Predictive Value of Ipratropium Responsiveness on Posterior Nasal Nerve Neurectomy Outcomes in Chronic Rhinitis
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Procedures targeting the posterior nasal nerve (PNN) are effective in treating chronic rhinitis after failed medical therapy. We evaluate how ipratropium response predicts PNN intervention outcomes. STUDY DESIGN: Retrospective review from January 2013 to June 2025. STUDY SETTING: Tertiary academic center. METHODS: We reviewed patients with chronic rhinitis who trialed ipratropium nasal spray and received PNN surgical neurectomy or in-office ablation (cryotherapy or radiofrequency ablation). Ipratropium responsiveness was self-reported. Outcomes were assessed with the SNOT-22 questionnaire, focusing on rhinologic components. RESULTS: 81 patients (43 male, 38 female; mean age 57.9 years) were included, of whom 44 (54.3%) reported response to ipratropium. SNOT-22 rhinologic subdomain scores improved significantly following both in-office PNN ablation (17.7 ± 5.8-14.5 ± 7.1, P = .04) and surgical neurectomy (19.1 ± 6.7-15.8 ± 7.3, P = .02). After PNN surgical neurectomy, ipratropium responders demonstrated significant improvement in postnasal drip (P = .03), nonresponders in rhinorrhea (P = .04), and both had similar rates of clinically meaningful improvement (MCID) in the SNOT-22 rhinologic subdomain (45.2% vs 50.0%, P = .73). In contrast, for in-office PNN ablation, ipratropium responders had a significantly higher rate of MCID achievement (64.7% vs 27.8%, P = .03) and significant improvements in rhinorrhea (P = .03), thick nasal discharge (P = .03), and rhinologic subdomain scores (P = .03), while nonresponders had no significant symptom changes following in-office ablation. CONCLUSION: Patients with positive response to ipratropium may be more likely to benefit from PNN in-office ablation techniques. Ipratropium response is not predictive of outcome for surgical PNN neurectomy, as both responders and nonresponders may experience benefit.
Source: Otolaryngology
DOI: 10.1002/ohn.70099
Institutions: Stanford Medicine, Stanford University
Language: English
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7117691086