Does ipratropium responsiveness predict posterior nasal nerve neurectomy/ablation outcomes in chronic rhinitis?
Reviewed by Richard (Wei Chern) Gan

This study’s main objective was to assess whether topical ipratropium response is predictive of subsequent response to posterior nasal nerve (PNN) interventions, including surgical neurectomy or in-office ablation, in chronic rhinitis (CR). This is a retrospective study of adult patients (single academic centre, January 2013 to June 2025). Inclusion criteria: CR diagnosis (allergic or non-allergic); over 18 years of age; underwent trial of ipratropium bromide nasal spray (minimum 1 month, 2 sprays each side 2 to 4 times daily) followed by PNN ablation (cryotherapy or radiofrequency ablation) or surgical neurectomy. Exclusion criteria: concurrent endoscopic sinus surgery; diagnosis of chronic sinusitis; unknown ipratropium response; and incomplete SNOT-22 data. Eighty-one patients (43 male, 38 female) were included, with an average age of 57.9 years. Forty-four patients (54.3%) reported improvement of symptoms with ipratropium and 37 (45.7%) reported no improvement. Fifty-three patients had surgical neurectomy, 30 patients had cryotherapy only, 4 patients had radiofrequency only and 1 patient had both (making up 35 patients having had in-office ablation). Following surgical neurectomy, the overall cohort demonstrated significant improvement in SNOT-22 rhinologic domain score (though it did not exceed the SNOT-22 subdomain minimal clinically important difference (MCID) of 3.8). These patients also showed statistically significant improvement in rhinorrhoea (3.5+/-1.5 pre vs. 2.6+/-1.6, P=0.004) and post-nasal drip (3.7+/-1.6 pre vs. 3.0+/-1.6, P=0.02). Following surgical neurectomy, ipratropium responders had a significant improvement in postnasal drip (P=0.03). No significant improvement in other individual items or rhinologic subdomain was noted, however runny nose had an improvement trending towards statistical significance (P=0.06). In ipratropium non-responders, there was significant improvement in rhinorrhoea (P=0.04), but no other significant improvement in other individual items or rhinologic subdomain. As for patients receiving PNN in-office ablation, the overall cohort demonstrated statistically significant improvement in SNOT-22 rhinologic domain score but did not exceed MCID. In ipratropium responders, there were significant improvements in rhinorrhoea (P=0.03), thick nasal discharge (P=0.03), and rhinologic domain total scores (P=0.03). Ipratropium nonresponders did not have significant change in post-ablation scores. The authors conclude that ipratropium response in not predictive of outcome after surgical PNN neurectomy as both responders and non-responders experience benefit from this technique. However, patients with positive response to ipratropium may be more likely to benefit from PNN in-office procedures. This may help guide clinical decision making in that if patients with CR show improvement with ipratropium spray, they may be excellent candidates for both in-office and surgical neurectomy. If they do not respond to ipratropium, clinicians may consider recommending primary surgical neurectomy.

Predictive Value of Ipratropium Responsiveness on Posterior Nasal Nerve Neurectomy Outcomes in Chronic Rhinitis.
Maddineni S, Hwang PH, Ayoub NF, et al.
OTOLARYNGOL HEAD NECK SURG
2026;174(2):359–65.