Comparison between botulinum toxin and steroid septal injection in the treatment of allergic rhinitis

Abstract

Objective: To compare the effects of botulinum toxin and steroid septal injections in treating allergic rhinitis (AR) by evaluating improvements in the rhinitis control assessment test (RCAT), visual analog scale (VAS), nasal obstruction symptom evaluation (NOSE) scores, and active anterior rhinomanometry (RMM) measurements.

Methods: This prospective, single-blinded cohort study was conducted at the Department of Otolaryngology, Taipei City Hospital between January 2017 and December 2018. Ninety-five patients were randomized to receive botulinum toxin, dexamethasone, or normal saline (group A, group B, and placebo, respectively). The main outcome measures were pretreatment subjective nasal symptoms (RCAT, VAS, and NOSE) and active anterior RMM measurements. All measurements were repeated during posttreatment 1, 2, and 3 months.

Results: No significant difference was observed in pretreatment questionnaire scores and RMM values between the study and placebo groups. The mean posttreatment RCAT, VAS, and NOSE scores after 1 and 2 months significantly improved in the treatment groups compared to placebo. The VAS and NOSE at posttreatment 2 months and RCAT, VAS, and NOSE at posttreatment 3 months were significantly different comparing group A to group B. All RMM parameters showed better values in group A than in group B at 1, 2, and 3 months posttreatment, with significant differences in four parameters in posttreatment 3 months.

Conclusions: Botulinum toxin septal injection is a safe treatment option for AR and improves subjective nasal symptoms for 3 months. Botulinum toxin A injection tended to be more effective than steroid septal injection in terms of duration and degree.Level of Evidence: 2b, individual cohort study.

Keywords: active anterior rhinomanometry; allergic rhinitis; botulinum toxins; septal injection; steroid.

FIGURE 1

Box plot analysis of pretreatment and posttreatment values of RCAT/VAS/NOSE and rhinomanometric measurements in botulinum toxins injection(group A) during the follow‐up 1, 2, and 3 months; RCAT, rhinitis control assessment test; VAS, visual analogue scale; NOSE, nasal obstruction symptom evaluation; NF, flow on the narrow side; WF, flow on the wide side; TF, total flow (ml/s); NNR, nasal resistance of the narrow side; WNR, nasal resistance of the wide side; TNR, total nasal airway resistance(Pa/ml/s). Symbols in the Box plot: box, interquartile range (range between 25th and 75th percentile); diamond, mean; horizontal line, median

FIGURE 2

Box plot analysis of pretreatment and posttreatment values of RCAT/VAS/NOSE and rhinomanometric measurements in steroid injection(group B) during the follow‐up 1, 2, and 3 months; RCAT, rhinitis control assessment test; VAS, visual analogue scale; NOSE, nasal obstruction symptom evaluation; NF, flow on the narrow side; WF, flow on the wide side; TF, total flow (ml/s); NNR, nasal resistance of the narrow side; WNR, nasal resistance of the wide side; TNR, total nasal airway resistance(Pa/ml/s). Symbols in the Box plot: box, interquartile range (range between 25th and 75th percentile); diamond, mean; horizontal line, median