Management of Intractable Rhinitis: Posterior Nasal Neurectomy with or without Posterior Turbinectomy

Abstract

Intractable rhinitis, characterized by persistent nasal obstruction, rhinorrhea, sneezing, and congestion, remains a clinical challenge when conservative therapies fail. Conventional medical treatments, including intranasal corticosteroids, antihistamines, and decongestants, often provide only partial or temporary relief for patients with severe disease. Posterior nasal neurectomy (PNN) has emerged as a minimally invasive surgical approach targeting the posterior nasal nerve, which carries parasympathetic fibers responsible for excessive nasal secretions and congestion. By interrupting these neural pathways, PNN reduces hypersecretion and nasal obstruction while preserving the structural integrity of the nasal cavity. The addition of posterior turbinectomy, either partial or complete, is considered in select cases to further improve nasal airflow and reduce turbinate hypertrophy. However, the necessity and efficacy of combining turbinectomy with PNN remain subjects of debate, with studies reporting variable outcomes in symptom control, recurrence rates, and complications. Therefore, evaluating the effectiveness of posterior nasal neurectomy with or without posterior turbinectomy is essential for optimizing surgical management strategies for patients with intractable rhinitis.