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Scientific Oral Presentations

Rhinology/Allergy

Session: Scientific Oral Presentation 2 - Rhinology and Allergy

Predictive Value of Ipratropium Responsiveness on Posterior Nasal Nerve Neurectomy Outcomes in Chronic Rhinitis

Sunday, October 12, 2025
1:06 PM - 1:12 PM EDT
Location: 125
Disclosure(s):
Sainiteesh Maddineni, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Peter H. Hwang, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Procedures targeting the posterior nasal nerve (PNN) are offered for patients with chronic rhinitis (CR) after medical therapy. Ipratropium responsiveness has been shown to be predictive of outcomes for patients undergoing PNN radiofrequency ablation. Here, we evaluate how response to ipratropium predicts outcomes of PNN surgical neurectomy.

Methods: We retrospectively reviewed patients seen at Stanford Sinus Center from 2013 to 2024 with CR who trialed ipratropium and received PNN neurectomy. Outcomes were assessed with the SNOT-22 questionnaire, with focus on the rhinologic components. We compared patients with self-reported improvement in CR on ipratropium to those without and conducted a multivariable regression analysis.

Results: Our cohort consisted of 41 patients (16 male, 25 female) who underwent PNN neurectomy after trial of ipratropium. Average age was 58.1 years and 8 (19.5%) had allergic rhinitis. 13 (56.1%) had a positive response to ipratropium. Patients with ipratropium response had significantly improved post-nasal drip (3.8 ± 1.6 pre, 2.7 ± 1.6 post, p=0.03) but not significantly improved rhinorrhea (3.3 ± 1.5 pre, 2.6 ± 1.5 post, p=0.13). Patients without ipratropium response showed significant improvement in need to blow nose (3.7 ± 1.4 pre, 2.6 ± 1.6 post, p=0.03) and rhinorrhea (3.7 ± 1.5 pre, 2.3 ± 1.9 post, p=0.02), but not significant improvement in post-nasal drip (3.9 ± 1.7 pre, 2.9 ± 1.9 post, p=0.10). Multivariable logistic regression found odds ratio of 0.45 (95% CI: 0.06 – 3.18) for ipratropium response predicting improvement in SNOT-22.

Conclusions: Ipratropium response may not be predictive of outcomes for PNN surgical neurectomy. Both ipratropium responders and non-responders may be benefit from PNN surgical neurectomy.

    Presenting Author(s)

  • Sainiteesh Maddineni, BS

    Medical Student
    Stanford University School of Medicine
    San Ramon, California, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • PH

    Peter H. Hwang, MD

    Professor
    Stanford University
    Palo Alto, CA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Zara M. Patel, MD

    Professor
    Stanford University
    Stanford, CA, United States

    Disclosure information not submitted.

  • JN

    Jayakar V. Nayak, MD, PhD

    Professor
    Stanford University
    Stanford, California, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Michael T. Chang, MD

    Assistant Professor
    Stanford University
    Stanford, CA, United States

    Disclosure information not submitted.