Patients whose condition is refractory to medical therapy may seek additional treatment. Surgical therapy should be considered a possible adjuvant to continued medical therapy. Intranasal examination may demonstrate a deviated septum and/or pronounced turbinate hypertrophy.Many surgical techniques are available to treat inferior turbinate hypertrophy, including submucous resection with or without outfracture, cryotherapy, laser cauterization, electrocauterization, and/or turbinectomy. A randomized control trial of 382 patients with 6-year follow-up was conducted to evaluate submucous resection with lateral displacement (outfracture) in terms of efficacy and complications, and found outcomes to be statistically better than turbinectomy, laser or cryotherapy, or electrocautery.
Most patients had moderate or severe disease (67.0%), which was assessed in terms of severity and persistence of symptoms, and comorbid conditions such as asthma and anxiety. Nasal and ocular symptoms were reported by 83% of patients, either currently or frequently, and 36.4% of patients reported that these symptoms were moderate or severe. More than half of the patients (59.1%) were using 2 or more medicines to manage their AR, and 73.7% of patients taking a nonsedating antihistamine plus an intranasal corticosteroid had moderate or severe disease. Thirteen randomized controlled trials assessed the efficacy of medications for treatment of nonallergic rhinitis symptoms. Only one study examined the role of antihistamines and three studies examined the efficacy of nasal corticosteroids.There is little published evidence for use of antihistamines or nasal corticosteroids for the management of nonallergic rhinitis. Overall, these treatment modalities were well tolerated and devoid of major side effects.