Radiofrequency Ablation Versus Laser Neurolysis of the Posterior Nasal Nerve in Patients With Chronic Rhinitis

OBJECTIVE: To compare the clinical outcomes of radiofrequency ablation of the intraturbinate segment of the posterior nasal nerve (RAPN) alone versus combined RAPN with CO₂ laser posterior nasal nerve neurolysis (RPN3) in patients with chronic rhinitis refractory to medical therapy. STUDY DESIGN: Retrospective cohort study. SETTING: Single tertiary care center. METHODS: Adult patients with chronic rhinitis unresponsive to medical treatment for over 6 months who underwent either RAPN or RPN3 between February 2023 and May 2024 were included. Inclusion criteria were 24-hour reflective total nasal symptom score (rTNSS) ≥ 3, rhinorrhea score ≥1, and NOSE score ≥11. Exclusion criteria included chronic rhinosinusitis, nasal polyps, and coagulopathy. Demographics and comorbidities were documented. Primary endpoints were changes in rTNSS, NOSE scores, and response rate (≥30% improvement from baseline) at 1-, 3-, and 6-months posttreatment. RESULTS: A total of 101 patients were analyzed (RPN3: 76; RAPN: 25). Baseline rTNSS and NOSE scores were comparable between the two groups (P = .144 and .414, respectively). Both groups demonstrated significant improvements in rTNSS and NOSE scores at all follow-up points (P < .001). From 1 to 6 months, RPN3 achieved significantly greater improvements compared to RAPN (P = .039-.045), particularly in the rhinorrhea and nasal itching sub-scores (P = .003-.039). Response rates for rTNSS ranged from 91% to 100% in the RPN3 group and 84% to 96% in the RAPN group. CONCLUSION: Both RAPN and RPN3 are effective in treating chronic rhinitis unresponsive to medication. The addition of CO₂ laser posterior nasal nerve neurolysis (RPN3) provides superior symptomatic relief, particularly for rhinorrhea and nasal itching.