Indications for surgery in refractory rhinitis

Medical treatment of chronic rhinitis is successful in a majority of patients, but there is a still large population of patients who fail medical therapy. Surgical treatment for patients with severe persistent allergic rhinitis is not a new solution, but recent advancements in technology and surgical technique have made surgery safer and more effective. There is no gold standard of treatment in patients with refractory rhinitis, and surgeons may select a variety of procedures and techniques based on a patient's anatomy, severity of disease, and comorbidities. Unfortunately, there are currently few large prospective, randomized controlled trials evaluating surgical treatments, and no study to date has compared immunotherapy to surgical intervention. Therefore, there is no hard and fast rule as to when to pursue surgical intervention after initial medical therapy has failed.