Posterior Nasal Neurectomy for Allergic and Non-Allergic Rhinitis: Efficacy, Safety, and Predictive Factors

INTRODUCTION: Posterior nasal neurectomy (PNN) is a relatively safer modification of the Vidian neurectomy procedure. It can be recommended for patients with moderate to severe chronic (allergic and non-allergic) rhinitis that is resistant to conservative treatment. The procedure aims to transect the neural network that is responsible for excessive secretion. Here, we present our experience with PNN, evaluating its efficacy and safety. METHODS: Patients who underwent PNN between 2020 and 2024 at Sheba Medical Center were included in this study. The severity of nasal discharge was evaluated using a visual analogue score (VAS) before the surgery and at least three months afterward. Surgical success was defined as a VAS reduction of at least 50%. Data regarding demographic and clinical characteristics, as well as VAS scores, were collected and compared between the groups. RESULTS: A total of 37 patients who underwent the PNN procedure were eligible for analysis. The mean follow-up was 59.3±28.5 months. Surgical success was achieved in 30 of 37 (81.1%) patients, with a reduction in VAS from 8.5±1.1 to 2.1±1.0. In the failure group (n = 7, 18.9%), the VAS decreased from 9.0 ± 1.4 to 7.3 ± 2.0. Comparing the two groups revealed that patients in the failure group were significantly older (51.6±25.2 vs. 28.5±15.8 years; p=0.05). Atopy patients showed greater VAS improvement compared to non-allergic patients (6.3±1.6 vs. 4.8±2.5; p=0.032). No significant impact on success rates was observed for concurrent inferior submucosal conchotomy. No major postoperative complications were noted; however, 2 of 37 patients (5.4%) reported transient nasal itching. CONCLUSION: PNN is an effective and safe treatment for intractable chronic rhinitis. PNN could be considered mainly in young atopic patients with allergic rhinitis resistant to conservative treatment. It should be considered as an alternative option for patients who are unwilling or contraindicated to allergen immunotherapy.