What Is NEUROMARK® — and Could It Stop Your Chronic Runny Nose?

NEUROMARK® is a radiofrequency device that down-regulates overactive posterior nasal nerves — the nerves responsible for chronic post-nasal drainage, cough, globus sensation, and Eustachian tube dysfunction when they are firing excessively. It is an in-office procedure performed under topical anesthesia with no general sedation required, and clinical data show more than 70% of patients maintain meaningful symptom reduction at two years.

By Franklyn R. Gergits, DO, MBA, FAOCO · Sinus & Allergy Wellness Center of North Scottsdale · Scottsdale, Arizona

If you have struggled with a chronic runny nose, constant throat clearing, post-nasal drip that never resolves regardless of what you try, or an ear that feels chronically full and blocked — and your workup has not identified a treatable upstream cause — you may be dealing with overactive posterior nasal nerves. NEUROMARK® is the most advanced tool available to address that problem directly.

What is NEUROMARK® and how does it work?

NEUROMARK® is a radiofrequency ablation device designed specifically to down-regulate the posterior nasal nerve — the parasympathetic nerve network that controls secretion and sensation across the posterior nasal cavity, nasopharynx, and related structures. When these nerves are overactivated by chronic inflammation, reflux, allergy, or other upstream triggers, they drive excessive mucus production, posterior drainage, cough, and referred symptoms in the ear and throat that no amount of antihistamines or nasal sprays will fully control.

What distinguishes NEUROMARK® from other posterior nasal nerve treatments is its delivery design. The device features longer, wire-like curved paddles that deliver radiofrequency energy across a significantly larger surface area than competing devices. This matters for two reasons. First, the increased surface area means the accuracy of pinpointing the exact nerve location is less critical — the energy blankets the region rather than requiring a precise bullseye hit. Second — and this is the feature that sets NEUROMARK® apart clinically — the paddles can extend treatment beyond where the posterior nasal nerve exits the sphenopalatine foramen on the posterior lateral nasal wall. They reach farther into the posterior nasopharynx, allowing treatment of the peripheral branches of the posterior nasal nerve and the adjacent trigeminal nerve bundle.

That extended reach has clinical consequences. Patients with Eustachian tube dysfunction have experienced significant improvement in ear symptoms following NEUROMARK® treatment — the peripatetic nerve branches serving the Eustachian tube orifice run through the same posterior nasopharyngeal territory the device reaches. Patients with migraine-pattern headache may also benefit, as chronic afferent input through the sphenopalatine ganglion circuit sensitizes the trigeminal pathway — and reducing that afferent load lowers the threshold for trigeminovascular activation.

Who is the right candidate for NEUROMARK®?

The right candidate is a patient with excessive post-nasal drainage who has not found meaningful relief despite attempting to identify and treat the upstream cause. These patients typically present with one or more of the following: chronic posterior drainage that is thick, tenacious, and present regardless of season or allergy treatment; cough that is worse at night and after meals; hoarseness and morning throat clearing; globus sensation — the persistent feeling of something in the throat; recurring tonsillar inflammation driven by chronic posterior drainage bathing the tonsillar tissue; and Eustachian tube dysfunction with ear fullness, pressure, and muffled hearing that is linked to the same posterior nasal inflammatory state.

The upstream triggers of posterior nasal nerve overactivation are multiple — allergy, chronic rhinosinusitis, non-allergic rhinitis, dehydration, and any inflammatory imbalance of the sinonasal mucosa. One upstream driver that is frequently overlooked is pepsin-induced Posterior Sinonasal Syndrome (PSS). Pepsin migrating into the posterior nasal cavity via laryngopharyngeal reflux activates the posterior nasal nerve network through intracellular inflammatory injury — driving the same secretory hyperdrive and afferent sensitization that other inflammatory triggers produce. When PSS is present, NEUROMARK® addresses the neurogenic amplification while upstream pepsin-directed treatment addresses the root cause. Neither intervention alone provides mechanistically complete treatment for the PSS patient — both are required.

What does the procedure involve?

NEUROMARK® at SAWC is performed entirely in our in-office procedure suite under topical anesthesia — no general anesthesia, no operating room, no IV sedation required. Before the procedure, the patient receives oral pre-medications including a comfort and relaxation agent. This takes the edge off and allows the patient to arrive in our procedure suite already calm.

Anesthetic neuro-paddies saturated with lidocaine and epinephrine are placed endoscopically along the floor of the nasal cavity and extending into the nasopharynx. A topical anesthetic gel is applied to the superior anterior attachment of the middle turbinate and delivered anteriorly and posteriorly around it. A smaller neuro-patty is then placed in a wrapping fashion along the middle turbinate. At this point I step out of the room, lower the lights, and the patient rests in a reclined beach chair position listening to music of their choice.

