Combined Neurolysis Offers Superior Relief in Refractory Chronic Rhinitis: Study

A new study published in the journal of Otolaryngology-Head and Neck Surgery found both radiofrequency ablation of the posterior nasal nerve (RAPN) alone and RAPN combined with CO₂ laser posterior nasal nerve neurolysis (RPN3) in patients with refractory chronic rhinitis, to significantly improve symptom scores (rTNSS and NOSE) for up to six months. However, the combined RPN3 approach provided greater overall symptom relief and higher response rates, with particularly better reduction in rhinorrhea and nasal itching when compared to RAPN alone

Chronic rhinitis, which is characterized by persistent nasal congestion, rhinorrhea, and itching, can significantly impact quality of life. For patients who fail to improve after at least 6 months of medical management, procedural interventions targeting the posterior nasal nerve have become an increasingly viable option.

The study analyzed 101 adult patients treated between February 2023 and May 2024. Of these, 76 underwent the combined RPN3 procedure, while 25 received RAPN alone. All participants met strict inclusion criteria, including moderate symptom severity based on standardized scoring systems such as the reflective Total Nasal Symptom Score (rTNSS) and the Nasal Obstruction Symptom Evaluation (NOSE) score.

At baseline, both groups were comparable in terms of symptom severity. However, outcomes began to diverge after treatment. While both RAPN and RPN3 resulted in statistically significant improvements in nasal symptoms at 1-, 3-, and 6-month follow-ups, the combined RPN3 approach consistently outperformed RAPN alone.

The patients who received RPN3 experienced greater reductions in overall symptom scores, particularly in rhinorrhea and nasal itching. These differences were statistically significant across multiple follow-up points, suggesting a sustained benefit from the combined therapy.

Also, response rates of at least a 30% improvement from baseline were notably high in both groups. The RPN3 group achieved response rates between 91% and 100%, slightly higher than the 84% to 96% observed in the RAPN group. Despite both procedures demonstrating strong efficacy, the enhanced outcomes with RPN3 highlighted the potential advantage of combining treatment modalities.

The study excluded patients with confounding conditions such as chronic rhinosinusitis, nasal polyps, or bleeding disorders, which ensured a more precise evaluation of treatment effects specifically to chronic rhinitis.

While both procedures are safe and effective, the addition of CO₂ laser neurolysis appears to amplify therapeutic benefits. This combined approach may represent an effective advancement for patients who have exhausted conventional medical options.

Source:

Lin, C.-C., Hwang, Y.-L., Liao, J.-Y., Teng, H.-L., Shih, T.-Y., & Huang, C.-Y. (2026). Radiofrequency ablation versus laser neurolysis of the posterior nasal nerve in patients with chronic rhinitis. Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 174(4), 954–962. https://doi.org/10.1002/ohn.70156