xRead - Nonallergic Rhinitis (September 2025)

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Fig. 2. The forest plot displays the results of four studies that assessed rhinorrhea using self-reported analog scales. The plot represents the effect size and con fi dence intervals for each study.

No heterogeneity or true variance between the studies was detected ( I 2 0%, p = 0.85). Patient ’ s ratings as “ good ” or “ excellent ” of either treatment ef fi cacy (Fig. 5) were also pooled, resulting in an SMD of 0.58 (95% CI 0.37 – 0.79), proving the higher satisfaction of those patients receiving IB. Indeed, no het erogeneity was detectable with an I 2 of 13% ( p = 0.28). Secondary Outcomes Other symptoms, such as sneezing, post-nasal drip, and nasal congestion were also evaluated in the studies. In terms of duration or intensity, there was no signi fi cant difference between the IB and the placebo nasal spray. These symptoms were excluded from the meta-analysis because they varied signi fi cantly between trials.

of IB (20 or 40 μ g BID), so both were presented in the forest plot. The studies were also divided into two groups (studies with doses not exceeding 84 μ g/day and studies with doses ≥ 126 μ g/day), both of which showed signi fi cant results and no speci fi c or overall study heterogeneity. The mean change in severity was 85% (95% CI 77 – 92%) and I 2 26% ( p = 0.24), explaining the use of a fi xed-effect model. There was no difference between the two subgroups (chi-square test, p = 0.09), suggesting that the two doses per day signif icantly reduce an individual ’ s rhinorrhea severity. The decrease in rhinorrhea severity was also assessed in terms of the change in duration in comparison to the baseline duration. Figure 4 shows the forest plots of three studies having assessed the difference in dura tion change between the treatments. A statistically signif icant difference was found, evidenced by an SMD of 0.35 (95% CI 0.15 – 0.55) proving IB superior to the placebo/ vehicle in terms of reducing the symptom ’ s duration/day.

Fig. 3. Forest plot plotting the results of all fi ve studies sub-grouped according to the doses administered/day. The plot represents the percentage-change in symptom alleviation between IB and vehicle/placebo and con fi dence intervals for each study.

Laryngoscope 133: December 2023

El Khoury et al.: Ipratropium Bromide in Non-Allergic Rhinitis 3251