Radiofrequency Ablation of Inferior Turbinates With Posterior Nasal Nerve Neurolysis for Refractory Rhinitis Medicamentosa

Objective: To explore the effectiveness of surgical intervention in treating refractory rhinitis medicamentosa (RM) and determine whether laser posterior nasal neurolysis improves outcomes. Method: This is a retrospective cohort study from February 2023 to June 2025, which enrolled patients with RM refractory to medical treatment who received either radiofrequency ablation turbinate reduction (RF) alone or combined RF ablation with laser posterior nasal nerve neurolysis (RPN3). Results: The study included 37 patients with refractory RM (RF group = 9, RPN3 group = 28). During the 12-month follow-up, 35 patients (94.6%) withdrew from nasal constrictors successfully. For the entire cohort, the baseline reflective total nasal symptom score was 6.6 ± 2.9, decreasing to 1.5 ± 2.1 during the 12-month follow-up ( P < .001). The baseline nasal obstruction symptom evaluation score was 13.3 ± 4.7, decreasing to 1.6 ± 2.7 during the 12-month follow-up ( P < .001). The RF group showed significant improvement in congestion ( P -value < .001), rhinorrhea, and sneezing ( P -value < .05) but not in itching during the 12-month follow-up. The RPN3 group showed significant improvement in all subscores from the 1st to 12th month follow-up ( P < .001). Conclusions: Surgical intervention successfully eliminated nasal decongestant dependency in patients with RM while improving their quality of life. The RPN3 procedure, which combines laser posterior nasal nerve treatment, may offer additional benefits by providing enhanced control of nasal itching and achieving earlier response in rhinorrhea and sneezing control. Level of Evidence: III