When I return ten to fifteen minutes later, the patient is often asleep. I speak softly to let them wake naturally, then remove the neuro-paddies. The pale color change of the posterior nasal mucosa tells me the anesthesia is working precisely as it should. I suction any excess gel, then inject less than one milliliter of one percent lidocaine with epinephrine into the posterior nasal cavity using the RAND needle — which provides the pinpoint accuracy and stability these injections require. Three to four precise injection points on each side. I then confirm anesthesia by touching the mucosal surfaces — the patient should feel pressure but no pain.

The NEUROMARK® device is then prepared with a slight lateral bend and guided endoscopically to the posterior nasopharynx. The paddles are deployed and lateral distal tension is applied while thirty seconds of radiofrequency energy is delivered. Four standard delivery positions are used: posterior nasopharynx, superior lateral, anterior junction of the nasal cavity and nasopharynx, and posterior middle meatus at the sphenopalatine ganglion region. I then apply two additional targeted deliveries to the posterior inferior mulberry turbinate — the endoscopic finding I have identified as a visible marker of posterior sinonasal syndrome. Treating this area opens the posterior nasal breathing pathway and addresses the neurogenic component of PSS directly. The same sequence is performed on the contralateral side. Additional treatment areas — nasal septal swell bodies, inferior turbinate obstruction sites — are addressed as the anatomy dictates.

The procedure itself takes approximately ten to fifteen minutes. Total in-and-out time including preparation and recovery is about one hour. Recovery involves nasal congestion and possibly mild throat discomfort as the topical anesthesia resolves — both are temporary.

How is NEUROMARK® different from ClariFix and RhinAer?

Three meaningful differences. First, surface area per energy delivery — NEUROMARK®’s paddle design covers significantly more mucosal territory per treatment than RhinAer’s point-contact tip, meaning less positional precision is required and coverage is more complete. Second, the ability to treat peripheral branches of the posterior nasal nerve and trigeminal nerve bundle in the posterior nasopharynx — a reach that ClariFix and RhinAer cannot achieve anatomically — provides the additional benefit to Eustachian tube dysfunction and migraine patients that those devices cannot offer. Third, energy modality — NEUROMARK® and RhinAer both use radiofrequency energy. ClariFix uses cryotherapy, delivering liquid nitrogen via an inflatable balloon placed endoscopically into the sphenopalatine ganglion region. Patients who receive ClariFix with insufficient pre-procedural anesthesia can experience severe, intense cephalgia — a risk profile that radiofrequency devices do not carry. At SAWC, we perform NEUROMARK® exclusively. We do not use ClariFix.

What results should patients expect?

Published clinical data show that more than seventy percent of patients maintain meaningful reduction in post-nasal drainage and cough symptoms at the two-year mark. That is a durable result for a fifteen-minute in-office procedure. The symptoms do not disappear overnight — most patients notice progressive improvement over the first several weeks as the nerve activity down-regulates. Patients who have both NEUROMARK® and upstream treatment for an identified driver — allergy, reflux, PSS — experience the most complete and durable results, because the neurogenic amplification and the upstream inflammatory trigger are being addressed simultaneously.

Want to Understand More?

This post is part of the Understanding Your Symptoms series on the Airway & Sinus Wellness Review.

→ What Is NEUROMARK® — and Could It Stop Your Chronic Runny Nose? — Full Post

→ What Is a Deviated Nasal Septum — and Do I Have One?

→ Will Balloon Sinuplasty Correct My Post-Nasal Drainage?

→ Can Sinus Infections Cause Brain Fog?

→ What Is Balloon Sinuplasty — and Are You a Candidate?

Airway & Sinus Wellness Review — Full Publication

This post is part of the Understanding Your Symptoms series.

About the Author

Dr. Franklyn R. Gergits, DO, MBA, FAOCO is an otolaryngologist and rhinologist with over 30 years of clinical experience treating sinus and airway disease in Scottsdale and the greater Phoenix metropolitan area. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale and performed the first balloon sinuplasty in Pennsylvania. He holds dual Entellus Centers of Excellence certifications and specializes in office-based nasal and sinus procedures under local or IV sedation anesthesia. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis — a clinical framework identifying pepsin-mediated posterior nasal mucosal injury as an upstream driver of chronic rhinosinusitis, with a mechanistic link to posterior nasal nerve overactivation. ORCID: 0009-0000-4893-6332. Preprint DOI: 10.20944/preprints202603.0858.v1. Dr. Gergits has no financial relationship with Neurent Medical.

SinusAndAllergyWellnessCenter.com · 480-525-8999

This content is for educational purposes only and does not constitute medical advice. Please consult a qualified physician for evaluation and treatment of your specific condition. NEUROMARK® is a registered trademark of Neurent Medical.