Cryoablation of the Posterior Nasal Nerves in Pediatric Patients with Chronic Rhinitis: A 5-Year Experience

Background: Chronic rhinitis, including allergic rhinitis (AR) and non-allergic rhinitis (NAR), affects millions of individuals, with a significant burden in pediatric populations.Vasomotor rhinitis (VMR), a subtype of NAR, is characterized by nasal symptoms of congestion and watery discharge.Cryoablation (CA) of the posterior nasal nerves (PNN) using the Clarifix™ device has shown efficacy in adults, but data on its application in pediatric patients is lacking.Objective: This study aimed to evaluate the safety, tolerability, feasibility, and effectiveness of cryoablation of the PNN in pediatric patients with AR and VMR.Methods: A retrospective cohort study was conducted on 97 pediatric patients aged 4-12 years who underwent cryoablation using the Clarifix™ device between January 2018 and December 2022.Patients included in the study were diagnosed with AR or VMR and underwent cryoablation during nasal surgeries such as septoplasty, endoscopic sinus surgery (ESS), turbinate reduction, or adenoidectomy.Collected data included demographic information, preoperative and postoperative medical treatments, intraoperative and postoperative complications/side effects, and symptomatic improvement measured by the Total Nasal Symptom Score (TNSS). Results:The study population consisted of 65 males (67%) and 32 females (33%), with a mean age of 7.5 years.Indications for surgery were VMR (70%) and AR (30%).A majority of our patients complained of nasal obstruction due to Grade 4 inferior hypertrophy (68%), middle turbinate concha bullosa (65%) and paradoxical middle turbinate (29%).Only 3 cases (3%) aborted due to inability to access the PNN region, primarily in younger children at age 4 years.There were no intra-operative complications and postoperative side effects were rare.Mild pain was reported in 1% of patients immediately post-op; bleeding and sinusitis, which occurred in 2%, was unrelated to the cryotherapy procedure.No other complications were reported postoperatively.Significant reduction in TNSS scores post-op showed effectiveness of the procedure (mean TNSS reduction from 7.03 to 2.23; p < 0.001, with VMR patients experiencing the greatest benefit (6.33 to 0.61; p < 0.001.Post-operative use of nasal steroid spray (20% of VMR patients) was not required for any patient with VMR.Conclusion: Cryoablation of the posterior nasal nerves under general anesthesia is a safe, well-tolerated, and effective treatment for pediatric patients with chronic rhinitis.The procedure demonstrates a high success rate in improving symptoms, particularly in patients with VMR and AR, making it a viable option for managing chronic rhinitis in children.