Radiofrequency Ablation Versus Cryoablation of the Posterior Nasal Nerve for Chronic Rhinitis: A Meta-Analysis and Systematic Review

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Background Posterior nasal nerve (PNN) ablation has demonstrated efficacy for chronic rhinitis, although differences between radiofrequency ablation (RFA) and cryoablation (CA) remain unclear. This meta-analysis aims to indirectly compare long-term efficacy and safety between these modalities. Methods A search for studies reporting efficacy or adverse events (AEs) of RFA or CA was conducted using 5 health science databases in January 2026. Meta-regression calculated change in the Total Nasal Symptom Score (TNSS), TNSS subscores, and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Fisher's exact test compared overall and specific AE incidences. Results This meta-analysis includes 12 studies and a total of 859 patients. Mean change for TNSS surpassed minimal clinically important threshold for both modalities at all follow-up time points. RFA demonstrated significantly greater improvement than CA at 30 days (0.63, 95% CI: 0.02-1.26, P = .045) until 365 days (0.60, 95% CI: 0.00-1.20, P = .049). TNSS subscores showed significant differences in favor of RFA over CA, for nasal itching (0.41, 95% CI: 0.23-0.58, P < .001) beginning at 30 days and sneezing (0.21, 95% CI: 0.03-0.39, P = .022) beginning at 90 days. RQLQ improvement at 90 days favored RFA over CA (0.19, 95% CI: 0.00-0.37, P = .047). RFA demonstrated lower AE incidence (5.3% vs 29.4%, P < .001). Specifically, CA had a higher incidence of headache and oral/palatal numbness events. Conclusions Both treatment modalities effectively reduce symptoms, although RFA demonstrated greater quality of life improvement and symptom relief, particularly for nasal itching and sneezing. While both modalities demonstrated low AE burden, RFA was generally associated with fewer AEs. Direct prospective comparisons are warranted.

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