Predictive Value of Ipratropium Responsiveness on Posterior Nasal Nerve Neurectomy Outcomes in Chronic Rhinitis.

Abstract

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. Retrospective review from January 2013 to June 2025. Tertiary academic center. 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. 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. 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.