title: Submucous turbinectomy decreases not only nasal stiffness but also sneezing and rhinorrhea in patients with perennial allergic rhinitis.
abstract: BACKGROUND
  Turbinate surgery, in which mucous epithelium is resected, has often been used for patients with perennial allergic rhinitis, since the mucous epithelium is the principal site for immunoglobulin (Ig)E-mediated allergic reactions and chronic inflammation.
  
  
  OBJECTIVE
  To assess the effect of submucous turbinectomy on allergic rhinitis.
  
  
  METHODS
  Sixty patients with severe perennial allergic rhinitis underwent submucous turbinectomy and were followed-up for 1 year. Nasal symptoms were evaluated with a standard symptom score. Rhinometry was used to evaluate nasal congestion, and nasal provocation tests in vivo were performed to evaluate allergic reactions. In 16 cases, biopsies from the nose were also available for immunohistochemical analysis. These examinations were performed before and after submucous turbinectomy.
  
  
  RESULTS
  The mean total nasal symptom score (7.2 +/- 1.7, mean +/- SD before surgery) was significantly reduced after surgery (1.2 +/- 1.4, P < 0.0001), and the effect of the surgery on nasal symptoms continued for at least 12 months (1.9 +/- 1.8, P < 0.0001). Submucous turbinectomy reduced both nasal discharge and sneezing, as well as nasal stiffness. Histopathological examination following surgery revealed that the lamina propria was occupied by fibrous tissues, and that the number of vessels, nasal glands, eosinophils and infiltrating IgE+ cells decreased in the turbinate. There were no significant differences in the levels of either house dust mite-specific or non-specific IgE in the serum between before and after surgery.
  
  
  CONCLUSIONS
  Submucous turbinectomy preserving the ciliary epithelium is a powerful strategy for improving nasal symptoms induced by allergic reaction via the reduction in the number of allergy-related cells in the nose.
authors.affiliation: Department of Otorhinolaryngology, Fukui Medical University, Fukui, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Mori
authors.forename: S
authors.initials: S
authors.lastname: Fujieda
authors.forename: M
authors.initials: M
authors.lastname: Igarashi
authors.forename: G K
authors.initials: GK
authors.lastname: Fan
authors.forename: H
authors.initials: H
authors.lastname: Saito
mesh_terms: D000328:Adult; D000403:Airway Resistance; D000818:Animals; D004391:Dust; D004804:Eosinophils; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007150:Immunohistochemistry; D008297:Male; D008925:Mites / Q000276:immunology; D009299:Nasal Provocation Tests; D012221:Rhinitis, Allergic, Perennial / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D012912:Sneezing / Q000502:physiology; D016896:Treatment Outcome; D014420:Turbinates / Q000601:surgery*
chemical_list: D004391:Dust; D007073:Immunoglobulin E