Show Notes
Clear, watery runny nose is only the beginning. The real question in chronic rhinitis is what is actually driving the symptoms, and the answer changes everything from diagnosis to treatment to whether a patient should ever need a procedure. Host Dr. John Craig is joined by two experts in the field, fellow rhinologists and skull base surgeons Dr. Michael Chang from Stanford University and Dr. Omar Ahmed from Houston Methodist for a clinically focused roundtable on the messy reality of non-allergic and mixed rhinitis. They break down why this diagnosis is still a diagnosis of exclusion, why history matters more than most endoscopies, and why so many patients sit in the overlap between allergic and non-allergic disease. You’ll discover: Why non-allergic rhinitis is really a bucket of different pathways, not one simple disease Which symptoms most strongly point to non-allergic disease versus allergy How often clear anterior rhinorrhea, post-nasal drip, congestion, sneezing, and itching actually show up in real practice When allergy testing changes the game and when it may be less useful Why nasal endoscopy is essential for ruling out other causes, but rarely proves rhinitis on its own How ipratropium, azelastine, capsaicin, and mometasone rinses fit into the treatment ladder What Atrovent response may predict about office ablation outcomes The conversation gets especially useful when the group gets into procedures. They compare in-office ablation, cryoablation, radiofrequency treatment, and posterior nasal neurectomy, and they do not shy away from the uncomfortable truth that recurrence, technique, and symptom selection matter a lot. They also dig into newer ideas like anterior nasal nerve treatment and why the future of rhinitis care may be moving beyond the posterior nose. If you treat runny noses, post-nasal drip, or patients who have already failed the usual sprays, this episode gives you the current thinking, the practical algorithm, and plenty of new ideas to apply in clinic tomorrow.
Timestamps 00:00 - Welcome to Rhinology Roundtable and episode setup 00:33 - Why this episode focuses on non-allergic rhinitis 01:28 - Speaker disclosures and why unbiased discussion matters 02:25 - What non-allergic rhinitis actually is 05:51 - Mixed rhinitis as the real-world pattern most clinicians see 07:59 - Why symptoms matter more than labels 08:46 - Classic symptom profile of non-allergic rhinitis 10:08 - Why postnasal drip is harder to interpret than anterior rhinorrhea 15:25 - When to test for allergies 17:03 - Key symptom differences between allergic and non-allergic 18:09 - Mucus viscosity and the feeling of watery versus sticky drainage 20:18 - How often allergy testing changes the diagnosise 24:54 - Endoscopy as a rule-out tool, not a definitive rhinitis test 27:03 - Medical therapy starts with clear runny nose and ipratropium 28:43 - How strong is the response to ipratropium spray? 30:00 - When azelastine gets added 32:05 - Capsaisin as an underused option with real evidence behind it 33:44 - How long to trial ipratropium before calling it a success or failure 36:35 - How many patients improve enough to avoid surgery 41:06 - When symptoms move from medical management to procedures 42:49 - Office ablation versus operative neurectomy 44:12 - Real-world outcomes after cryoablation and recurrence patterns 48:14 - Radiofrequency versus cryoablation durability 49:49 - Outcomes after repeat procedures and why technique matters 52:39 - Ipratropium response as a predictor for ablation outcomes 55:24 - Why postnasal drip remains the hardest symptom to study and treat 58:40 - What anterior nasal nerves are and why they matter 60:07 - Why rhinitis is entering a rapid innovation phase
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In this episode of Rhinology Roundtable, Dr. Ashleigh Halderman talks with Dr. Greg Davis and Dr. Leah Hauser about the expanding role of awake, in-office procedures in rhinology and otolaryngology. They discuss how to decide which procedures belong in the clinic or operating room, how to identify patients who are likely to tolerate office treatment, and the importance of thoughtful anesthesia, trained staff, consistent workflows, and protected scheduling. The conversation also explores the practical side of office-based care: reimbursement and insurance denials, patient comfort, and how procedure durability can differ between office and OR approaches. Their central message is that successful in-office care depends not only on the procedure itself, but also on honest conversations with patients and systems that make the work safe, repeatable, and sustainable.
