Vasomotor rhinitis is a chronic non-allergic rhinitis caused by an imbalance of the autonomic nervous system leading to hyperactivity of the nasal mucosa. Symptoms include recurrent sneezing, rhinorrhea, and nasal obstruction. The exact cause is unknown but it involves overactivity of the parasympathetic nervous system causing vasodilation and secretion from the nasal glands. Treatment focuses on avoiding triggers, using oral or topical decongestants and steroids, and in severe cases, short term systemic steroids or surgical procedures like turbinate reduction.

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