Abstract: Objective: To explore the clinical efficacy of endoscopic vidian nerve branch transection combined with probiotic intervention in the treatment of perennial moderate-to-severe allergic rhinitis (AR), and to clarify the impact of the "local nerve regulation + intestinal immune modulation" combined approach on the improvement of AR symptoms, immune balance, and intestinal flora in moderate-to-severe AR patients, providing a new strategy that combines minimally invasive and systemic regulation for the treatment of moderate-to-severe AR. Methods: Sixty patients with perennial moderate-to-severe AR who were unresponsive to conventional antihistamine treatment from June 2023 to June 2024 were selected and randomly divided into three groups (20 cases each) by lottery: the combined group (endoscopic vidian nerve branch transection +probiotics), the surgery group (endoscopic vidian nerve branch transection), and the probiotics group (probiotics). On this basis, each group's intervention plan was implemented. After treatment, all patients were given standardized antihistamine treatment. The visual analogue scale (VAS) scores for nasal congestion, rhinorrhea, sneezing, and nasal itching, the rhinoconjunctivitis quality of life questionnaire (RQLQ) scores, serum immune indicators (IgE, eosinophil ratio EO%), and the occurrence of complications were compared and analyzed before treatment and at 3 and 6 months after treatment. Results: At 3 and 6 months after treatment, the VAS scores (nasal congestion, rhinorrhea, sneezing, and nasal itching) and RQLQ scores of the combined group were significantly lower than those of the surgery group and the probiotics group (P< 0.05); serum IgE and EO% levels were significantly reduced, and the improvement in these indicators was better than that of the other two groups (P< 0.05). Conclusion: Endoscopic vidian nerve branch transection combined with probiotics for the treatment of moderate-to-severe AR can relieve symptoms through local precise nerve block and improve systemic immune balance through intestinal flora regulation. The combination of the two enhances therapeutic efficacy and prolongs the duration of action, with good safety. It is an innovative treatment approach that combines the advantages of minimally invasive surgery and systemic regulation, and is worthy of clinical promotion.