The effect of intranasal injection of botulinum toxin A on the symptoms of vasomotor rhinitis

Purpose: Vasomotor rhinitis (VMR) is a common disease that is unrelated to allergy, infection, structural abnormalities, and systemic diseases. Patients with VMR usually complain of nasal obstruction accompanied by profuse watery nasal discharge. The exact pathophysiologic mechanisms of VMR are not known. Some studies suggested that it results from an autonomic nervous system dysfunction. No effective long-term treatment modalities exist for the VMR. Materials and methods: Thirty patients with VMR were randomly and equally divided into 2 groups. The mean age was 38.46 years (range, 18-59 years; 1 men, 14 women) for group 1 and 41.60 (range, 29-62 years; 4 men, 11 women) for group 2. Five patients with VMR were accepted as a control group. Fifteen patients were injected 10 U of botulinum toxin A (BTX-A) (group 1) and patients in group 2 were injected 20 U to inferior and middle turbinates. Control patients were injected with saline solution into the inferior and middle turbinates. Results: Total symptom scores generally decreased after the first week and increased after the eighth week. The symptoms of patients (nasal obstruction, sneezing, nasal discharge, and nasal itching) were scored from 1 to 5, with 1 as less severe and 5 as most severe. The statistical significance of the results was analyzed using Kruskal-Wallis and Mann-Whitney U test. When total symptom scores of group 1 (10 U BTX-A) were compared with the control group, there was a statistically significant difference regarding symptoms scores at all control weeks. There was also a statistically significant difference for total symptom scores between group 2 and control group, except for the first control week. Conclusion: Intranasal injection of BTX-A is a highly effective, safe, and simple symptomatic treatment modality with a long-lasting effect for patients with VMR. Botulinum toxin A may be a good alternative especially for the treatment of resistant VMR cases. (C) 2006 Elsevier Inc. All rights reserved.