Q&A: Improved chronic rhinitis symptoms follow nerve treatment for 2 years
Click Here to Manage Email Alerts
Patients with chronic rhinitis who had temperature-controlled radiofrequency neurolysis of their posterior nasal nerve experienced improved symptoms and quality of life, according to a study of 129 patients published in The Laryngoscope.
The improvements exhibited in the RELIEF study also included a substantial decrease in medication burden and were sustained for 2 years, the researchers continued.
The patients (53% female; mean age, 57.8 years) had a mean pretreatment 24-hour reflective total nasal symptom score (rTNSS) of 7.8 (95% CI, 7.5-8.1). At 3 months, the rTNSS treatment effect was –4.2 (95% CI, –4.6 to –3.8; P < .001).
At 2 years, the rTNSS treatment effect was –4.5 (95% CI, –5 to –3.9; P < .001), for a 57.7% improvement, and 80% (95% CI, 71.4%-86.5%) of the patients had a minimal clinically important difference (MCID) of 30% or greater reduction in rTNSS from baseline.
Further, 77.4% (95% CI, 68.5%-84.3%) of the patients reached the MCID of a 0.4-point improvement in their Mini Rhinoconjunctivitis Quality of Life Questionnaire score at 2 years, with significant improvements in individual postnasal drip and cough symptom scores, according to the researchers.
Among the 81 patients who were using chronic rhinitis medications at baseline, 28.4% had stopped and 33.3% had decreased the use of one or more medication classes at 2 years. There were no serious adverse events related to the device or the noninvasive procedure throughout the 2-year study period either.
Healio spoke with Daniel D. Charous, MD, of Arizona Desert Ear, Nose & Throat Specialists in Goodyear, Arizona, to find out more about the RhinAer System from Aerin Medical Inc., the procedure and its results.
Healio: What are the most significant burdens of living with chronic rhinitis?
Charous: The nose is a vital organ that enables us to take every breath and to smell food and other wonderful aromas. It is a real drain on patients to have constant nasal congestion, runny nose, nasal itching and sneezing. Living with chronic rhinitis can negatively affect a patient’s quality of life.
No one wants to be constantly reminded of their nasal issues every moment of the day and always have to carry around a bunch of tissues or different nasal sprays. Although it is true that chronic rhinitis may not be life threatening, nasal symptoms such as these, with constant wiping and dabbing, for sure can be extremely irritating and contribute to depression, anxiety and social phobia, among other consequences.
Healio: What are the limitations of current treatments for chronic rhinitis?
Charous: Current treatments essentially fall into the categories of sprays and pills. Most patients have had symptoms for years, and many have seen other specialists. Patients usually have tried many varieties of antihistamine and decongestant pills, alone or in combination, and have invariably tried nasal steroid spray, saline and other types of topical nasal medications.
Sometimes, patients are fortunate enough to find treatments that give some temporary relief. But then they have to constantly take those medications. However, some patients either find that nothing helps or, alternatively, the treatments that do help have too many side effects or drug interactions. So, then they are just stuck on the sideline.
Healio: Could you summarize how the RhinAer System works?
Charous: The nose is a complex place. To understand how the RhinAer System works, we have to understand a little bit of anatomy. There are special nerves at the back of the nose that are responsible for the excessive output of mucus. These nerves can become overactive, and this overactivity seems to be causing chronic rhinitis symptoms such as runny nose, congestion and postnasal drip.
RhinAer uses temperature-controlled radiofrequency energy [4 W at 60°C] that is applied to the area of the overactive nerve for 12 seconds. The radiofrequency energy essentially calms the nerves from being overactive, and this is why symptoms lessen after the procedure.
Healio: Are there any data from the study that you would like to highlight?
Charous: One of the most common questions my patients have is whether the procedure needs to be repeated regularly. The data from the RELIEF study are extremely exciting. For me, the best part is that the study demonstrates that RhinAer is not just a quick fix, or some other form of medication treatment that needs to be repeated on a regular basis. RELIEF data show that patients see beneficial effects 3 months after the procedure, and these effects are durable at 2 years. We have to remain cautious about speculating 5 or 10 years after the procedure, but the results we are seeing are extremely encouraging.
Healio: Do allergists need any kind of training before they can begin using this system?
Charous: That’s an excellent question because patients will likely have seen an allergist at some point during their journey with chronic rhinitis. It is important to understand that patients with different conditions often require treatment from different specialists. Chronic rhinitis is no exception. Patients will likely seek help from allergists who can offer wonderful, state-of-the-art medical management. The RhinAer procedure, though, is performed exclusively by an otolaryngologist, or ear, nose and throat surgeon. As otolaryngologists, we have the unique surgical training and anatomical understanding to be able to perform the procedure.
Healio: What is the next step in this research?
Charous: The RELIEF study will track patients through 36 months.