الفهرس 
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Abstract
Rhinitis is defined as an inflammatory disease that involves mucosal lining of the nose and paranasal sinuses, specified by nasal congestion, rhinorrhea, nasal irritation, sneezing and/or post-nasal discharge.
More than 20% of the people worldwide complaining of chronic rhinitis.
Based on the allergic cause, non-infectious type of rhinitis can be subgrouped into allergic and non-allergic. With more than six hundred million people affected, allergic rhinitis is the most common atopic condition in the world. The occurrence of allergic rhinitis is raising.
The primary treatment modality is medical (histamine or leukotriene receptor blockers, oral and local nasal steroids, etc.) Although several times these treatments show little influence on the condition and a considerable impact on long-term care costs occurred.
The posterior nasal nerve which is a peripheral branch of the vidian nerve that emerges into the nose from the sphenopalatine foramen after the division of the nerve within the foramen.
The posterior superior nasal nerves divided into several branches that supply the nasal mucosa.
BTX can also be used for hypersecretory and autonomic abnormalities like increased salivary production(sialorrhea), hyperhidrosis, increased lacrimation, gustatory sweating, and Frey’s syndrome.
The function of its use in treatment of many diseases comes from its neurotransmitter release state at the neuromuscular junction. BTX type A (BTX-A) has the most potent cholinergic antagonist activity of other serotypes at the neuromuscular junction.
Surgical treatment can be used in patients with resistant rhinitis with failed medical treatment. Various surgical methods are available, including Vidian neurectomy, posterior nasal neurectomy, operations of the inferior turbinate, with different success rates depending on each technique.
The aim of this study is to evaluate the outcome of surgical and medical parasympathectomy in patients who have refractory rhinitis by measuring subjective symptom improvement after surgery or BTX injections and assess for possible complications.
Clinical evaluation of allergic rhinitis symptoms (sneezing, nasal itching, nasal obstruction, rhinorrhea, posterior nasal discharge and QOL) of allergic rhinitis in 100 patients aged between (18-39 years) who were diagnosed as allergic patients by history, examination and positive skin prick test.
Patients subdivided into three groups. group (A) undergo Botox injection in middle turbinate, inferior turbinate and septum, group (B) undergo single nerve neurectomy and bilateral surgical partial inferior turbinectomy, while group (C) undergo multiple nerve neurectomy and bilateral surgical partial inferior turbinectomy.
Evaluation done preoperatively and 1, 3 and 6 months postoperatively.
This study included 100 patients (aged from 18-39 years old and of both sexes) divided into 3 groups:
group (A): included 40 patients were injected by BTA in inferior, middle turbinates and septum.
group (B): included 30 patients underwent single nerve neurectomy and bilateral surgical partial inferior turbinectomy.
Group(C): included 30 patients underwent multiple nerve neurectomy and bilateral surgical partial inferior turbinectomy.
In our study patients who injected with BTA in inferior and middle turbinates and septum ( group (A) ) showed significant improvement in the parameter of rhinorrhea, sneezing and nasal itching while there is no significant change in nasal obstruction at 1 and 3 months postoperatively while after 6 months the condition reversed near to preinjection state.
Patients underwent surgical parasympathectomy (group (B&C)) showed significant improvement in symptoms of nasal allergy and QOL with superior results in group (C).
Our study showed that BTA injection causing significant improvement in case of sneezing and rhinorrhea parameters and the improvement increased overtime until it become stationary then decreased at 3 months of injection near to preinjection state at 6 months.
As medical parasympathectomy give results up to 3 months, botox injection may be needed every 3-6 months as indicated by some studies, the cost benefit relationship between botox and other medical and surgical therapies should be evaluated.
Surgical parasympathectomy give more control of allergic symptoms over long period of follow-up.
While surgical parasympathectomy showing significant improvement, multiple neurectomy is superior in controlling sneezing and nasal itching.