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

Fig. 4. The forest plot features the results of three studies that assessed the duration-change in rhinorrhea. The plot represents the effect size and con fi dence intervals for each study.

DISCUSSION NAR drastically reduces people ’ s quality of life, highlighting the importance of proper treatment. 20 This systematic review and meta-analysis found that all the articles supported the use of INIB to treat rhinorrhea in NAR. With a SMD of 0.93 (95% CI 0.06 – 1.8) and having a lower CI limit near 0, the percentage-change from base line indicated a modestly statistically signi fi cant superior effect of IB compared with the placebo when it comes to lowering rhinorrhea. INIB signi fi cantly reduced the severity of rhinorrhea. There was no difference between dosage subgroups, implying that the two daily doses have the same effect on the severity of rhinorrhea. In both adults and children, the IB spray caused less severe and shorter-lasting rhinorrhea than the vehicle spray. As a result, patients who received INIB reported higher levels of satisfaction. These improvements were noticeable after the fi rst week and lasted for the rest of the treatment. Patient diary records, a global assessment of treatment by both patients and physicians, and an improvement in the patients ’ sense of well-being as measured by a quality-of-life assessment all con fi rmed the therapeutic importance of this reduction in rhinorrhea. Sneezing, con gestion, and postnasal drip did not improve signi fi cantly with either therapy. In terms of adverse nasal events, IB was related to uncommon local nasal AE (epistaxis and nasal dryness). When compared with its vehicle, the ipratropium spray had no systemic anticholinergic side effects. A poor understanding of the underlying pathophysiol ogy, a lack of recommendations, and insuf fi cient research on available treatments all contribute to the dif fi culty of managing NAR. The parasympathetic nervous system is involved in the pathogenesis of NAR. The glandular stimu

It should be noted that studies evaluating quality of life in various age groups based on various cognitive parameters and daily activities revealed a signi fi cant improvement in mental outcomes with the INIB com pared with a placebo ( p < 0.05). However, they were not suitable for meta-analysis. Adverse Events Patients did not exhibit systemic anticholinergic side-effects, as stated explicitly in three studies. Intermit tent and brief nasal AE were generally observed. The risk ratios (RR) of these AE were extracted from four studies, resulting in a pooled RR of 1.73 (95% CI 0.98 – 3.02) in dis favor of IB (Fig. 6, bottom-most plot). Speci fi cally, the most common side-effects experienced were epistaxis (RR 3.15, 95% CI 1.17 – 8.49), nasal congestion (RR 1.59, 95% CI 0.2 – 12.85), and nasal dryness (RR 3.06, 95% CI 0.82 – 11.34), proving the potential of IB for increasing epi staxis speci fi cally (CI excluding 1). Nasal exams and nasal cytology analysis revealed that intranasal administration of IB had no negative effects on the nasal mucosa. Risk of Bias The Cochrane Risk of Bias tool was used to assess the risk of bias in the included studies. All studies were judged to have a low risk of bias, although there are some concerns regarding the randomization process in each of the fi ve studies. The diagram for the tool is shown in Figure 7.

Fig. 5. The forest plot displays the results of two studies assessing the difference in treatment ratings of patients. The plot represents the effect size and con fi dence intervals for each study.

Laryngoscope 133: December 2023

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

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