Vasomotor rhinitis in children: symptoms and treatment
The content of the article:
- Development reasons
- Symptoms of vasomotor rhinitis in children
- Diagnostics
- Treatment of vasomotor rhinitis in children
- Video
The most common chronic diseases in otorhinolaryngology include vasomotor rhinitis in children. What it is?
Children are often diagnosed with vasomotor rhinitis of various etiologies.
Vasomotor rhinitis is a chronic disease in which the vessels of the turbinates expand under the influence of specific (allergic rhinitis) or non-specific (neurovegetative rhinitis) exogenous and endogenous factors.
There are the following forms of vasomotor rhinitis:
- by etiology: allergic, neurovegetative;
- by the severity of clinical manifestations: hypersecretory, vasomotor, combined;
- by the duration of the course: seasonal, constant;
- by the nature of the course: acute, subacute, chronic.
The ICD-10 code for vasomotor rhinitis in children and adults is J30.0.
Development reasons
Predisposing factors for the development of the disease:
- curvature of the nasal septum;
- the presence of adenoids, polyps in the nose;
- foreign bodies in the nasal cavity and paranasal sinuses;
- disorders of the gastrointestinal tract;
- hereditary diseases (for example, cystic fibrosis);
- long-term use of vasoconstrictor nasal drops;
- a general decrease in immunity.
One of the reasons for the development of the disease is polyps in the nose.
The allergic form of vasomotor rhinitis develops in response to the ingestion of an allergen on the mucous membrane of the upper respiratory tract, to which there is an increased sensitivity of the body. An immunopathogenetic specific reaction develops between the antigen and the antibody, followed by the release of inflammatory mediators (histamine, acetylcholine, serotonin) by mast cells.
The neurovegetative form of vasomotor rhinitis occurs with organic and functional changes in the central and autonomic nervous system, diseases of the endocrine system, and immunovegetative dystonia.
Trigger factors for the development of vegetative nasal hyperreactivity, characteristic of the neurovegetative form of rhinitis, are:
- a past respiratory infection;
- tobacco smoke;
- pungent odors;
- increased content of ozone in the air;
- pollutants;
- a sharp change in the temperature of the inhaled air;
- forced exhalation through the nose;
- increased blowing out;
- gastroesophageal reflux.
The pathogenesis of vasomotor rhinitis is based on an increase in the tone of the parasympathetic division of the autonomic nervous system.
As a result of vascular neurosis, the nasal mucosa reacts inadequately to normal physiological stimuli. Violation of the innervation of blood vessels at the level of the microvasculature leads to a change in tissue homeostasis.
Due to the effect of various irritants on the mucous membrane of the nasal cavity, damage to the epithelium, an increase in vascular permeability, migration of leukocytes and mast cells occurs. As a result, the production of mediators involved in the formation of nasal hyperreactivity is stimulated: neurokinin A, substance P, etc.
Symptoms of vasomotor rhinitis in children
The disease most often begins in children over 6-7 years of age. The main symptoms of the disease:
- difficulty in nasal breathing;
- profuse watery discharge from the nose;
- attacks of paroxysmal sneezing;
- itching and burning in the nasal cavity.
The disease is usually accompanied by attacks of paroxysmal sneezing
Also, increased sweating, paresthesia, facial redness, conjunctivitis, lacrimation are possible. A runny nose can be aggravated by various stimuli (cold, nervous tension). In the interictal period, a child may have:
- nasal congestion;
- decreased sense of smell and hearing;
- general weakness;
- increased fatigue;
- sleep disturbance;
- tachycardia;
- paroxysmal headache (due to cerebrovascular spasms).
Diagnostics
Vasomotor rhinitis rarely occurs in newborns and young children, which is associated with the age-related anatomical features of the body: the cavernous tissue of the turbinates is underdeveloped.
For diagnosis, an X-ray may be prescribed to detect foreign bodies, tumors, etc. in the sinuses.
