Intranasal Cryoablation Associated with Positive Outcomes for Management of Refractory Allergic and Non-Allergic Rhinitis

by Linda Kossoff •

CLINICAL QUESTION

What is the impact of cryoablation of the posterior nasal nerve on symptoms of rhinitis in individuals with allergic rhinitis (AR) and non-allergic rhinitis (NAR)?

BOTTOM LINE

Subjective symptom scores related to rhinitis, particularly for rhinorrhea and congestion, decrease after cryoablation of the posterior nasal nerve, with better long-term efficacy in NAR than in AR.

BACKGROUND: Vidian neurectomy has been considered the preferred surgical intervention for patients with refractory chronic rhinitis. However, alternative techniques, such as cryoablation, have emerged that target the distal posterior nasal nerves, thereby reducing the complications associated with vidian neurectomy. Cryoablation may yield different results in patients with AR and NAR.

STUDY DESIGN: Systematic review and meta-analysis.

SETTING: Department of Otolaryngeology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul.

SYNOPSIS: Researchers mined multiple databases for studies on patients diagnosed with chronic rhinitis (AR or NAR) refractory to medical management who received cryotherapy under local anesthesia and for whom before-and-after, rhinitis-related symptoms and quality-of-life scores were available. Study design was not limited, and sham-controlled studies were included. The review included data from seven studies and 382 patients. Results of statistical analysis indicated that patients who underwent cryoablation showed a significant improvement in rhinitis-related symptoms in both AR and NAR, particularly in symptoms of rhinorrhea and congestion. Furthermore, cryoablation improved the disease-specific quality of life per the Rhinoconjunctivitis Quality of Life Questionnaire. The rate of clinical improvement in the total nasal symptom score after cryotherapy was 74%. Changes in the total nasal symptom score after 12 months of cryotherapy treatment were greater in the NAR group than the AR group, indicating that cryoablation is effective for both types of rhinitis, and has better long-term efficacy in NAR than in AR. Study limitations included a lack of past evaluative studies on cryoablation for the management of chronic rhinitis and, thus, limited available evidence.

CITATION: Kim DH, Kang YJ, Kim SW, et al. Effectiveness of the posterior nasal nerve cryoablation in allergic and non-allergic rhinitis. Laryngoscope. 2024;134:2502–2512.