The study, the researchers settled on a

The article “Botulinum Toxin inRhinitis: Literature Review and Posterior Nasal Injection in Allergic Rhinitis,”by Edward Zhiyong Zhang (ENT), Sophocles Tan(MBBS) and Ian Loh (ENT), was published on March 10, 2017. There are various approaches to themanagement of allergic rhinitis (AR). These techniques all require frequentadministration. However, they vary in the onset, length and symptom control.

Single-dosebotulinum toxin (BTX) is a familiar treatment option in rhinitis. In thearticle, the authors reviewed existingliterature on the use of BTX in rhinitis and investigate the effectiveness andsafety profile of novel intranasal injection sites for AR control. This study tookplace in the Department of Otolaryngology-Headand Neck Surgery at Changi General Hospital in Singapore. It was supported bythe Singapore National Research Foundation, Master of Clinical InvestigationStudent Research Project Fund. The study is unbiased and well-designed.The researchers conducted a single-armnon-randomized pilot study where all ten participants received experimentaltherapy. The procedure entailed administering an intranasal injection ofbotulinum toxin (BTX) to the posterior lateral nasal wall close to thesphenopalatine ganglion. Zhang, Tan, andLoh (2017) also conducted a literature review on the usage of botulinum toxinin rhinitis.

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Doses used in other studies ranged between 12 and 80 units. Forthis study, the researchers settled on adose of 25 units as a balance between safety and effectiveness. The study was approved by theChangi General Hospital Institutional Review Board as well as Singapore HealthScience Authority. Patients, clinicians, and study personnel were not blind tothe treatment. There was full disclosure and informed consent was obtained frompatients at their initial visits.

Additionally, the participants were requestednot to use any anti-allergens or undergo surgery for the duration of the trial.No ethical issues were reported in the study. A total of ten participants wererecruited for the study with no dropouts. The patientassignment was non-randomized.

The researchers recruited patients withrecurrent allergic rhinitis based on their medical histories and clinicalexamination. All the participants were required to be above 21 years old, withmoderate to severe or persistent allergic rhinitis and an opening TNSS (totalnasal symptom score) above 10. Since patient assignment was notrandom, the participating patients were analyzed in a single group. Theresearchers compared weekly total nasal symptom and subscale scores for allpatients. There were no reported noncompliant patients, protocol violations,dropouts or treatment refusals hence the study adhered to the intention totreat analysis. This means that allenrolled participants were included in the analysis, further reducing the riskof a biased outcome. Moreover, the study was impartial.

For the purposes of excluding physician and patient bias, the researchers onlyincluded patients with positive skin prick tests for house dust mites. Allparticipants were treated fairly at no charge. The procedure was consideredmoderately uncomfortable with minor postprocedural complaints which wereself-limiting and did not require medical intervention.

Conclusively, AR – the mostcommon cause of rhinitis – is characterized by symptoms such as nasal congestion,sneezing, rhinorrhea and nasal itch. Botulinum toxin (BTX) has been termed asan effective treatment for the treatment of AR. Zhang, Tan, and Loh (2017)reviewed current literature and revealed BTX’s effectiveness in dealing withthe symptoms of allergic and intrinsic rhinitis. The researchers sought toinvestigate the effectiveness of novel intranasal injections for the control ofallergic rhinitis. Their well-designed, unbiased and comprehensive studyreveals that “Single-dose posterior nasalinjection demonstrates good efficacy and duration of action, with moderatediscomfort (Zhang, Tan, and Loh, 2017 p.

1).” Although the outcome was desirable,the subjects or participants in the research could not represent the populationas a whole because the numbers of participants in the research was too small.This research would not change the treatment guidelines for allergic rhinitisyet since it did not specify a minimum effective dosage and complications ofnasal BTX injection were not widely explored. The research may initiate the newway to treat allergic rhinitis but more studies were needed in the future.     


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