Office treatment for persistent rhinorrhoea
Reviewed by Sangeeta Maini and Bhaskar Ram

Vasomotor rhinitis (VR) is a common condition across the world. Patients suffering from VR commonly have symptoms of persistent bilateral rhinorrhoea, that can have a significant negative impact on their quality of life. Vasomotor rhinitis can be treated medically with anticholinergic nasal sprays but up to 22% of patients fail medical treatment. In the past, Vidian neurectomy was the mainstay surgical treatment option for patients with vasomotor rhinitis. This option required severing the Vidian nerve to disrupt parasympathetic nerve fibres and would effectively reduce symptoms, but it also resulted in side effects such as dry eyes. The anatomy of the Vidian canal can also vary and can be quite challenging to access the nerve endoscopically. With recent advances in technology, other ways to manage the PNNs have been proposed. These options include treatment with cryoablation and radiofrequency ablation. These innovations also allow otolaryngologists to treat patients in the clinic under local anaesthesia, as long as the nasal anatomy is favourable for in-office procedures. In this article, the two most common types of in-office procedures are mentioned for the treatment of VR: cryoablation (ClariFix, Stryker, Kalamazoo, MI) and radiofrequency ablation (RhinAer, Aerin Medical, Sunnyvale, CA and Neuromark, Neurent-Oranmore, Galway, Ireland). The technique is well explained and easy to understand and can be put into practice. I felt these techniques could be very useful, less invasive, effective techniques for managing refractory vasomotor rhinitis. It would have been more useful if long-term results of these techniques were covered in this article. 

Office-Based Laryngology.
Lamm SA, Buckmire RA, Shah RN.
OTOLARYNGOL CLIN NORTH AM
2025;58(4):623–40.