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Let’s start with some numbers. Between 0.5-2% of upper respiratory viral illnesses convert to true acute bacterial rhinosinusitis. Only 3-6% of the general population is thought to have chronic rhinosinusitis. An astounding 34.6% of people have a primary headache disorder. That is 1 person in 3.
This episode of Rhinology Roundtable, the podcast of the American Rhinologic Society, hosted by Dr. Ashleigh Halderman breaks down pediatric sinusitis from the first diagnostic crossroads to surgical decision-making. The conversation focuses on how children differ from adults, why adenoids matter so much, and how to sort out chronic symptoms, recurrent infections, and the cases where an immune or systemic workup is needed. Joining the discussion are Dr. Chadi Makary Professor, Vice Chair of Clinical Services, and Chief of Rhinology at West Virginia University, and Dr. Sarah Maurrasse Assistant Professor, Assistant Program Director, and Pediatric otolaryngologist at Yale School of Medicine. Our experts share practical, age-specific guidance on diagnosis, imaging, antibiotics, surgery, and long-term management.
In this episode of Rhinology Roundtable, hosted by Dr. Ashleigh Halderman, we explore the complex relationship between allergy and chronic rhinosinusitis (CRS). Our expert guests, Dr. Elina Toskala and Dr. Stella Lee, discuss current evidence, testing strategies, and treatment approaches, emphasizing personalized care and the importance of understanding each patient's unique inflammatory profile. Key topics covered: The distinction between allergy and CRS and common misconceptions Whether allergy causes CRS or acts as a disease modifier The significance of CRS phenotypes and endotypes in management When and how to test for allergies in CRS patients The role of allergy treatment, including immunotherapy, in modulating CRS Controversies surrounding allergic fungal rhinosinusitis and central compartment atopic disease Environmental factors affecting sinus health, including indoor air quality Practical tips on allergy testing methods and interpretation The impact of allergy control on surgical outcomes Considerations for immunotherapy in CRS, especially with biologic treatments Timestamps: 00:00 - Introduction to the complex link between allergy and CRS 02:42 - Meet the experts: Dr. Toskala and Dr. Lee 03:05 - Common misconceptions about allergy and CRS 04:00 - The coexistence of allergy and CRS 06:19 - Does allergy cause CRS? Insights from experts 08:24 - The relationship between allergy, disease severity 10:06 - Modulation versus causation: How allergy influences CRS 12:21 - CRS phenotypes: Polyps, endotypes, and clinical relevance 15:02 - Differentiating allergy symptoms from CRS symptoms 17:26 - The importance of assessing environmental and lifestyle factors 26:14 - Geography and genetics in fungal rhinosinusitis prevalence 30:16 - How environmental factors, like air quality, impact sinus health 39:26 - The role of allergy in specific CRS phenotypes 43:03 - Allergy testing methods: skin prick vs. blood tests 49:19 - Treating allergy to modulate CRS symptoms and improve outcomes 69:03 - Immunotherapy: indications, benefits, and limitations for CRS 78:19 - Key takeaways Resources & Links: American Rhinologic Society https://sinushealth.com/conditions/adult-sinusitis/ https://sinushealth.com/conditions/allergic-rhinitis-allergies-or-hay-fever/ https://onlinelibrary.wiley.com/doi/10.1002/alr.23090 (ICAR: Allergic Rhinitis) https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 (ICAR: Rhinosinusitis) Connect with the Experts: Dr. Elina Toskala - https://www.jeffersonhealth.org/find-a-doctor/t/toskala-elina-m Dr. Stella Lee - https://physiciandirectory.brighamandwomens.org/details/15252/stella-lee-otolaryngology_ears_nose_and_throat-boston