Minimally invasive application of botulinum toxin A in patients with rhinitis

Abstract

Background: Botulinum toxin A has been investigated in the treatment of rhinitis by injection into the nasal cavity for therapy-resistant rhinitis. The aim of this study is to evaluate the effectiveness of a novel minimally invasive topical application of intranasal botulinum toxin A in the subjective relief in the symptoms of rhinitis and quality of life. Design: A prospective cohort study design Methods: 23 patients with rhinitis were studied from January 2016 to June 2016. A minimally invasive application of botulinum toxin A was investigated by applying ribbon gauze soaked with botulinum toxin A, 25 units in each nostril for 30 minutes. Visual Analog Scale (VAS) of symptoms scores (nasal congestion, rhinorrhea, post nasal drip, sneezing) and quality of life measured by Rhinoconjunctivitis Quality of Life Questionnaire Standard (RQLQ-S) were collected. The patients were followed up at weeks 1, 4, 8 and 12. Results: VAS symptoms score in the scale of 0 to 10 showed mean decrease of symptoms scores of nasal congestion (2.92, p=0.002), rhinorrhea (2.34, p=0.057), post nasal drip (1.33, p=0.283) and sneezing (0.36, p=0.030). RQLQ-S showed clinically meaningful overall improvement in quality of life (0.79, p=0.037). In the separate domains of RQLQ-S, the domains of daily activities and nasal symptoms showed statistically significant changes, with mean decrease of 0.87 in activities and 0.93 in nasal symptoms, p=0.009 and p=0.030 respectively. Conclusion: In patients with therapy-resistant rhinitis, a minimally invasive application of topical intranasal botulinum toxin A with ribbon gauze can achieve long lasting improvement in symptoms and improvement in overall quality of life and daily activities.