Comparative Effectiveness of Cryotherapy and Radiofrequency Ablation for Chronic Rhinitis: A Systematic Review and Meta-analysis

Abstract

Objectives: Multiple minimally invasive techniques for chronic rhinitis treatment focus on posterior nasal nerve ablation. We conducted a systematic review and meta-analysis to evaluate the efficacy of cryotherapy and radiofrequency ablation for alleviating symptoms in patients with allergic and nonallergic rhinitis.

Methods: We retrieved studies from PubMed, Scopus, Embase, Web of Science, and Cochrane Database up to July 2023. Data on the impact of cryotherapy and radiofrequency ablation on quality of life and symptom ratings of rhinitis were extracted and evaluated.

Results: An analysis of 12 studies involving 788 patients demonstrated significant improvements in quality of life and rhinitis-related symptoms (nasal obstruction, itching, rhinorrhea, and sneezing) in patients treated with cryotherapy or radiofrequency ablation (symptom score at 24 months and quality of life score at 3 months). However, radiofrequency ablation had a more positive effect on nasal symptoms after 3 months than cryotherapy. Nonallergic rhinitis patients responded more favorably to posterior nerve ablation than patients with allergic rhinitis. Both techniques enhanced disease-specific quality of life during the initial 3 months of treatment (cryotherapy, 84.6%; radiofrequency, 81.6%; P=0.564). After 3 months of treatment, a clinical improvement in all nasal symptoms (minimal clinically important difference in the total nasal symptom score: >1.0 points) was seen in 81.8% and 91.9% of patients who underwent cryotherapy and radiofrequency ablation, respectively (P=0.005), suggesting that radiofrequency is more likely to lead to clinical improvement.

Conclusion: Rhinitis-associated subjective symptom scores and quality of life may be improved by both cryotherapy and radiofrequency ablation. Ablation was more efficacious than cryotherapy for nasal symptoms in patients with nonallergic rhinitis. To corroborate these findings, further randomized controlled studies directly comparing these two techniques are warranted.

Keywords: Cryotherapy; Nose; Radiofrequency Ablation; Rhinitis; Rhinitis, Allergic.

Fig. 1.

Flowchart illustrating the article search and selection process. ESS, endoscopic sinus surgery.

Fig. 2.

Rates of clinical response (total nasal symptom score [TNSS]≥minimal clinically important difference [MCID] of 1 point; A) and good response (>30% decrease in total TNSS; B) after 3 months. MDs in TNSS scores between baseline and 1 month (C). MDs in TNSS scores between baseline and 3 months (D), 6 months (E), 12 months (F), and 24 months (G) after treatment (total: individuals per group). CI, confidence interval; SD, standard deviation; MD, mean difference; NA, not available.

Fig. 3.

Rate of clinical response (total Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ] score≥minimal clinically important difference [MCID] of 0.4 or 0.5 point) at 3 months (A) and changes in RQLQ score at 3 months (B) after cryotherapy and radiofrequency ablation (total: number of participants per group). CI, confidence interval; SD, standard deviation; MD, mean difference.