Ipratropium bromide nasal spray for treatment of rhinorrhea in the laryngectomized patient: A pilot study

Many who have a total laryngectomy complain of unrelenting rhinorrhea that is often very difficult to control. This study was undertaken to evaluate the effect of ipratropium bromide (IB), an anticholinergic nasal spray, on rhinorrhea in these patients. This was designed as a prospective, randomized, double-blind, placebo-controlled, crossover pilot study. Participants were selected if they had a total laryngectomy and complained of rhinorrhea. They were asked to rate the severity and duration of their rhinorrhea each day throughout the study on a scale from zero to six. Each participant was initially given a saline nasal spray for one week. They were then randomized to use either IB or saline for the double-blinded portion of the study. Two sprays of Ib at a dose of 42 micrograms/spray (0.06%), or saline, were administered intranasally twice daily for two weeks, after which time the participants were given another nasal spray (either IB or saline) for the crossover portion of the study. Six patients entered and completed the study. Those patients using the IB recorded a mean 55% decline in severity and a mean 51% decline in duration of the rhinorrhea as compared to placebo. The relief in both severity and duration of rhinorrhea obtained by patients was anlayzed using the Wilcoxon signed-rank test and found to be highly significant (p < 0.001). Despite the limitations of a small sample size in this study, ipratropium bromide nasal spray significantly reduced both the severity and duration of rhinorrhea in laryngectomized patients. We suggest ipratropium nasal spray as a safe, effective way to treat chronic rhinorrhea in laryngectomized patients, improving their quality of life.