Vasomotor rhinitis
The content of the article:
- Causes of vasomotor rhinitis
- Forms
- Symptoms of vasomotor rhinitis
- Vasomotor rhinitis in children
- Diagnostics
- Treatment of vasomotor rhinitis
- Possible complications and consequences
- Forecast
- Prevention
Vasomotor rhinitis is a chronic disease caused by a disorder of the neurovegetative and endocrine regulation of the blood vessels of the turbinates, which leads to hyperemia of the mucous membranes, narrowing of the nasal cavity and difficulty in nasal breathing. According to WHO statistics, vasomotor rhinitis accounts for about a quarter of cases of chronic rhinitis. The disease most often occurs in young people aged 20-40 years.
Picture of vasomotor rhinitis
Causes of vasomotor rhinitis
At the heart of the pathological process in vasomotor rhinitis is the increased excitability of the autonomic nervous system, which causes an abnormal reaction to ordinary stimuli. In parallel, the ciliated epithelium of the mucous membranes of the nasal cavity is transformed into goblet cells, the function of which is to produce mucus. As a result, the amount of secretion increases sharply, while its advancement slows down and the absorption capacity of the mucous membranes decreases, due to which the patient constantly feels nasal congestion and has difficulty with nasal breathing.
Dysregulation of vascular tone in this case can affect only the nasal cavity or act as one of the manifestations of a general violation of vascular tone in neurocirculatory dysfunction with a predominance of the parasympathetic department. The role of provoking factors is played by:
- acute and chronic upper respiratory tract infections;
- anatomical defects that impede the passage of air through the nasal passages;
- endocrine disorders;
- fluctuations in hormonal levels during puberty, during pregnancy and during menopause;
- emotional shocks and neuroses;
- irritants and allergens;
- fluctuations in temperature and humidity.
Allergens, acute and chronic upper respiratory tract infections can lead to the development of vasomotor rhinitis
Another common cause of vasomotor rhinitis is the long-term uncontrolled use of nasal vasoconstrictor drugs and other medications that affect the regulation of vascular tone - oral contraceptives, anti-inflammatory and antihypertensive drugs, antipsychotics, etc.
Sometimes vasomotor rhinitis is one of the manifestations of chronic gastritis, hiatal hernia and other diseases of the digestive system, accompanied by gastroesophageal reflux. Ingress of stomach contents into the nasal cavity injures the surface epithelium of the mucous layer and, ultimately, leads to sensitization and hyperreactivity of the mucous membranes. Vasomotor rhinitis, first diagnosed before the age of 50, may be due to frequent alcohol consumption. Sometimes it is not possible to establish the cause of the disease, in such cases the diagnosis of idiopathic vasomotor rhinitis is made.
Forms
Depending on the predominant etiological factor, two forms of vasomotor rhinitis are distinguished - neurovegetative and allergic. The neurovegetative form usually occurs against the background of neurocirculatory dysfunction. With allergic vasomotor rhinitis, in turn, the year-round and seasonal varieties are differentiated.
By the severity of symptoms:
- mild - only local symptoms are present, and the patient's general well-being remains satisfactory;
- moderate severity - moderate asthenic manifestations and limitation of the patient's activity in the daytime;
- severe - characterized by frequent prolonged exacerbations and a decrease in the patient's ability to work.
Severity of vasomotor rhinitis
The frequency of attacks is also important in the selection of a therapeutic strategy, therefore, in clinical practice, intermittent vasomotor rhinitis is differentiated from persistent. In the first case, exacerbations occur no more than 3-4 times a week, in the second, paroxysmal attacks are repeated almost every day.
Symptoms of vasomotor rhinitis
Most often, vasomotor rhinitis occurs against the background of a clinical picture of a chronic rhinitis, the symptoms of which are well known:
- persistent nasal congestion;
- a large amount of mucous discharge;
- the appearance of crusts in the nasal passages;
- a feeling of heat and dryness in the nose;
- sneezing;
- loss of smell.
Persistent nasal congestion, loss of smell are the main symptoms of vasomotor rhinitis
The differential sign of vasomotor rhinitis is the paroxysmal course of the disease. Exacerbations are of a paroxysmal nature and are provoked by external factors - inhalation of cold air, tobacco smoke and household chemicals, strong odors, dust, hot or spicy food, stress, etc. Often, the symptoms of vasomotor rhinitis intensify after eating or in the morning after waking up, as well as in a supine position and when turning from side to side. At the same time, difficulty breathing is noted alternately in the right, then in the left nostril.
