Effect of Laser Posterior Nasal Neurolysis for the Treatment of Chronic Rhinitis: A Randomized Controlled Trial.

BACKGROUND

To determine the safety and efficacy of laser ablation of the posterior nasal nerve (PNN) for the treatment of chronic rhinitis.

METHODS

This study was a single-center, prospective, single-blinded, randomized sham-controlled trial. Patients with a 24-h reflective Total Nasal Symptom Score (rTNSS) ≧ 5, rhinorrhea ≧ 2, and congestion ≧ 1, were randomized 2:1 to active PNN treatment with a CO2 laser device or a sham procedure. Outcome measures included the rTNSS, Nasal Obstruction Symptom Evaluation (NOSE), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). The primary endpoint was the change in scores at 3 months.

RESULTS

Patients had a mean baseline rTNSS of 8.5 (95% CI, 7.9-9.1) and 8.2 (95% CI, 7.4-8.9) (p = 0.589) in the active treatment (n = 43) and sham control (n = 22) arms, respectively. At 3 months, the active treatment arm had a significantly greater decrease in rTNSS -4.7 (95% CI, -5.5 to -3.9) versus -2.6 (95% CI, -3.4 to -1.8) (p = 0.002). While the responder rate (RR, defined as ≧30% improvement rTNSS) was not significantly higher in the active treatment arm (81.4% vs. 63.6%, p = 0.119), post-hoc analysis of RR (≧ 50% improvement) showed a significantly higher rate of 65.1% versus 31.8% (p = 0.011). There were greater improvements in the PSQI and ESS scores for the active arm over the sham arm at follow-ups. (p = 0.041 and 0.005, respectively).

CONCLUSIONS

The CO2 laser posterior nasal neurolysis of the PNN area is associated with minimal adverse events and is superior to a sham procedure in reducing the symptom burden of chronic rhinitis.