Surgical Treatments for Rhinitis Significantly Reduce Symptoms, Review Shows

A study showed that all surgical treatments for rhinitis, from turbinate procedures to posterior nasal nerve procedures, improve patient symptom burden.1

Rhinitis symptoms include severe nasal obstruction, rhinorrhea, nasal itching, and sneezing. Patients may take medications to manage symptoms, such as intranasal saline, intranasal corticosteroids, intranasal anticholinergics, oral/topical antihistamines, and oral/topical decongestants; however, these do not always bring symptom relief. Several surgical treatment options exist, such as inferior turbinate procedures that target nasal congestion and posterior nasal nerve procedures that target rhinorrhea.

Turbinate procedures involve removing excess tissue around the turbinate bones to improve airflow and breathing.2 The turbinates are crucial in filtering, warming, and humidifying air as it moves through the nasal cavity into the lungs. According to the Cleveland Clinic, turbinate reduction is successful in approximately 82% of cases.

Posterior nasal nerve procedures, such as radiofrequency ablation and cryotherapy, target the posterior nasal nerve location in the posterior aspect of the middle meatus, near the sphenopalatine foramen.3 These thermal techniques are designed to disrupt nerve signals that contribute to chronic nasal symptoms. In February 2023, the American Academy of Otolaryngology-Head and Neck Surgery endorsed the use of posterior nasal nerve ablation for treating medically refractory conditions, stating that these procedures are not considered experimental.

Investigators, led by Asher T. Ripp, an MD candidate and clinical research fellow in the department of otolaryngology-head and neck surgery at the Medical University of South Carolina, conducted a systematic review and meta-analysis to evaluate how many rhinitis symptoms resolved following numerous procedures.1 They had hoped the findings would guide clinical decision making.

In their literature search, the team identified 20 studies (n = 1408) reporting rhinitis symptoms at baseline and after surgical treatment. Outcomes included the 4-item Total Nasal Symptom Score and individual Visual Analog Scale ratings for each of the symptoms: Rhinorrhea, nasal obstruction, nasal itching, and sneezing. Studies also collected postnasal drip scores.

The Total Nasal Symptom Score dropped by 50% after the surgical procedure (mean difference, 3.86 points; 95% confidence interval [CI], 3.03 – 4.69), with all 4 symptoms significantly improving across various procedure types. Nasal congestion, rhinorrhea, and postnasal drip had the greatest improvement on the Total Nasal Symptom Score, with reductions between 1.2 and 1.5 points. The Visual Analog Scale showed the greatest improvements for nasal obstruction and postnasal drip.

The review demonstrated that turbinate and posterior nasal nerve procedures brought similar improvements in congestion and rhinorrhea, with average score reductions of 56.8% and 57.6%, respectively (P = .7168). Posterior nasal nerve procedures significantly improved post-nasal dip (mean difference, 31.6%; 95% CI, 21.2 – 40.6%) and nasal itching (14.2%; 95% CI, 4.7 – 23.4%) (P < .0001).

“All surgical treatments for rhinitis improve patient symptom burden, having the most drastic effect on nasal congestion and rhinorrhea,” investigators concluded. “[Posterior nasal nerve] procedures result in greater improvements in nasal itching and [post-nasal drip] but otherwise perform similarly to inferior turbinate surgeries.”

References

1. Ripp AT, Patel PA, Nguyen SA, Schafer IV, Duffy AN, Soler ZM, Schlosser RJ. Surgical Treatment Outcomes in the Management of Rhinitis: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol. 2025 May 26:34894251341110. doi: 10.1177/00034894251341110. Epub ahead of print. PMID: 40417957.

2. Turbinate Reduction. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/22805-turbinate-reduction. Accessed May 28, 2025.

3. Position Statement: PNN Ablation for the Treatment of Chronic Rhinitis. American Academy of Otolaryngology-Head and Neck Surgery. January 17, 2023. https://www.entnet.org/resource/position-statement-posterior-nasal-nerve/. Accessed May 28, 2025.