Rhinophototherapy has been used to treat both allergic rhinitis (AR) and chronic rhinosinusitis [
It has been suggested that rhinophototherapy could relieve the nasal symptoms of AR [
This study was approved by the Ethics Committee of Taichung Veterans General Hospital. Written consent was obtained from each patient.
Patients experiencing moderate to severe symptoms of allergic rhinitis were collected from the outpatient clinic of the Department of Otolaryngology between March of 2018 and June of 2018. The clinical diagnosis of allergic rhinitis was based on the Clinical Practice Guideline: Allergic Rhinitis publication from the American Academy of Otolaryngology Head-Neck Surgery Foundation [
All patients underwent a specific IgE test against the common perennial inhaled allergens found in Taiwan (house dust mites, molds, cats, dogs, and cockroaches) to confirm the diagnosis of AR. However, these results did not exclude the patients from this study because only a few allergens were tested. The severity of the rhinitis symptoms was assessed through use of a standardized score scale (1). A score of 0 (no symptoms), 1 (mild symptoms), 2 (moderate symptoms), to 3 (severe symptoms) was used to evaluate the severity of nasal congestion, runny nose, itchy nose, and sneezing. Patients receiving a total score of 4 or more were enrolled in the study. Patients with age below 20 years, severe deviated nasal septum, rhinosinusitis, and nasal polyposis were excluded from the study. Those who had a history of immunodeficiency or previous sinus surgery, suffered from an upper respiratory tract infection, or took oral corticosteroids within a month prior to the study were also excluded.
Eligible patients were randomly divided into 2 groups. Randomization assignments were generated by an independent statistician. Patients in the study group were treated with one treatment session of RLRPT (40mW/nostril for 15 minutes) at the outpatient clinic after completing a nasal patency test using both active anterior rhinomanometry and acoustic rhinometry. Upon completing RLRPT treatment, patients took a rest for 30 minutes. They were then asked about the severity of their rhinitis symptoms, and as to whether the overall level of change in those rhinitis symptoms was worse, unchanged, slightly improved, much improved, or cured. Patients were also questioned about any adverse events of RLRPT before undergoing another nasal patency test. Finally, medical treatment involving an intranasal steroid (mometasone furoate nasal spray, 4 sprays, once a day), along with an oral antihistamine (levocetirizine 5 mg qd) was given for continued management of AR. Questions regarding the severity of each patient’s rhinitis symptoms, the overall change in their rhinitis symptoms, and any adverse events from RLRPT were asked via telephone communication 2 days later. Patients in the active control group were medically treated with an intranasal steroid (mometasone furoate nasal spray, 4 sprays, once a day), along with an oral antihistamine (levocetirizine 5 mg qd). Telephone calls were placed 2 days later in order to evaluate the severity of each patient’s rhinitis symptoms, along with any overall change in rhinitis symptoms.
The device used for RLRPT was the Transverse Many Channels Laser Instrument (Transverse, Ind, Co., Ltd., Taipei, Taiwan) (Figure
Transverse Many Channels Laser Instrument (Transverse, Ind, Co., Ltd., Taipei, Taiwan).
A patient receiving red light rhinophototherapy through two light-emitting nasal probes.
The nasal patency was objectively measured by both active anterior rhinomanometry and acoustic rhinometry. Anterior active rhinomanometry was performed according to the guidelines of the International Committee on Standardization of Rhinomanometry using a NR6 Rhinomanometer (GM Instruments, Ltd., Kilwinning, UK) [
An A1 Acoustic Rhinometer (GM Instruments, Ltd., Kilwinning, UK) was used to measure the geometry of the nasal cavity [
All data is presented as mean ± standard deviation. Patient’s gender was compared between the two groups using the Chi-square test. The ages and rhinitis symptom scores during the visit and 2 days after the visit were compared between the two groups using the Mann-Whiney U test. The rhinitis symptoms in the study group were compared before RLRPT, 30 minutes after RLRPT, and 2 days after RLRPT using the Wilcoxon signed-rank test. Rhinitis symptoms in the active control group were compared during the visit and 2 days after the visit using the Wilcoxon signed-rank test. Total nasal resistance, total nasal flow, MCA1, MCA2, V03, and V25 were compared between before RLRPT and 30 minutes after RLRPT using the Wilcoxon signed-rank test. It was considered statistically significant when p-values were < 0.05. A SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) was used to perform all analyses.
Sixty patients with a clinical diagnosis of allergic rhinitis were enrolled between March and June of 2018. There were 18 males and 12 females in the study group, with 20 males and 10 females in the active control group. The mean age was 45.4 years with a range of 20 to 87 years in the study group and a mean age of 45.7 years with a range of 20 to 88 years in the active control group. There were no significant differences in gender and age (p=0.789, 0.712, respectively). Seventeen patients in the study group and 18 in the active control group experienced a positive specific IgE test against the common perennial inhaled allergens found in Taiwan.
All rhinitis symptoms significantly improved 30 minutes after RLRPT (Table
Comparison before and 30 minutes after red light rhinophototherapy (RLRPT).
