Shanshan Zhang, Yihan Chen, Jianhui Zhao, Jun Han, Yibei Wang, Yiding Liu, Jianfeng Liu
Objective To evaluate and compare the efficacy and safety of endoscopic neurectomy versus radiofrequency ablation targeting both the posterior nasal nerve (PNN) and lateral internal nasal branches of the anterior ethmoidal nerve (LINB-AEN) in patients with allergic rhinitis (AR). Methods In this prospective randomized controlled trial, adult patients with moderate to severe AR undergoing endoscopic nerve intervention from November 2023 to September 2025 were randomized to receive either neurectomy or ablation. Surgical targets included both PNN and LINB-AEN. Outcomes were assessed at 1, 3, and 6 months postoperatively and included nasal symptom visual analog scale (VAS), total nasal symptom score (TNSS), rhinoconjunctivitis quality of life questionnaire (RQLQ), total nasal resistance (TNR), olfactory function (VAS, QOD-NS, and Sniffin’ Sticks), and adverse events. Results 61 patients completed follow-up (neurectomy group: n = 30; ablation group: n = 31). Both groups achieved significant symptomatic improvement by 6 months ( p < 0.001). The ablation group demonstrated significantly greater improvement in nasal obstruction ( p < 0.001) and sneezing ( p = 0.008) at 1 month, while the neurectomy group showed earlier improvement in rhinorrhea ( p = 0.002). Both procedures improved nasal resistance. Neurectomy provided a faster, sustained nasal resistance improvement ( p 3 months = 0.001, p 6 months = 0.003) with superior improvement in odor identification ( p < 0.001) and TDI score ( p = 0.005). Notably, no serious complications were reported. Additionally, symptoms of nasal dryness improved from baseline in both groups. Conclusion This is the first randomized controlled study to compare dual-target endoscopic neurectomy and ablation for AR. Both approaches are effective and safe. Ablation offers faster symptom relief, while neurectomy provides superior long-term control of nasal airflow and olfactory function. Individualized surgical planning is recommended based on symptom profile and patient preference. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2500111543 Level of Evidence 2.