From the Guidelines
Posterior nasal nerve (PNN) disorders are typically treated with intranasal corticosteroids as the most effective monotherapy for seasonal and perennial allergic rhinitis (SAR and PAR) 1. The treatment of PNN disorders often involves managing the underlying condition of rhinitis, which can be achieved through various pharmacological agents.
- Oral agents such as antihistamines, corticosteroids, and decongestants can be used to alleviate symptoms of rhinitis.
- Intranasal agents like antihistamines, corticosteroids, and cromolyn can also be effective in reducing nasal symptoms. However, intranasal corticosteroids are the most effective monotherapy for SAR and PAR, making them the preferred choice for treating PNN disorders 1. It's essential to note that the treatment of PNN disorders should prioritize reducing morbidity, mortality, and improving quality of life, and intranasal corticosteroids have been shown to be effective in achieving this goal 1. In terms of specific treatment options,
- intranasal corticosteroids can be used to reduce nasal congestion and other symptoms of rhinitis.
- oral antihistamines can be used to alleviate symptoms of rhinitis, but may have sedating effects and other side effects.
- leukotriene receptor antagonists can also be used to treat rhinitis, but may have minimal side effects. Overall, the most effective treatment for PNN disorders is intranasal corticosteroids, due to their ability to reduce nasal symptoms and improve quality of life 1.
From the Research
Treatment Options for Posterior Nasal Nerve (PNN) Disorders
- Posterior nasal neurectomy is a surgical procedure that involves the selective resection of posterior nasal nerve branches to treat severe allergic rhinitis (AR) and other PNN disorders 2, 3.
- The procedure can be performed endoscopically, allowing for feasible access to the confined area and selective resection of the nerve branches with preservation of the sphenopalatine artery (SPA) 2.
- Studies have shown that posterior nasal neurectomy can significantly improve total nasal symptom scores (TNSS) in patients with severe AR, with some studies reporting improvements of up to 70.2% at 12 months after the procedure 2, 3.
Efficacy of Posterior Nasal Neurectomy
- A systematic review and meta-analysis found that posterior nasal nerve neurectomy (PNNN) can improve TNSS in adult patients with chronic rhinitis, with a significantly greater responder rate (≥ 30% reduction in TNSS from baseline) compared to sham treatment 4.
- Another study found that PNNN can improve symptoms of sneezing and rhinorrhea caused by allergic rhinitis combined with chronic rhinosinusitis with nasal polyps (ARwCRSwNP), but did not show a clear statistical advantage for improving overall symptoms and controlling the recurrence of nasal polyps 5.
Alternative Treatment Methods
- Cryosurgical posterior nasal tissue ablation is a novel device designed for office-based treatment of chronic rhinitis, which has been shown to be safe and well-tolerated, with significant reductions in TNSS at 30,90,180, and 365 days after treatment 6.
- Radiofrequency ablation of the posterior nasal nerve is another alternative treatment method that has been shown to improve TNSS in adult patients with chronic rhinitis 4.
Key Findings
- Posterior nasal neurectomy is a effective treatment option for severe allergic rhinitis and other PNN disorders, with significant improvements in TNSS and quality of life 2, 3.
- Alternative treatment methods, such as cryosurgical posterior nasal tissue ablation and radiofrequency ablation, may also be effective in improving TNSS and symptoms of chronic rhinitis 4, 6.