Ablation of posterior nasal nerves may alleviate condition
DEAR DR. ROACH: I am a 72-year-old female in relatively good health. I have a history of allergic rhinitis. A regimen of allergy testing and shots was successful in controlling my seasonal allergies. I also have vasomotor rhinitis, which results in a runny nose during meals, drinking hot or cold beverages and after tooth brushing. I never get through a meal without needing a tissue or two. I have seen several ENTs over the years regarding this condition. I recently tried ipratropium bromide nasal spray, which the ENT was sure would alleviate this condition. It didn't. Now the ENT doctor suggests ablation of the posterior nasal nerves using low frequency radio waves. Have you heard of this procedure? My ENT says it has been in use for about 10 years. The clinical studies appear to have been done by the manufacturer of the device. My concern is the ablation procedure may alleviate the rhinitis problem but create another problem. -- N.P.
ANSWER: Ablation of the posterior nasal nerves is a new treatment for vasomotor rhinitis, which is characterized by a runny nose after eating or with changes in temperature. The idea is to decrease the amount of signals the nerve sends to the nasal tissue, which will in turn decrease the amount of nasal discharge and other symptoms. A very similar procedure can be done using laser treatment or cold to have the same effect on the nerves. At the time of this writing, only the radiofrequency and cold ablation devices are approved by the Food and Drug Administration.
I found quite a few trials, not all of which were funded by the manufacturers of the different devices, that showed high effectiveness with very few side effects. The longest trial showed effectiveness up to 52 weeks with the radiofrequency device, and greater than 50% reduction in symptoms.
I would not rush to recommend this procedure. There are many effective medications to be tried -- I particularly recommend azelastine nasal spray if you haven't tried it. These kinds of procedures should be reserved for people with significant symptoms that have not responded to treatment. Any relatively new treatment has the potential for undiscovered side effects that show up only after many people have used it for a prolonged period of time; however, I think the likelihood of serious adverse effects are small.
DEAR DR. ROACH: I have read that thiamine levels in the brains of Alzheimer's patients showed a deficiency of thiamine. Because of this, it has been suggested that one take a supplement of benfotiamine. What is your opinion? -- F.C.
ANSWER: You are correct that in autopsy studies, the brains of people who suffered from Alzheimer's disease have shown low thiamine levels. While we use intravenous thiamine in one kind of acute memory disorder, Wernicke-Korsakoff syndrome, oral thiamine is a poor way of getting thiamine into the brain. But the oral treatment benfotiamine has been shown to be an effective way of supplementing thiamine. The theory is sound, and while some animal studies showed some benefit, a year-long study of benfotiamine was unable to show a statistically significant benefit in cognitive decline.
Benfotiamine is safe but has not yet been proven effective. A healthy diet, regular exercise and keeping an active brain remain the best ways of reducing dementia risk.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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