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Keith Roach, MD

Dear Dr. Roach: I am a relatively healthy 72 year old female. I have a history of allergic rhinitis. A diet of allergy testing and shots has been successful in controlling my seasonal allergies. I also have vasomotor rhinitis which results in a runny nose during meals, when drinking hot or cold drinks and after brushing my teeth. I never go through a meal without needing a handkerchief or two. I have seen several ENTs over the years regarding this condition. I recently tried ipratropium bromide nasal spray, which the ENT was sure would relieve this condition. This was not the case. Now the ENT doctor offers the ablation of the posterior nasal nerves using low frequency radio waves. Have you heard of this procedure? My ENT says it’s been in use for about 10 years. The clinical studies seem to have been carried out by the manufacturer of the device. My concern is that the ablation procedure may alleviate the problem of rhinitis but create another problem. —NP

ANSWER: Posterior nasal nerve ablation is a new treatment for vasomotor rhinitis which is characterized by a runny nose after eating or with temperature changes. The idea is to decrease the amount of signals the nerve sends to the nasal tissue, which will in turn decrease the amount of runny nose and other symptoms. A very similar procedure can be done using laser or cold treatment to have the same effect on the nerves. As of this writing, only radiofrequency and cold ablation devices are approved by the Food and Drug Administration.

I found quite a few trials, not all of which were funded by the manufacturers of the various devices, that showed great effectiveness with very few side effects. The longest trial showed efficacy for up to 52 weeks with the radiofrequency device and a greater than 50% reduction in symptoms.

I wouldn’t rush to recommend this procedure. There are many effective medications to try – I particularly recommend azelastine nasal spray if you haven’t tried it. These types of procedures should be reserved for people with significant symptoms who have not responded to treatment. Any relatively new treatment has the potential for undiscovered side effects that only appear after many people have used it for an extended period of time; however, I think the likelihood of serious adverse effects is low.

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