Non-allergic perennial rhinitis (Vasomotor Rhinitis) : Causes, Factors, Symptoms, Treatment
What is Vasomotor Rhinitis / NANIPER :
Vasomotor rhinitis is believed to result from disturbed regulation of the parasympathetic and sympathetic systems in which the parasympathetic system dominates, resulting in vasodilation and edema of the nasal vasculature.
Possible compounding factors included previous nasal trauma and extraesophageal manifestations of gastroesophageal reflux disease.
- nasal obstruction,
- These symptoms are excessive at times and are exacerbated by certain odors (e.g., perfumes, cigarette smoke, paint fumes, inks); alcohol; spicy foods; emotions; and environmental factors such as temperature, barometric pressure changes, and bright lights.
- Rates of anxiety and depression are higher in women with vasomotor rhinitis than in healthy women without rhinitis.
changes in weather or humidity, the presence of irritating fumes, or air conditioning or stress
Patients with vasomotor rhinitis are further divided into two subgroups: “runners,” who demonstrate “wet” rhinorrhea; and “dry” patients, who exhibit nasal obstruction and airflow resistance with minimal rhinorrhea.
1. Medical / Pharmacological:
- Intranasal anti-choloinergics (that act on parasympathetic system) such as Ipratropium bromide, may be useful in patients with in patients with nasal secretions as predominant symptom
- The use of Nasal decongestants such as xylometazoline, should be avoided or limited to ten days
- Topical steroids and antihistamines are two main classes of drugs employed
- Azelastine is effective for rhinnorhea, post-nasal-discharge and nasal congestion
- The results of use of steroids are inconsistent. Their use shall be reserved for patients with severe symptoms that are associated with predominant inflammatory process.
- Those patients who don not respond to steroids treatment with non-conventional therapies such as silver nitrate, botulin toxin and intranasal capsaicin.
- The use of Capsaicin (which acts on vanillinoid receptors that mediate pain, burning sensations) has been reported in NANIPER patients. Once daily for five days intranasal capsaicin significant improvement in symptoms
Where nasal obstruction is predominant symptom and if inferior turbinate is hyperplastic surgical interventions is indicated to reduce its size. The various methods to reduce the size of the inferior turbinate include: electric cautery, chemical cautery, cryo-cautery, sub-mucosal diathermy, turbinectomy and sub-mucosal diathermy.
Vidian neurectomy by excision, cryocauter or diathermy