There are many causes of vasomotor rhinitis. Mental stress, anxiety, environmental temperature changes, and endocrine dysfunction can cause excessive release of parasympathetic neurotransmitters, causing nonspecific release of histamine, vasodilation, and increased glandular secretion, resulting in corresponding clinical symptoms. Sometimes structural deformities in the nasal cavity, such as deviated nasal septum, are often in contact with or even against the turbinates in heavy cases. This long-lasting irritation can aggravate the disease.
Etiology
1.Psychological and emotional factors
Long-term mental tension, excessive fatigue, mood swings are the root cause of the disease. If you are in an environment with a high sense of urgency, depression and loss for a long time, the incidence will increase sharply.
2, external stimulus factors
Climate change, such as sudden changes in temperature and humidity can cause attacks. Sometimes mistaken for seasonal allergic rhinitis. Atmospheric pollution, such as smoke, dust, alcohol and other chemicals can also induce the disease. Getting up, exercise, etc. can also be a trigger.
3.Endocrine factors
Common in adolescence, menstruation, pregnancy, menopause and the elderly. Sexual excitement can also cause attacks. Diabetes, arteriosclerosis, hypothyroidism can also cause this disease.
4.Drug effects
Long-term use of blood pressure, lipid-lowering drugs, can cause edema of the nasal mucosa; abuse of nasal drops drugs cause drug rhinitis, resulting in nasal mucosa autonomic nervous system dysfunction and induce the disease.
5.Infection factors
A history of chronic rhinitis and sinusitis before the onset of the disease.
Clinical manifestations
1.Nasal congestion type
The symptoms are mainly nasal congestion, mostly intermittent. Some patients have severe nasal congestion in the morning, which is reduced or disappears during the day. Some patients also aggravate every night, often accompanied by alternating nasal congestion with changes in body position. If polypoid changes or nasal polyps occur in the nasal mucosa, there may be persistent nasal congestion of varying degrees. Sneezing may occur from time to time, but to a lesser extent. The nose may be relieved briefly after sneezing. Patients are often unusually sensitive to changes in climate and environmental temperature.
2.Nasal overflow type
Increased watery nasal discharge is the main symptom, mostly accompanied by episodic sneezing. The onset of the disease is often for several days in a row, and several handkerchiefs are changed or a lot of toilet paper is used every day. After a certain interval, itchiness in the nose can develop again under the action of some triggers. This type is more common in women aged 20 to 40 years old, and the mental type is more unstable.
3.Other symptoms
There are still symptoms such as loss of smell and dizziness caused by continuous swelling and congestion of mucous membrane and edema.
Examination
1.Anterior rhinoscopic examination
There is no constant change in the color of the nasal mucosa during rhinoscopy. There are dark red color produced by congestion, or light blue color produced by volume vasodilation, or pale white color produced by mucosal edema. In some cases, one side of the nasal mucosa is congested and dark red, while the other side is pale and edematous.
2.X-ray sinus radiograph
To clarify the presence of concurrent sinus infection.
Differential diagnosis
1.Allergic rhinitis
Positive allergen skin test, eosinophils and basophils in nasal secretions. Seasonal rhinitis episodes are seasonal in nature.
2. Infectious rhinitis
There are acute rhinitis and chronic rhinitis. Nasal secretions are often mucopurulent or mucopurulent, and the secretions are mostly neutrophilic.
3.Very reactive eosinophilic rhinitis
There are a lot of eosinophils in the nasal secretions, but there is no other basis for metaplasia.
4.Aspirin intolerance triad
Although there can be a large number of eosinophils in the nasal secretions, the patient has a history of allergy to salicylic acid preparations or other antipyretic analgesics and a history of asthma, and nasal polyps in the nose.
5.Overpowerful reverse rhinitis
It is caused by the reversal of strong sensory nerve axons in the nose, with sudden sneezing as the main symptom, and the attack is sudden and disappears quickly.
Treatment
Because of the many triggering factors and complex pathogenesis of this disease, comprehensive measures should be taken in the treatment.
1.Avoid or remove triggering factors
Improve working conditions and environment, master the rhythm of life, stabilize emotions, and do not overwork and stress. Implement the necessary psychotherapy or suggestive language to patients, sometimes will also receive obvious effect.
2.Drug treatment
(1)Nasal decongestant
It can be used for those who have nasal congestion as the main symptom. But when applying it, we should pay attention to the occurrence of drug rhinitis. Can take intermittent or alternate administration. Sodium adenosine triphosphate (ATP) has significant efficacy in relieving nasal congestion.
(2) Antihistamines
Many non-immune factors can cause the release of histamine from mast cells, so antihistamines are still effective in many cases, and can be used first for those with obvious symptoms of nasal itching and sneezing.
(3) Anticholinergics
It is suitable for patients with nasal overflow as the main symptom. Isoproterenol bromide aerosol, which can effectively control nasal overflow.
(4)Adrenal corticosteroids
Corticosteroids exert non-specific anti-inflammatory effects at all levels inside and outside the cells, so they have significant efficacy in some cases of vasomotor rhinitis with obvious sneezing symptoms, more watery nasal discharge and obvious edema of nasal mucosa.
3.Surgical treatment
Surgical treatment can be considered in one of the following cases: obvious anatomical deformities in the nasal structure, affecting ventilation or sinus drainage; irreversible lesions, such as proliferative changes in the nasal mucosa or large polyps.
(1) Correction of anatomical deformities
The main structural deformity in the nose that can aggravate the symptoms of vasomotor rhinitis is the deviation of the nasal septum, which is often in contact with the turbinates and even against the pressure. This long-standing irritation can not only aggravate the local inflammatory response, but also often causes headaches. Early correction of the above deformities can significantly reduce the symptoms and even cure.
(2) Removal of non-invertible tissue
Obviously cause nasal congestion hypertrophic turbinates, nasal mucosa long-term edema formed by nasal polyps, should be promptly removed. Reduce the excitability of nerves in the nose and cut off the innervation of parasympathetic nerve fibers to the nasal cavity, but should be carefully chosen.
Prevention
1.Participate in physical exercise regularly to increase the resistance.
2.Be careful not to enter or leave the hot and cold environment abruptly.
3, often do nasal massage, such as long-term use of cold water to wash the face better.
4.Try to avoid contact with known allergens.
5.Take care to keep warm during the attack.