Vasomotor rhinitis and other non allergic rhinitis

1. Vasomotor rhinitis
&
other non allergic rhinitis
Dr. K.RAVI KUMAR
ASSISTANT PROFESSOR
Dept of ENT
Great eastern medical school,Srikakulam

2. VASOMOTOR RHINITIS (VMR)
It is nonallergic rhinitis but clinically simulating nasal
allergy with symptoms of nasal obstruction,
rhinorrhoea and sneezing.
One or the other of these symptoms may
predominate.
The condition usually persists throughout the year
and all the tests of nasal allergy are negative.

3.  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
 parasympathetic stimulation
causes vasodilation and
engorgement.

4. PATHOGENESIS
Autonomic nervous system is under the control of
hypothalamus and therefore emotions play a great role
in vasomotor rhinitis.
Overactivity of parasympathetic system also causes
excessive secretion from the nasal glands.
Autonomic system is unstable in cases of vasomotor
rhinitis.
Nasal mucosa is also hyperreactive and responds to
several nonspecific stimuli, e.g. change in temperature,
humidity, blasts of air, small amounts of dust or smoke.

5. Stress
Unstable autonomous nervous system
Imbalance between sympathetic and
parasympathetic systems
Overactivity of parasympathetics
Excessive secretion of nasal glands and
congestion of mucosa
Nasal obstruction,Rhinorhhea

6. SYMPTOMS
1. Paroxysmal sneezing. Bouts of sneezing start just after
getting out of the bed in the morning.
2. Excessive rhinorrhoea. This accompanies sneezing or
this may be the only predominant symptom.
3. Nasal obstruction. This alternates from side to side.
Usually more marked at night.
4. Postnasal drip.

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

8. Medical Treatment
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.

9. Surgical Treatment
1. Nasal obstruction can be relieved by measures which reduce
the size of nasal turbinates (see hypertrophic rhinitis). Other
associated causes of nasal obstruction, e.g. polyp, deviated
nasal septum, should also be corrected.
2. Excessive rhinorrhoea, not corrected by medical therapy , can
be relieved by sectioning the parasympathetic secretomotor
fibres to nose (vidian neurectomy).

10. COMPLICATIONS
Long-standing cases or VMR develop
 Nasal polypi,
Hypertrophic rhinitis
Sinusitis.

11. OTHER FORMS OF NONALLERGIC RHINITIS
Nasal mucosa responds to several different stimuli
producing symptoms of rhinitis.
Some of these conditions have acquired specific
eponyms.
Some authorities categorize them under the catch-all
term of vasomotor rhinitis.

12. Drug induced rhinitis
 Antihypertensive drugs such as reserpine,
guanethidine, methyl dopa and propranolol are
sympathetic blocking agents and cause nasal stuffiness.
Anticholinesterase drugs, e.g. neostigmine, used in the
treatment of myasthenia gravis, have acetylcholine like
action and cause nasal obstruc- tion.
Contraceptive pills also cause nasal obstruction
because of oestrogens.

13. Rhinitis Medicamentosa
Topical decongestant nasal drops are notorious to
cause rebound phenomenon.
Their excessive use causes rhinitis.
It is treated by withdrawal of nasal drops
short course of systemic steroid therapy
surgical reduction of turbinates, if they have become
hypertrophied.

14. Rhinitis of Pregnancy
 Pregnant women may develop persistent rhinitis due to hormonal
changes.
 Nasal mucosa becomes oedematous and blocks the airway.
 Some may develop secondary infection and sinusitis.
Treatment:
 local measures such as limited use of nasal drops, topical steroids
and limited surgery (cryosurgery) to turbinates are sufficient to relieve
the symptoms.
 Safety of the developing fetus is not established for newer
antihistaminics and they should be avoided.

15. Honeymoon rhinitis
This usually follows sexual excitement leading to
nasal stuffiness

16. Emotional rhinitis
 Nose may react to several emotional stimuli.
 Psychological states like anxiety, tension, hostility,
humiliation, resentment and grief are all known to
cause rhinitis.
 Treatment is proper counselling for psychological
adjustment.
 Imipramine, which has both antidepressant and
anticholinergic effects, has been found useful.

17. Rhinitis Due to hypothyroidism
Hypothyroidism leads to hypoactivity of the
sympathetic system with predominance of
parasympathetic activity causing nasal stuffiness
and “colds.”
Replacement of thyroid hormone relieves the
condition.

18. Gustatory rhinitis
 Spicy and pungent food may in some people produce
rhinorrhoea, nasal stuffiness, lacrimation, sweating and even
flushing of face.
 This is a cholinergic response to stimulation of sensory
receptors on the palate.
 Spicy food, particularly the red pepper, contains capsaicin
which is known to stimuate sensory nerves.
 It can be relieved by ipratropium bromide nasal spray (an
anticholinergic), a few minutes before meals.

19. Non airflow rhinitis
 It is seen in patients of laryngectomy and
tracheostomy.
 Nose is not used for air- flow and the turbinates
become swollen due to loss of vasomotor control.
 Similar changes are also seen in
nasopharyngeal obstruction due to choanal
atresia or adenoidal hyperplasia, the latter having
the additional factor of infection

20. Thank you