Vasomotor Rhinitis

Question 1

VASOMOTOR RHINITIS

Answer 1

It is nonallergic rhinitis but clinically simulating nasal allergy with symptoms of nasal obstruction, rhinorrhoea and sneez- ing.

Question 2

The condition usually persists throughout

Answer 2

the year

Question 3

the tests of nasal allergy

Answer 3

negative

Question 4

PATHOGENESIS

Answer 4

Nasal mucosa has rich blood supply. Its vasculature is similar to the erectile tissue in having venous sinusoids or “lakes” which are surrounded by fibres of smooth muscle which act as sphincters and control the filling or emptying of these sinusoids. Sympathetic stimulation causes vasoconstriction and shrinkage of mucosa, while parasympathetic stimula- tion causes vasodilation and engorgement. Overactivity of parasympathetic system also causes excessive secretion from the nasal glands.

Question 5

Autonomic ner vous system is under the control of

Answer 5

hypothal- amus and therefore emotions play a great role in vasomotor rhinitis. Autonomic system is unstable in cases of vasomotor rhinitis.

Question 6

Nasal mucosa is also

Answer 6

hyper-reactive and responds to several nonspecific stimuli, e.g. change in temperature, humidity, blasts of air, small amounts of dust or smoke.

Question 7

SYMPTOMS

Answer 7

Paroxysmal sneezing
Excessive rhinorrhoea
Nasal obstruction.
Postnasal drip.

Question 8

Paroxysmal sneezing

Answer 8

Bouts of sneezing start just after getting out of the bed in the morning.

Question 9

Excessive rhinorrhoea

Answer 9

accompanies sneezing or this may be the only predominant symptom. Pofuse and watery and may even wet several handkerchiefs. The nose may drip when the patient leans forward and this may need to be differentiated from CSF rhinorrhoea

Question 10

Nasal obstruction

Answer 10

marked at night. It is the dependent side of nose which is often blocked when lying on one side

Question 11

SIGNS

Answer 11

Nasal mucosa over the turbinates is generally congested and hypertrophic. In some, it may be normal.

Question 12

COMPLICATIONS

Answer 12

nasal polypi, hypertro- phic rhinitis and sinusitis.

Question 13

MEDICAL TREATMENT

Answer 13

1. Avoidance of physical factors which provoke symptoms, e.g. sudden change in temperature, humidity, blasts of air or dust.
2. Antihistaminics and oral nasal decongestants are helpful in relieving nasal obstruction, sneezing and rhinorrhoea.
3. Topical steroids (e.g. beclomethasone dipropionate, budesonide or fluticasone), used as spray or aerosol, are
   useful to control symptoms.
4. Systemic steroids can be given for a short time in very
   severe cases.
5. Psychological factors should be removed. Tranquillizers
   may be needed in some patients.

Question 14

SURGICAL TREATMENT

Answer 14

1. Nasal obstruction can be relieved by measures which reduce the size of nasal turbinates (see hypertrophic rhini- tis). Other associated causes of nasal obstruction, e.g. polyp, deviated nasal septum, should also be corrected.
2. Excessive rhinorrhoea, not corrected by medical therapy and bothersome to the patient, can be relieved by sec- tioning the parasympathetic secretomotor fibres to nose (vidian neurectomy).