients were followed up for minimum period of 3 months for improvement in symptoms based on SNOTT 22 score. .