Symptoms/Nasal patency | Before RLRPT | 30 minutes after RLRPT | P-value |
---|---|---|---|
Nasal congestion | 1.83±0.91 | 1.13±1.01 | <0.0001 |
Runny nose | 1.57±0.73 | 0.47±0.82 | <0.0001 |
Itchy nose | 1.20±0.89 | 0.50±0.73 | <0.0001 |
Sneezing | 1.40±0.72 | 0.13±0.43 | <0.0001 |
Total rhinitis score | 6.00±1.53 | 2.23±1.59 | <0.0001 |
Nasal resistance | 0.32±0.23 | 0.28±0.11 | 0.245 |
Nasal flow | 293.71±133.22 | 317.47±121.25 | 0.156 |
MCA1 | 0.71±0.11 | 0.71±0.06 | 0.674 |
MCA2 | 0.44±0.21 | 0.36±0.17 | 0.006 |
V03 | 2.22±0.51 | 2.13±0.40 | 0.09 |
V25 | 3.38±1.45 | 2.79±0.94 | 0.001 |
MCA1: the first minimal cross sectional area. MCA2: the second minimal cross sectional area. V03: the volume between the tip of the nosepiece and 3.0 cm into the nasal cavity. V25: the volume of the nasal cavity between 2.0 and 5.0 cm from the tip of the nosepiece.
Comparison before and 2 days after red light rhinophototherapy (RLRPT).
Symptoms/Nasal patency | Before RLRPT | 2 days after RLRPT | P-value |
---|---|---|---|
Nasal congestion | 1.83±0.91 | 1.17±0.91 | 0.001 |
Runny nose | 1.57±0.73 | 0.87±0.94 | 0.004 |
Itchy nose | 1.20±0.89 | 0.50±0.73 | 0.001 |
Sneezing | 1.40±0.72 | 0.53±0.78 | <0.0001 |
Total rhinitis score | 6.00±1.53 | 3.07±2.1 | <0.0001 |
All rhinitis symptoms also significantly improved 2 days after medical treatment in the active control group (Table
Comparison before and 2 days after medical treatment in the control group.
Symptoms/Nasal patency | Before RLRPT | 2 days after RLRPT | P-value |
---|---|---|---|
Nasal congestion | 2.07±0.98 | 1.40±1.00 | <0.0001 |
Runny nose | 1.73±0.91 | 0.87±0.86 | <0.0001 |
Itchy nose | 1.30±1.12 | 0.77±0.97 | 0.003 |
Sneezing | 1.63±0.93 | 0.70±0.84 | <0.0001 |
Total rhinitis score | 6.73±2.32 | 3.73±2.63 | <0.0001 |
Nasal resistance slightly decreased, while nasal airflow slightly increased 30 minutes after RLRPT, when compared with prior to RLRPT (Table
RLRPT with wavelengths of 660 nm at a power of 40 mW for a 15-minute illumination period was well tolerated by most patients. One patient felt a burning sensation around the nostril 30 minutes after RLRPT and still felt pain around the nostril 2 days later. Another had pain around the nostril 30 minutes after RLRPT but the pain went away 2 days later. Another two suffered from mild headaches 30 minutes after RLRPT, but their headaches soon disappeared.
Rhinophototherapy has been recommended into the ARIA guidelines for those patients with allergic rhinitis who do not respond to standard medical treatment [
Tatar et al. reported that rhinophototherapy paired with medical therapy (topical mometasone furoate and oral levocetirizine) had a better effect on allergic rhinitis symptoms, including nasal obstruction, than did medical therapy on its own [
It has been reported that nasal obstruction was improved by rhinophototherapy; however objective evaluation was not included in most studies. Albu and Baschir [
When acoustic rhinometry is used to measure the geometry of the nasal cavity, MCA1 is considered to correspond to the nasal valve, and is 0.5 to 1.0 cm from the nasal inlet. MCA2 corresponds to the anterior half of the inferior turbinate which contains much cavernous erectile tissue, and is 2.0 to 5.0 cm from the tip of the nosepiece [
RLRPT has been claimed to generate some heat which alters mucosal blood supply. The size of the edematous congestion of the inferior turbinate and the amount of nasal discharge were observed to become decreased after RLRPT, through use of a nasal endoscopy [
Dry nostrils have been reported to be the most common adverse event of rhinophototherapy [
There were some limitations in our study. The improvement of rhinitis symptoms after RLRPT may have been affected by placebo-effects [
In this study, we evaluated the effect of one RLRPT treatment on rhinitis symptoms and nasal patency. Our results show that all rhinitis symptoms, including nasal congestion, significantly improved after a single RLRPT treatment. However, the improvement of rhinitis symptoms after RLRPT may have been affected by placebo-effects. On the other hand, one RLRPT treatment did not objectively improve patient’s nasal patency, but the actual effect of RLRPT on nasal patency still requires further investigation.
The data used to support the findings of this study are available from the first author upon request.
The first author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study was presented as an oral presentation at the 10
The authors declare that there are no conflicts of interest regarding the publication of this paper.