Surgical Management of Non-Allergic Rhinitis-An EAACI Task Force Position Paper

Area of Science:

• Otolaryngology
• Rhinology
• Surgical Innovation

Background:

• Non-allergic rhinitis is a common condition causing chronic nasal symptoms like congestion and rhinorrhoea.
• Pathophysiology involves neurogenic dysregulation, leading to mucus overproduction and vasodilation.
• Persistent symptoms often necessitate surgical intervention beyond medical management.

Purpose of the Study:

• To review key surgical options for refractory non-allergic rhinitis.
• To compare the efficacy and safety of inferior turbinate reduction, vidian neurectomy, and posterior nasal nerve ablation.

Main Methods:

• Review of surgical techniques including inferior turbinate reduction (cold instruments, radiofrequency, laser, coblation, microdebrider).
• Evaluation of vidian neurectomy for rhinorrhoea.
• Assessment of posterior nasal nerve (PNN) interventions (cryotherapy, cold instruments, radiofrequency) for minimally invasive treatment.

Main Results:

• Inferior turbinate reduction is a primary treatment for nasal obstruction, providing durable relief with low complication rates.
• Vidian neurectomy effectively reduces rhinorrhoea but has risks (ocular dryness, facial numbness), limiting use to severe cases.
• PNN interventions offer a minimally invasive, outpatient option with significant, lasting symptom improvement by targeting specific nerve fibers.

Conclusions:

• Surgical management of non-allergic rhinitis is effective and safe when individualized.
• Advances in endoscopic and minimally invasive techniques have improved safety profiles.
• Surgical options are integral to comprehensive care for refractory non-allergic rhinitis.