Topical application versus intraturbinate injection of botulinum toxin type A in the treatment of noninfectious chronic rhinosinusitis

Abstract

Background Chronic rhinosinusitis is a very common disorder caused by chronic inflammation or irritation of nasal mucosa. Objectives The purpose of this study was to evaluate the efficacy and safety of topical application of botulinum toxin type A (BTX-A) compared with intraturbinate injection for the treatment of noninfectious chronic rhinosinusitis. Patients and methods This prospective comparative study was carried out on 30 patients with noninfectious chronic rhinosinusitis. Patients were divided randomly into two groups. BTX-soaked merocel was applied topically in group A (topical group), which included 15 patients. Intraturbinate BTX injection was applied in group B (injected group), which included 15 patients. The total nasal-symptom score (TNSS) was applied initially and after the procedure for 8 weeks of follow-up period. Results Both groups showed significant improvement of the TNSS all over the period of the study compared with the baseline, except at the eighth week in group A (topical group). At the eighth week, the TNSS was significantly higher in group A than group B, median (range) of 8 (4–11) compared with 5 (3–6), P value was less than 0.001. No one complained from epistaxis and only three patients in group B reported nasal-dryness sensation at the fourth and sixth weeks and improved by the eighth week. Conclusion BTX-A topical application using soaked merocel could be a safe and a very successful way for managing the symptoms of chronic noninfectious rhinosinusitis. However, injections had a longer duration of impact than topical application.