Vasomotor rhinitis a ppt for exam prep presented in 2009 for classroom discussion

1. Vasomotor Rhinitis & NARES
-R.Malarvizhi

2. Vasomotor Rhinitis (VMR)
 Also called perennial non-allergic
rhinitis & intrinsic rhinitis
 Clinically resembles allergic rhinitis
 Tests of nasal allergy - negative
 Chronic rhinitis
 3-4 th decade

3. Pathology
 Exact etio not known
 Rich blood supply to nasal mucosa
 Sympathetic stimulation –
vasoconstriction & mucosa shrinkage
 Parasypathetic stimulation- vasodilation &
engorgement
 Parasympathetic overactivity – likely to cause
the condition ( excessive secretion from nasal
glands)

4. Pathology
 Thus Vasomotor imbalance –
offending event
 There is instability in autonomic
control-
 Nasal mucosa is hyperactive &
responds to several non- specific
stimuli eg: temp, humidity, air blasts,
dust & smoke (NARES)

5.  Predisposing drugs- anti-HT, local
vasodilators, physical stress,,
endocrine imbalance,etc

6. Symptomatology
 Paroxysmal sneezing
 Bouts just after getting up from bed
 Excessive rhinorrhoea
 Accompanies sneezing or may b a predominant
symptom
 Profuse & watery
 Leaning forward drips from nose
 Nasal obstruction
 Alternates from side-side i,e dependent side
 Throat & nasal itching
 Frequent nasal infections

8. Signs ( O/E)
 ANTEREIOR RHINOSCOPY
 Nasal mucosa over turbinates- congested &
hypertrophic

9.  POSTERIOR RHINOSCOPY
 Post nasal drip

10. Complications
 Long standing cases
 Nasal polypi
 Hypertrophic rhinitis
 Sinusitis

11. Treatment
 Medical
 Avoid provoking factors eg: dust
 Antihistamines & oral nasal decongesants for
sneezing & rhinorrhoea
 Topical steroids – spray or aerosol
 Beclomethasone dipropionate
 Budesonide
 fluticasone
 Systemic steroids- short time in v. severe
cases
 Psychological factors removal . Tranquilizers
may b needed

12. Treatment
 Surgical
 Nasal obstruction relieved by reducing
size of turbinates
 Asso causes like polypi, DNS needs
appropriate correction
 Vidian neurectomy for excessive
rhinorrhoea not controlled by medical
t/t
 Sectioning parasympathetic n.fibres of
nose

13. NARES
 Non- Allergic Rhinitis with
Eosinophilia Syndrome
 Form of chronic rhinitis asso with
polypi
 Etio – hyperactive nasal mucosa
responding to several non- specific
stimuli
 Symptoms & signs as of VMR

14. Various eponyms
 Drug induced rhinitis
 Rhinitis medicamentosa
 Rhinitis of pregnancy
 Honeymoon rhinitis
 Emotional rhinitis
 Rhinitis due to hypothyroidism
 Gustatory rhinitis
 Non-air flow rhinitis

15. Drug induced rhinitis
 Anti – HT
 Resepine, guanethidine, methyl dopa &
propranolol
 Are sympathetic blocking agents causing nasal
stuffiness
 Anticholinesterases
 Neostigmine in t/t myasthenia gravis
 Acetyl choline- like action --- Nasal obstruction
 OCP

16. Rhinitis medicamentosa
 Topical decongesants cause
rebound phenomenon
 Esp excessive use
 T/T
 Withdrawal of nasal drops
 Short course systemic steroids
 In case of turbinate hypertrophy
surgical reduction

17. Rhinitis of pregnancy
 Persistant rhinitis due to hormonal
changes
 Nasal mucosa- oedematous &
blocks airway
 Sec infection– sinusitis
 Care in prescribing drugs
 T/T
 Local measures
 Cryosurgery

18.  Honeymoon rhinitis
 Follows sexual excitement leading to nasal
stuffiness
 Emotional rhinitis
 Psychological states like anxiety, tension,
hostility, humiliation, resentment & grief
 T/T
 Proper counselling for psychological
adjustment
 Imipramine- has both antidepressant &
anticholinergic action

19. Rhinitis due to Hypothyroidism
 Hypothyroidism leads to hypoactivity
of sympathetic system
 Predominance of parasympathetic
system
 Leads to nasal stuffiness & ‘colds’
 T/T Thyroid hormone replacement

20. Gustatory rhinitis
 Cholinergic response to stimulation of sensory
receptors on palate
 Spicy & pungent food
 Rhinorrhoes, nasal stuffiness, lacrimation,
sweating & flushing of face
 Spicy esp red pepper containing capsaicin
known to stimulate sensory nerves
 RELIEVED by Ipratopium bromide (anti
cholijergic) nasal spray taken few min before
meals

21. Non-air flow rhinitis
 Seen in pts of laryngotomy &
tracheostomy
 Sinz nose not used for air flow --- swollen
turbinates due to loss of vasomotor
control
 Similar changes in nasopharyngeal
obstruction due to choanal atresiaor
adenoidal hyperplasia
 Latter having addi factor of infection due to
stagnation of discharge in nose which wud
otherwise drain freely into nasopharynx

22. Thank You