Temperature-Controlled Radiofrequency Neurolysis of the Posterior Nasal Nerve Effective Long Term in Patients with Chronic Rhinitis

by Linda Kossoff •

CLINICAL QUESTION

What is the long-term safety and effectiveness of temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN) in patients with chronic rhinitis?

BOTTOM LINE

Temperature-controlled RF neurolysis of the PNN resulted in continued, durable improvement in both chronic rhinitis symptom burden and quality of life through two years, as well as a substantial decrease in medication burden.

BACKGROUND: Temperature-controlled RF neurolysis is a minimally invasive alternative to surgical PNN neurectomy for the treatment of chronic rhinitis. The efficacy of the treatment was previously demonstrated in a single-arm pivotal study. With this efficacy now established, the next step in assessing TCRF is to determine its effectiveness in a larger population.

STUDY DESIGN: Prospective study.

SETTING: Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, Calif.

SYNOPSIS: Researchers enrolled 129 adult patients (53% female, mean age 57.8 years) with chronic rhinitis symptoms across 16 centers in the U.S. and Germany between October 2020 and March 2021. Patients were treated using a single-use disposable device and RF generator. Patient-report outcome measures were the 14-hour reflective total nasal symptom score (rTNSS) and mini rhinoconjunctivitis quality of life questionnaire (MiniRQLQ). The mean pretreatment rTNSS was 7.8. The significant rTNSS treatment effect at 3 months (4.2) was sustained through 2 years, a 57.7% improvement. At two years, the proportion of patients with a minimum clinically important difference (MCID) of ≥30% improvement in rTNSS from baseline was 80.0%. Individual postnasal drip and cough symptom scores were significantly improved from baseline through two years. The proportion of patients who reached the MCID for the MiniRQLQ at two years was 77.4%. Of 81 patients using chronic rhinitis medications at baseline, 61.7% either stopped all medication use (28.4%) or stopped or decreased (33.3%) use of ≥1 medication class at two years. No device- or procedure-related serious adverse events were reported throughout two years. Study limitations included the lack of a control arm.

CITATION: Lee JT, Abbas GM, Charous DD, et al. Two-year outcomes after radiofrequency neurolysis of posterior nasal nerve in chronic rhinitis. Laryngoscope. 2024;134:2077–2084.