VASOMOTOR RHINITIS

Vasomotor Rhinitis

• Definition: A non-allergic form of rhinitis, characterized by increased vasomotor tone leading to rhinorrhea, nasal obstruction, and sneezing.

• Pathology: The pathology of vasomotor rhinitis involves the overstimulation of the parasympathetic nervous system, leading to the release of acetylcholine and subsequent constriction of the blood vessels in the nasal mucosa. This causes the nasal mucosa to become edematous, leading to rhinorrhea and nasal obstruction.

  The nasal mucosa is innervated by both the sympathetic and parasympathetic nervous systems. The parasympathetic nervous system is responsible for promoting nasal secretion and vasodilation, while the sympathetic nervous system promotes vasoconstriction and nasal dryness.

  In vasomotor rhinitis, the parasympathetic nervous system is overactive, leading to an imbalance in the sympathetic and parasympathetic tone. This imbalance causes the nasal mucosa to become overactive and produces symptoms of rhinitis.

• Types:

  1. Allergic vasomotor rhinitis: This is the most common type of vasomotor rhinitis and is characterized by an allergic response to environmental allergens.
  2. Non-allergic vasomotor rhinitis: This type of rhinitis is not caused by an allergic response and is often associated with other conditions such as sinusitis or gastroesophageal reflux disease.

• Causes:

  1. Allergens: Exposure to environmental allergens such as pollen, dust, and mold can trigger an allergic response and lead to vasomotor rhinitis.
  2. Hormonal changes: Hormonal fluctuations during pregnancy, menstruation, or menopause can lead to vasomotor rhinitis.
  3. Sinusitis: Chronic sinusitis can lead to vasomotor rhinitis due to the chronic inflammation and infection of the sinuses.
  4. Gastroesophageal reflux disease (GERD): GERD can lead to vasomotor rhinitis due to the chronic inflammation of the esophagus and the stomach.
  5. Medications: Certain medications such as antidepressants, antihistamines, and decongestants can trigger vasomotor rhinitis as a side effect.

• Clinical features:

  1. Rhinorrhea: The nasal discharge is often watery and clear, but can also be thick and yellowish.
  2. Nasal obstruction: The nasal passages become swollen and constricted, leading to difficulty breathing through the nose.
  3. Sneezing: Sneezing is a common symptom of vasomotor rhinitis, especially in response to allergens.
  4. Postnasal drip: The sensation of mucus dripping down the back of the throat is a common symptom of vasomotor rhinitis.
  5. Loss of smell: The nasal passages become inflamed and swollen, leading to a loss of smell.

• Investigations:

  1. Nasal endoscopy: A flexible tube with a camera is inserted into the nasal passages to visualize the nasal mucosa and identify any signs of inflammation or infection.
  2. Allergy testing: Blood tests or skin prick tests are used to identify any allergens that may be triggering the vasomotor rhinitis.
  3. Sinus CT scan: A CT scan of the sinuses is used to identify any signs of sinusitis or other conditions that may be contributing to the vasomotor rhinitis.

• Complications:

  1. Sinusitis: Chronic sinusitis can lead to the development of abscesses or other complications in the sinuses.
  2. Nasal septum perforation: The chronic inflammation and infection of the nasal passages can cause the nasal septum to perforate.
  3. Chronic nasal discharge: The chronic inflammation and infection of the nasal passages can lead to a persistent nasal discharge.

• Management:

  1. Avoidance of allergens: Avoiding exposure to environmental allergens can help to prevent the development of vasomotor rhinitis.
  2. Medications: Antihistamines, decongestants, and corticosteroids can be used to manage the symptoms of vasomotor rhinitis.
  3. Nasal saline irrigation: Rinsing the nasal passages with saline solution can help to remove mucus and debris and reduce inflammation.
  4. Saline nasal spray: Using a saline nasal spray can help to moisturize the nasal passages and reduce inflammation.

• Treatment:

  1. Antihistamines: Diphenhydramine, chlorpheniramine, and loratadine are commonly used to manage the symptoms of vasomotor rhinitis.
  2. Decongestants: Pseudoephedrine and phenylephrine are commonly used to reduce nasal congestion and sinus pressure.
  3. Corticosteroids: Fluticasone and triamcinolone are commonly used to reduce inflammation and swelling in the nasal passages.
  4. Nasal saline irrigation: Rinsing the nasal passages with saline solution can help to remove mucus and debris and reduce inflammation.

• Homoeopathic treatment:

  1. Pulsatilla: This remedy is often used to treat vasomotor rhinitis, especially when the symptoms are triggered by emotional stress.
  2. Natrum mur: This remedy is often used to treat vasomotor rhinitis, especially when the symptoms are triggered by hormonal changes.
  3. Euphrasia: This remedy is often used to treat vasomotor rhinitis, especially when the symptoms are triggered by exposure to allergens.
  4. Luffa operculata: This remedy is often used to treat vasomotor rhinitis, especially when the symptoms are triggered by sinusitis.