ClariFix for Chronic Runny Nose and Congestion

by , last modified on 11/12/18.
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Normally, a persistently runny nose and congestion is treated with medications. Such medications include decongestants like sudafed, steroid nasal sprays, anti-histamine nasal sprays, oral antihistamines, and even ipratropium nasal spray. Such medications are used to treat allergies and/or non-allergic rhinitis that may be triggering the runny nose and congestion.

Often, these medications DO work. If severe allergies are present, allergy shots can even be considered.

However, in some patients, medications may help, but incompletely resulting in improved, but still persistent symptoms. In rare patients, the symptoms are only minimally improved.

In other patients, although medications DO help, they wish to cut down on the amount of drugs being used on a daily basis.

A surgical procedure called turbinate reduction may help symptoms of congestion, but runny nose complaints may not resolve as much.

For such individuals with symptoms of an intractable persistent runny nose with or without congeston, there is a different surgical option to significantly help called ClariFix.

The nerve that governs nasal mucus production is called the Vidian Nerve. It is located within the very back wall of the nose. From this main nerve trunk, smaller neural branches spread out from the back wall towards the rest of the nasal cavity. These smaller nerve branches are called the posterior nasal nerves depicted in yellow in the image below.



All images from Arrinex. Reproduced with Permission.

 

Historically, the surgical method to resolve an intractable persistent runny nose with or without congestion is to cut the vidian nerve. This procedure is performed under general anesthesia and it works well, but does have potential for significant side effects including dry eyes, nasal crusting, nosebleed, visual disturbance, headache, facial pain, and numbness of palate, cheek, or teeth. It is also technically difficult to perform.

ClariFix differs from vidian neurectomy in that it addresses the smaller posterior nasal nerves rather than the vidian nerve itself. Consequently, ClariFix offers additional advantages over vidian neurectomy as follows:

• Technically easier to perform
• Can be performed in the office under local anesthesia
• Potential minor side effects include temporary dry eyes, congestion, crusting, nosebleed, ear blockage, and numbness of lip/upper teeth/palate
• Pain after the procedure can typically be managed with tylenol and ibuprofen alone. Pain typically described as brain freeze headache.
• Complete healing occurs within 4 weeks with 80% of patients reporting over 50% reduction in runny nose and congestion symptoms on average.


The ClariFix device is essentially composed of two parts. The cryogen chamber which contains the liquid nitrogen and the cryo probe which is what is inserted into the patient's nose to precisely administer the freezing and ablate the posterior nasal nerves. Although the nerves are ablated with freezing, the blood vessels are preserved with ClariFix.

Watch the video here to see how the whole thing works:

Aftercare is fairly straightforward. Pain control is mainly with tylenol and ibuprofen. The patient should also perform saline flushes to the nose at least 4 times a day for 2-4 weeks (until crusting that develops during the healing process has fully resolved). Read postop instructions here.

Patients who are candidate for ClariFix must:

• Be over 18 years old
• Suffer from an intractable runny nose in spite of medications (or desire to reduce the number medications to treat the runny nose)
• Have no significant anatomic nasal deformities (ie, deviated septum, very large obstructive turbinates, nasal polyps, etc)
• Not be on any type of blood thinner
• And NOT suffer from any of these conditions: recurrent nosebleeds, cryoglobulinemia, cold urticaria, raynaud’s disease, chronic sinus infections, paroxysmal cold hemoglobinuria, neuropathic conditions

Please keep in mind that ClariFix does not CURE a runny nose. ClariFix does NOT cure allergies either. If you get sick with a viral upper respiratory infection, the nose WILL get drippy. If you have a bad allergy attack, you will still have some degree of a runny nose.

What ClariFix will help with is to reduce the overall amount of how runny the nose is baseline.

References:

Cryosurgical Posterior Nasal Tissue Ablation for the Treatment of Rhinitis. Int Forum Allergy Rhinol. 2017 Oct;7(10):952-956.

Cryotherapy for the Treatment of Chronic Rhinitis: A Qualitative Systematic Review. Am J Rhinol Allergy. 2018 Sep 19:1945892418800879. doi: 10.1177/1945892418800879.

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