Endoscopic Vidian neurectomy for treating postcoital unilateral hydrorhinorrhea: A case report and literature review

Introduction and importance: Hydrorhinorrhea in response to sexual intercourse and orgasm (honeymoon rhinitis) is an underreported clinical presentation producing physical and behavior discomfort. Vidian neurectomy has been proposed for treating this condition when pharmacological treatment fails.

Case presentation: We present a case of honeymoon rhinitis consisting of a 48 years-old male patient with left unilateral nasal discharge mainly present during sexual intercourse and orgasm. Exploratory nasal endoscopy, CT and MRI were normal. Beta-trace test and all allergy tests were negative. The response to antihistamines and corticosteroids had been negative. A Vidian endoscopic neurectomy was carried out.

Clinical discussion: Using Vidian neurectomy, a complete sympathetic-parasympathetic denervation of the nasal mucosa was achieved. After a follow-up of 15 days, the patient stated that his symptoms had improved. Nasal obstruction, sneezing, and rhinorrhea had decreased without showing symptoms either in the morning or during sexual intercourse. After two years of follow-up, the symptoms were still resolved without any complaints related to his preoperative "honeymoon rhinitis." Anatomical structural relationships between the activation of the autonomic nervous system in the pelvic region and the stimulation of sympathetic-parasympathetic neurons in the nasal mucosa is unknown. However, the use of Vidian neurectomy for treating these cases reveals they may be mediated by a possible disbalance of the autonomic activity.

Conclusion: This case report gives background on the autonomic innervation of the nasal mucosa and how its imbalance causes a clinical condition that we suggest it could be solved by the Vidian neurectomy when other therapeutic measures fail.