With a prolonged course of the disease due to respiratory disorders, ventilation of the lungs worsens, signs of insufficient blood supply to the brain and severe asthenic symptoms appear: weakness, apathy, fatigue, irritability, headaches, trembling of hands, loss of appetite, insomnia, memory and attention disorders.
Vasomotor rhinitis in children
In young children, vasomotor rhinitis is often associated with allergic conditions and ENT diseases. In particular, there is a direct connection between the incidence of vasomotor rhinitis and adenoiditis, inflammation of the paranasal sinuses, curvature of the nasal septa and other pathologies of the ENT organs. After elimination of the underlying disease, vasomotor rhinitis in children usually resolves by itself.
Vasomotor rhinitis is especially dangerous for infants. Nasal congestion leads to loss of energy, breast rejection and increases the risk of respiratory arrest. With partial nasal congestion, the possibility of breastfeeding remains, however, the sucking movements require serious efforts from the baby. Fatigue and frequent regurgitation prevent them from getting enough nutrients, which can cause children to stunted in growth and development.
Vasomotor rhinitis is a frequent companion of children with inflamed adenoids
The neurovegetative form of vasomotor rhinitis in young children is less common than allergic, however, with a general tendency to autonomic neuroses, there is a risk of developing the disease due to chronic stress. In adolescents, the debut of vasomotor rhinitis may be associated with a sharp change in hormonal levels.
Diagnostics
The preliminary diagnosis is made by an otolaryngologist based on the clinical picture and anamnesis data. During the examination, a thorough examination of the mucous membranes of the nasal cavity, pharynx and larynx is carried out - rhinoscopy, pharyngoscopy and laryngoscopy. During the period of exacerbations, swelling and dryness of the mucous membranes, marble pattern or white-bluish spots on the inner surface of the upper respiratory tract are observed; there may be defects in the nasal septum, hypertrophy of the mucous layer and polyps in the sinuses.
Vasomotor rhinitis is differentiated from allergic rhinitis, sinusitis, tuberculosis, scleroma, syphilis and Wegener's granulomatosis. To clarify the diagnosis, an X-ray of the paranasal sinuses, a complete blood count and allergy tests are usually prescribed. With neurovegetative rhinitis, the level of eosinophils and class E immunoglobulins (IgE) remains within the form, skin tests give a negative result. In the allergic form, eosinophilia and an increased level of serum IgE are noted; during skin tests, as a rule, it is possible to identify allergens. In pregnant women, the initial autonomic tone and hormonal status of the body is also determined; Of particular importance are the indicators of estradiol, estriol and progesterone - hormones that affect neurovegetative reactions.
To differentiate vasomotor rhinitis with other pathologies of the ENT organs, X-ray of the paranasal sinuses is performed
According to the indications, additional studies are carried out - rhinopneumometry and endoscopic examination of the nasal cavity, microscopy of samples of the epithelium of the mucous membranes and bacterial culture of mucous secretions from the nose.
Treatment of vasomotor rhinitis
Mild and moderate forms of vasomotor rhinitis are amenable to conservative treatment. When developing therapeutic regimens, priority is given to eliminating concomitant diseases and provoking factors, restoring microcirculation and vascular tone in the tissues of the nasal cavity, deep sanitation of the nasopharynx and normalizing the functions of the autonomic nervous system as a whole.
The use of intranasal vasoconstrictor drugs to facilitate breathing and relieve edema is strictly excluded; in extreme cases, oral decongensants are prescribed. With a mild course of vasomotor rhinitis, nasal drops based on essential oils give a good effect.
In moderate cases, the edema of the mucous membranes is eliminated by the introduction of intranasal glucocorticoids and sclerosing drugs into the area of the inferior turbinates, novocaine and steroid blockades, or chemical cauterization of hypertrophied mucous membranes. Mucous discharge is removed from the nasal passages using finely dispersed irrigation of the nasal cavity with complex salt solutions. Additionally, tissue preparations that stimulate local immunity can be prescribed.
For mild vasomotor rhinitis, effective oil-based nasal drops
In the case of detection of chronic foci of infection, a course of antibacterial or antiviral drugs is included in the therapeutic regimen. With an allergic form of vasomotor rhinitis, antihistamines of systemic action are used; further the possibility of desensitizing therapy is considered.
