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ARS Position Statement: Posterior Nasal Nerve Ablation

January 2022 

The American Rhinologic Society (ARS) supports the use of posterior nasal nerve ablation for the treatment of chronic rhinitis, including both allergic and non-allergic subtypes. This procedure should not be considered experimental, but should be considered as an effective option in treating chronic rhinitis and improving patient quality of life in those suffering from rhinorrhea and nasal congestion based on the following data. 

Chronic rhinitis is a common finding in otolaryngology practices affecting an estimated 2 billion individuals worldwide including 87 million in the United States1. Symptoms include runny nose, nasal congestion, nasal itching, and sneezing. Initial treatment for rhinitis traditionally involves use of topical intranasal steroid, antihistamine, and anticholinergic nasal sprays. Symptoms refractory to medical therapy have historically required surgical treatment involving neurectomy of the vidian or posterior nasal nerves in attempt to disrupt parasympathetic innervation to the mucosa of the nasal cavity2. These approaches however require general anesthesia and carry a significant risk of facial and oral numbness, postoperative bleeding, as well as dry eyes in as many as 35% of patients3,4,5,6. Given the associated risk and morbidity, newer techniques have been developed offering an alternative means for treatment of chronic rhinitis in an in office setting. Utilizing cryotherapy or radio frequency heat ablation these devices provide a minimally invasive approach for targeted localized ablation of the posterior nasal nerve. Clinical studies have demonstrated both safety and tolerance with use of the device as well as efficacy in treating patients with chronic rhinitis7,8. These data were further supported by a prospective multi-center study with long-term (12-24 month) follow up demonstrating improvement in nasal congestion and rhinorrhea symptoms scores as well as a sustained safety profile9.

Given these data on safety and efficacy, the ARS supports the use of ablation of the posterior nasal nerve for treatment of chronic rhinitis. We do not consider treatment of the posterior nasal nerve to be experimental and urge all payors to support the use of these devices in treatment of patients presenting with these conditions.

The American Rhinologic Society also endorses the American Academy of Otolaryngology Head & Neck Surgery position statement on PNN Ablation for the Treatment of Chronic Rhinitis, available at: https://www.entnet.org/resource/position-statement-posterior-nasal-nerve/

1. Settipane RA. Epidemiology of vasomotor rhinitis. World Allergy Organ J 2009;2:115–118. [Values updated for 2020 world population estimate of
7.8 billion]. 

2. Golding-Wood PH. Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis. J Laryngol Otol 1961;75:232–247. 

3. Ozenberger JM. Cryosurgery for the treatment of chronic rhinitis. Laryngoscope 1973;83:508–516.  

4. Terao A, Meshitsuka K, Suzaki H, Fukuda S. Cryosurgery on postganglionic fibers (posterior nasal branches) of the pterygopalatine ganglion for vasomotor rhinitis. Acta Otolaryngol 1983;96:139–148. 

5. Girdhar-Gopal H, Okurowski L, Strome M. An assessment of postganglionic cryoneurolysis for managing vasomotor rhinitis. Am J Rhinol Allergy 1994;8:157–164.

6. Robinson SR, Wormald PJ. Endoscopic vidian neurectomy. Am J Rhinol 2006;20:197–202.

7. Hwang PH, Lin B, Weiss R, Atkins J, Johnson J. Cryosurgical posterior nasal tissue ablation for the treatment of rhinitis. Int Forum Allergy Rhinol 2017;7:952–956.

8. Kompelli AR, Janz TA, Rowan NR, Nguyen SA, Soler ZM. Cryotherapy for the treatment of chronic rhinitis: a qualitative systematic review.
Am J Rhinol Allergy 2018;32:491–501.

9. Ow RA, O’Malley EM, Han JK, Lam KK, Yen DM.. Cryosurgical Ablation for Treatment of Rhinitis: Two-Year Results of a Prospective Multicenter Study Laryngoscope 2021, 00:1–6.