Three-year outcomes of posterior nasal neurectomy for allergic rhinitis: Clinical outcomes by surgical technique with a focus on ENS-related symptoms

OBJECTIVE: This study aimed to evaluate the 3-year outcomes of submucous inferior turbinectomy combined with posterior nasal neurectomy (PNN) in patients with allergic rhinitis and explore empty nose syndrome (ENS)-related symptoms. METHODS: We retrospectively reviewed 40 patients who underwent submucous inferior turbinectomy combined with PNN under general anesthesia. Symptom severity, medication use, and postoperative complications, including patient-reported ENS-related symptoms, were assessed. Inferior turbinate bone reinsertion was performed in 23 patients. RESULTS: Significant improvements were observed at 1 and 3 years postoperatively in sneezing, rhinorrhea, nasal obstruction, nasal itching, and ocular itching, postnasal drip, and tearing, along with visual analog scale (VAS) scores. Overall, 89.5% of patients reported minimal or no medication use. No patients reported persistent nasal dryness. One patient (2.5%) experienced worsened nasal obstruction, and four (10.0%) reported persistent crusting. Validated diagnostic tools for ENS (e.g., Empty Nose Syndrome 6-Item Questionnaire or cotton test) were not used; therefore, the absence of ENS cannot be definitively confirmed. In an exploratory analysis, inferior turbinate bone reinsertion was not significantly associated with changes in overall condition at 3 years. CONCLUSION: Submucous inferior turbinectomy combined with posterior nasal neurectomy provided sustained symptom relief and reduced medication dependence in patients with allergic rhinitis. Complications were uncommon, and no patients reported symptoms strongly suggestive of clinically evident ENS within the scope of routine follow-up and self-reported assessment tools used in this study. Inferior turbinate bone reinsertion was not associated with a reduced frequency of ENS-related symptoms, and its potential contribution to reducing ENS risk remains uncertain.