Severe deformities of the nasal septum and other serious defects of the intranasal structures are indications for septoplasty or endoscopic correction. In the management of children with adenoiditis, the issue of surgical removal of lesions of lymphoid tissue - adenotomy - is resolved.
In order to restore the soft tissues and blood vessels of the nasal cavity as soon as possible, physiotherapeutic methods are widely practiced:
- inhalation using nebulizers;
- electrophoresis and ultrasonophoresis;
- magnetotherapy;
- ozone-ultraviolet sanitation of the nasal cavity.
The positive results of using photodynamic therapy in vasomotor rhinitis have been reported. The essence of the method: a two-component effect is exerted on the altered areas of the mucous membrane: treatment of damaged tissues with a photosensitizer and irradiation with an exclusive red laser with a wavelength equal to the absorption bands. During the procedure, strong oxidants are formed, and the oxygen contained in the tissues is converted into a cytotoxic form. Since the ability of healthy and pathologically altered tissue to absorb light is not the same, the damaging effect is limited to areas of the proliferating epithelium in the foci of inflammation; healthy cells remain unaffected.
With vasomotor rhinitis, inhalation using nebulizers is indicated
With a low effectiveness of conservative treatment, an operation for vasomotor rhinitis is indicated using the most gentle approach. In moderately severe cases, it is possible to do with the methods of outpatient minimally invasive surgery, such as ultrasound or microwave disintegration, submucosal vasotomy, radio wave or laser destruction of the inferior turbinates. If the need for repeated intervention repeatedly arises, it is recommended to perform a conchotomy - removal of altered mucous membranes together with the bone skeleton of the lower turbinates. The operation is performed in a hospital under endotracheal anesthesia.
Possible complications and consequences
Difficulty breathing with vasomotor rhinitis worsens the aeration of the turbinates and paranasal sinuses, creating the preconditions for the development of sinusitis and sinusitis, and is also considered one of the risk factors for the development of obstructive sleep apnea syndrome - a pathological condition that is accompanied by short-term respiratory stops during sleep and can lead to sudden death … In addition, constant irritation of the pharynx and larynx with an air stream during forced mouth breathing provokes pharyngitis, laryngitis and tonsillitis, and also aggravates the course of chronic tonsillitis.
Difficulty breathing with vasomotor rhinitis can cause sleep apnea
Long-term course of vasomotor rhinitis leads to oxygen starvation of the brain and cerebrovascular accidents, which has negative consequences for the cognitive functions and intellectual productivity of the patient; the ability to learn decreases in children.
Forecast
With timely and adequate treatment, the chances of a complete cure for mild to moderate vasomotor rhinitis are highly estimated. The long course of the disease contributes to the development of chronic hypertrophic rhinitis: proliferative changes in the mucous membranes of the nasal cavity become irreversible. In such cases, surgical intervention is required to achieve a lasting positive effect. In severe vasomotor rhinitis, the prognosis depends on the severity of general symptoms, response to therapy, the presence of complications and concomitant diseases, but in most cases it is possible to achieve a stable remission.
Prevention
For the prevention of vasomotor rhinitis, the general well-being of the nervous system is important, therefore, it is necessary to avoid stressful situations, observe a sparing daily regimen, eat well, give up bad habits and not abuse stimulants. A contrast shower is useful, which serves as a good gymnastics for the vessels.
For relaxation, you can practice breathing exercises, yoga and meditation; useful walks in the fresh air, trips out of town, swimming and water aerobics. Sports loads for patients prone to autonomic disorders are too tiring; moderate but constant physical activity is preferred. Roughness, intimidation and moral pressure are unacceptable in the treatment of excitable children.
For acute upper respiratory tract infections, do not self-medicate; the haphazard reception of potent agents is especially undesirable. Patients with chronic diseases who have to constantly take medication should strictly adhere to the recommended regimen and not resort to self-replacement of drugs. With frequent colds and allergic rhinitis, nasal sprays and drops with a vasoconstrictor effect should not be used for more than two weeks in a row. In order to prevent colds, hardening is recommended, and in case of a tendency to allergies - contact an allergist-immunologist. Reliable determination of the allergen using immunological tests and modern methods of desensitizing therapy allow you to quickly get rid of allergies.
Compliance with hygiene standards in living and working areas has a positive effect on the state of the respiratory system. Regular airing of rooms and wet cleaning at least twice a week are mandatory.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
