Improvement in TNSS After PNN Cryoablation for Chronic Rhinitis

Introduction: To determine the efficacy of posterior nasal nerve (PNN) cryoablation in controlling and improving the symptoms of chronic rhinitis as measured by the Total Nasal Symptom Score (TNSS).

Methods: A retrospective chart review was conducted to study subjects >18 yo with chronic (>6 months) allergic and nonallergic rhinitis who had failed medical management and who underwent an in-office procedure for PNN cryoablation using a handheld device (ClariFix, Arrinex, Inc.). Data was collected from electronic medical records dating from April 2019 to September 2022. TNSS and Mini Rhinoconjunctivitis Quality of Life Questionnaire (mRQLQ) scores were measured at pretreatment baseline and posttreatment at 6 weeks. Adverse effects and medication usage were recorded. Statistical analyses were conducted using Microsoft Excel and GraphPad Prism 9.

Results: A total of 60 patients (mean age 52 y, 55% female) underwent the procedure; data collection is ongoing. TNSS significantly improved from treatment baseline (mean ± SD: 6.27 ± 2.83) to 6-week post-treatment follow up (3.83 ± 2.39) (p < .0001). Nasal congestion (2.22 ± .90) and rhinorrhea (1.68 ± 1.04) TNSS sub-scores improved significantly by 6 weeks (1.44 ± .97) and (.83 ± .85), respectively (p < .0001). Both allergic and nonallergic rhinitis sub-cohorts showed a comparable degree of improvement (p < .0001). mRQLQ significantly improved from baseline (2.47 ± 1.10) to 6 weeks post-treatment (1.20 ± .89) (p < .0001). Twenty eight (47%) of patients discontinued use of one or more of their pre-operative medications at or before their post-op appointment. Adverse effects such as epistaxis, headache, and mild dryness were reported for less than one week after treatment in 18 (30%) patients.

Conclusions: Office-based cryotherapy of the PNN is a safe and effective treatment for chronic rhinitis in adults and results in clinical and statistical improvement of patient rated nasal symptoms.