xRead - Nonallergic Rhinitis (September 2025)

15314995, 2023, 12, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/lary.30706 by University Of Chicago, Wiley Online Library on [15/07/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

Primary Outcomes The severity of patients ’ rhinorrhea was evaluated in all fi ve studies. The studies investigated the effectiveness of the treatment in reducing symptom severity (by assessing its score and duration), improving the quality-of-life score, and participants ’ ratings of the treat ment ’ s ef fi cacy. This was determined by comparing the scores before and after the treatment or by comparing them with those of the control, placebo, or vehicle. The details can be found in Table I. For the study of severity, the percentage-change from baseline was calculated for four studies (excluding Becker et al .), and the standardized mean difference (SMD) between the two treatments was calculated. We found a superior effect of IB in comparison to the vehicle/placebo when it comes to reducing rhinorrhea, with a SMD of 0.93 (95% CI 0.06 – 1.8). Moreover, a subgroup of patients receiv ing doses higher than 126 μ g/day did not show evidence of superiority of IB compared with vehicle/placebo groups with an SMD of 0.97 (95% CI 0.245 – 2.18). The forest plot (Fig. 2) shows that all but one of the studies had effect sizes in favor of the intervention. Signi fi cant heterogeneity and true variance were observed between the studies ( I 2 = 90%, p < 0.01), suggesting that there is substantial variation in the effect sizes reported across studies. A random-effects meta-analysis was therefore conducted to account for this variability. A second severity study was conducted to assess the proportional-change in rhinorrhea severity between the treatments, regardless of baseline scores (Fig. 3). Becker et al. chose to treat their volunteers with two different doses

RESULTS Study Selection

Following the initial search and the removal of duplicate records, 931 documents were identi fi ed. Out of these, 837 records were considered irrelevant based on their title or abstract and were excluded. The remaining 94 records were assessed through full-text evaluation, and from these, fi ve articles were selected for qualitative analysis, as presented in Table I. 8,16 – 19 The entire screen ing and selection process of the manuscripts is demon strated in a fl ow chart represented by Figure 1. Five studies were deemed appropriate for pooling the fi ndings, though extensive repurposing of data was needed because no study published original data or summary statistics. Participants Five trials assessed a total of 472 patients with a diagnosis of NAR based on negative allergy testing. Four articles included adult participants, whereas the fi fth article involved children aged 6 to 18 years. 16 Interventions IB nasal spray 0.03% was used in all studies. All tri als compared IB with a placebo (saline vehicle adjusted to the pH of the nasal mucosa). The fi rst table (Table I) details the intervention used in each of the trials, the dose and frequency of IB administration, and the number and characteristics of participants in each treatment arm.

Fig. 1. Flow chart detailing study selection process. [Color fi gure can be viewed in the online issue, which is available at www. laryngoscope.com.]

Laryngoscope 133: December 2023

El Khoury et al.: Ipratropium Bromide in Non-Allergic Rhinitis

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