From the Guidelines
The procedure for postnasal (nasopharyngeal) nerve ablation involves using an endoscope, typically a 4mm 30 degree endoscope, to visualize the nasal cavity and locate the posterior nasal nerves, and then using a method such as radiofrequency energy to ablate the nerves. The procedure can be performed with the patient upright, and topical decongestant/anaesthetic spray may be used if necessary 1. The endoscope is inserted into the nasal cavity, and the first pass is made along the floor of the nose to the nasopharynx, examining the general anatomy, septum, inferior turbinates, and nasal mucosa 1. Some key points to consider when performing the procedure include:
- Using a 2.7mm endoscope and/or a zero degree endoscope as an alternative to the 4mm 30 degree endoscope 1
- Making multiple passes with the endoscope to thoroughly examine the nasal cavity, including above the inferior turbinate to the middle meatus and medial to the middle turbinate into the sphenoethmoidal recess 1
- Using flexible endoscopes as an alternative, particularly if the larynx and pharynx need to be assessed as well 1 The goal of the procedure is to accurately locate and ablate the posterior nasal nerves, which can help to reduce excessive mucus production and provide relief from chronic postnasal drip and related symptoms 1.
From the Research
Procedure for Postnasal (Nasopharyngeal) Nerve Ablation
The procedure for postnasal (nasopharyngeal) nerve ablation involves targeting the posterior nasal nerves to treat chronic rhinitis. The following steps and methods have been described in various studies:
- Targeting the extensive innervation of the posterior nasal nerves, including three additional treatment sites posterior to the middle turbinate using radiofrequency ablation, and one focused treatment posteroinferior to the middle turbinate attachment using cryotherapy ablation 2
- Using a 940 nm diode laser with CW 5 W output for endoscopic laser ablation (ELA) of the posterior nasal nerves, under topical or local anesthesia 3
- Performing temperature-controlled radiofrequency (TCRF) ablation of the posterior nasal nerve, with a significant reduction in chronic rhinitis symptom burden through 2 years 4
- Utilizing cryotherapy or radiofrequency ablation of the posterior nasal nerve, with some limited evidence suggesting improvement in Total Nasal Symptom Score (TNSS) in adult patients 5
Methods of Ablation
Different methods of ablation have been used, including:
- Radiofrequency ablation: targeting the posterior nasal nerves with radiofrequency energy to reduce symptom burden 2, 4
- Cryotherapy ablation: using cryotherapy to target the posterior nasal nerves, with some evidence suggesting improvement in TNSS 2, 5
- Endoscopic laser ablation (ELA): using a diode laser to ablate the posterior nasal nerves, with significant reduction in symptom scores 3
Outcomes and Efficacy
The outcomes and efficacy of postnasal nerve ablation have been reported in various studies, including:
- Significant improvement in overall rhinitis symptoms, with a 30% improvement in symptoms reported by 72.5% of patients 6
- Significant reduction in Total Nasal Symptom Score (TNSS) and improvement in rhinitis and congestion scores 3
- Significant and sustained reduction in chronic rhinitis symptom burden through 2 years, with a substantial reduction in concomitant medication burden 4
- Limited evidence suggesting improvement in TNSS in adult patients, with a need for further research to draw more valid conclusions 5