Your good health: Only try rhinectomy if medications don't work

Your good health: Only try rhinectomy if medications don’t work

Any relatively new treatment has the potential for undetected side effects that only appear after many people have used it for an extended period of time.

Dear Dr. Roach: I am a 72-year-old female in relatively good health. I have a history of allergic rhinitis. The allergy testing and shots regimen was successful in controlling my seasonal allergies. I also have vasomotor rhinitis, which results in a runny nose during meals, drinking hot or cold drinks and after brushing my teeth. I never eat a meal without a napkin or two. I have seen many ENT doctors over the years regarding this condition. I recently tried ipratropium bromide nasal spray, which my ENT was sure would relieve this condition. you did not. An otolaryngologist now suggests excision of the posterior nasal nerves using low-frequency radio waves. Have you heard about this procedure? My ENT device says it has been in use for about 10 years. Clinical studies appear to have been performed by the device manufacturer. My concern is that the ablation procedure may alleviate the problem of rhinitis but it creates another problem.


Posterior nasal neurectomy 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 reduce the amount of signals the nerve sends to the nasal tissues, which in turn reduces the amount of nasal secretions and other symptoms. A very similar procedure can be done with laser therapy or cold to have the same effect on the nerves. At the time of writing, only radiofrequency and cold ablation devices have been approved by the Food and Drug Administration.

I found quite a few trials, not all funded by different device manufacturers, that showed high efficacy with very few side effects. The longest efficacy trial of 52 weeks with the radiofrequency device showed a reduction in symptoms of over 50%.

I would not rush to recommend this procedure. There are many effective medications to try – I especially recommend azelastine nasal spray if you haven’t tried it. These types of procedures should be intended for people who have significant symptoms and have not responded to treatment. Any relatively new treatment has the potential for undetected side effects that only appear after many people have used it for an extended period of time; However, I believe that the possibility of serious adverse effects is small.

Dear Dr. Roach: I have read that thiamine levels in the brains of Alzheimer’s patients showed a deficiency of thiamine. For this reason, it has been suggested that one take a supplement of benfotiamine. What do you think?


You are correct that in autopsy studies, the brains of people who had suffered from Alzheimer’s disease showed low levels of thiamine. While we use intravenous thiamine in one type of severe memory disorder, Wernicke-Korsakoff syndrome, oral thiamine is a poor way to get thiamine into the brain. But oral benfotiamine treatment has been shown to be an effective way to supplement thiamine. The theory is sound, and while some animal studies have shown some benefits, a one-year study of benfotiamine was unable to show a statistically significant benefit in cognitive decline.

Benfotiamine is safe but its effectiveness has not yet been proven. Eating a healthy diet, getting regular exercise, and keeping your brain active remain the best ways to reduce your risk of developing dementia.

sorry d. Roach as he is unable to respond to individual messages, but will include them in the column whenever possible. Readers can email questions to

2022-06-03 11:50:00

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