Posterior nasal nerve surgical neurectomy versus ablation for chronic rhinitis

Introduction: For chronic rhinitis (CR) refractory to medical management, several ablative procedures exist that target the posterior nasal nerve (PNN). Here we compare outcomes of PNN surgical neurectomy to in-office ablative procedures. Methods: We retrospectively reviewed patients with CR who trialed ipratropium at our center from 2013 to 2024 and received PNN ablation (cryoablation or radiofrequency) or neurectomy. We used the SNOT-22 questionnaire to assess outcomes, specifically evaluating the rhinologic subdomain: need to blow nose, sneezing, runny nose, nasal obstruction, loss of smell, cough, post-nasal discharge, and thick nasal discharge. Results: Our cohort consisted of 55 patients, 34 receiving PNN ablation and 26 receiving surgical neurectomy (9 receiving both). Mean follow-up time was 243 f 353 days. Surgical neurectomy (18.6 f 5.5 to 14.9 f 5.9, p = 0.02) were associated with significant SNOT-22 rhinologic domain improvements, and neurectomy was associated with significant rhinorrhea improvement (3.4 f 1.6 to 2.4 f 1.7, p = 0.04). Surgical neurectomy was associated with a greater decrease in sneezing (p = 0.04) scores than ablation, although there were no significant differences in total or rhinologic subdomain SNOT-22 scores between ablation and neurectomy. No clear improvements were observed in patients undergoing a neurectomy following ablation. Multivariable logistic regression analysis did not reveal any predictors of post-procedure improvement. Conclusion: Both surgical neurectomy and in-office ablation were associated with improvements in rhinologic symptoms for patients with CR, although neurectomy may have increased benefit for specific symptoms like sneezing. There is limited evidence that secondary procedure after an initial ablation is beneficial.