Sniffing Out the Runny Nose

PROGRAM DESCRIPTION: Every otolaryngologist encounters patients with a runny nose – whether that be anterior rhinorrhea or post-nasal drip/discharge. Chronic rhinitis is characterized into allergic and non-allergic rhinitis based on the presence (allergic rhinitis) or absence (non-allergic rhinitis) of allergen specific IgE mediated response. Non-allergic rhinitis is a common symptom evaluated in Otolaryngology clinics, affecting approximately 30 million Americans. NAR is associated with a negative impact on patient quality of life, and despite evidence to support topical pharmacotherapies, many patients remain symptomatic and are considered surgical/procedural candidates. The primary goal of this expert series is to provide clinicians who evaluate patients with non-allergic rhinitis with evidence-based comparisons of the medical and surgical options available for patients with debilitating non-allergic rhinitis. The second aim of this series is to provide the audience with detailed surgical techniques for treatment of NAR as well as options for in-office topical anesthetic regimens. Surgical /procedural techniques evaluated include inferior turbinate reduction, botulism toxin injection, endoscopic vidian neurectomy, posterior nasal neurectomy, and ablation of the posterior nasal nerve. Post-nasal discharge has been attributed to sinonasal, laryngeal, and esophageal diseases. We will explore a step-wise approach to evaluation and treatment of post-nasal discharge.

OUTCOME OBJECTIVE 1: • Describe the pathophysiology of non-allergic rhinitis
• Evaluate the current evidence in support of the surgical treatment of non-allergic rhinitis

OUTCOME OBJECTIVE 2: • Examine in-office anesthetic regimens for procedural/surgical treatment of non-allergic rhinitis
• Compare surgical techniques for the surgical treatment of non-allergic rhinitis

OUTCOME OBJECTIVE 3: • Implement surgical technique for treatment of non-allergic rhinitis
• Discuss evaluation and management of post-nasal discharge

BACKGROUND STATEMENT: There has been a recent rejuvenation in clinician interest in the surgical management of chronic rhinitis. A new expert series is needed to provide clinicians with a detailed examination of both historical and recent literature evaluating surgical techniques for non-allergic rhinitis.