On examination, signs of vagotonia may be detected:
- acrocyanosis (cyanosis of the tip of the nose, fingers, toes);
- bradycardia;
- low blood pressure;
- drowsiness;
- neurasthenia.
With rhinoscopy, swelling of the nasal mucosa is noted. Hyperemic areas alternate with pale, pink and cyanotic - a symptom of Voyachek ("game of vasomotors").
An important role is played by contact microendoscopy, which makes it possible to make differential diagnosis of various forms of rhinitis.
A cytological, microbiological study of the detachable nasal cavity is prescribed with the determination of sensitivity to antibiotics.
According to the indications, an X-ray examination or computed tomography of the nose and paranasal sinuses, a biopsy (in the presence of granulomas, tumors) are performed.
Neurological examination of the child is necessary to identify organic or functional changes in the nervous system: encephalitis, arachnoiditis, vegetative neurosis, diencephalic pathology.
Treatment of vasomotor rhinitis in children
The treatment regimen depends on the cause of the disease and includes several areas:
- decrease in reflex excitability and blood filling of the nasal mucosa;
- normalization of the function of the central and autonomic nervous system;
- identification and elimination of an allergen or nonspecific irritant from the environment;
- specific immunotherapy;
- symptomatic treatment.
It is recommended to moisturize the nasal mucosa with solutions of sodium chloride (saline). Saline is prescribed to patients of any age as care for the nasal cavity and with difficulty in nasal breathing and rhinorrhea.
Saline has the following effects:
- helps to moisturize and cleanse the nasal mucosa in case of dryness and irritation during colds, adverse environmental conditions and for daily hygiene of the nasal cavity;
- loosens mucus and makes it easier to remove it from the nose;
- maintains the normal physiological state of the nasal mucosa, enhances its resistance to pathogenic bacteria and viruses, helps to remove allergens from its surface;
- improves the functioning of the mucociliary epithelium.
The use of the drug is advisable in children suffering from secondary hyperreactivity of the mucous membrane against the background of hypertrophy of the adenoids, adenoiditis, with post-infectious syndrome.
With pronounced edema of the mucous membrane and nasal obstruction, vasoconstrictor nasal drops (Xylometazoline, Vibrocil) are prescribed.
As part of the complex treatment, antiseptic solutions are prescribed, in particular Miramistin
In pediatric practice, drugs are actively used that form a film on the mucous membrane of the nasal cavity. Silver proteinate (Protargol, Collargol) protects the mucociliary epithelium and has antiseptic properties. Also, positive reviews on the use of antiseptic solutions of Chlorhexidine or Miramistin prove their important role in the therapy and prevention of exacerbations of vasomotor rhinitis.
It should be remembered that the nose is a reflexogenic zone and affects the entire body. Physiotherapy methods for vasomotor rhinitis include:
- the effect of diadynamic current on the upper cervical sympathetic ganglia;
- electrophoresis of 1% novocaine solution on the collar zone according to Shcherbak;
- contact laser therapy of the pterygopalatine node;
- intranasal blockade with novocaine, hydrocortisone;
- phonophoresis of corticosteroid drugs;
- exposure to a helium-neon laser;
- magnetotherapy;
- acupuncture and electroacupuncture in case of parasympathetic orientation of vegetative tone.
Depending on the indications, surgical treatment may be prescribed
In children, surgical treatment of vasomotor rhinitis is required in the presence of diseases that contribute to congestion in the nasal mucosa. According to the indications, adenotomy, submucosal resection of the nasal septum, radio wave or laser conchotomy, vasotomy, removal of chronic foci of infection in the body (for example, osteomyelitis) are performed.
Pediatrician Komarovsky E. O. recommends changing the conditions in which a sick child stays, and his daily routine: control the air temperature and humidity in the room, regularly carry out wet cleaning, use air purifiers.
Although vasomotor rhinitis is not life-threatening, nasal symptoms interfere with daily activities, interfere with sleep, and affect the quality of life of both the child and the parents. The disease can affect the intellectual and social development of the baby, so timely diagnosis and treatment is very important.
Video
We offer for viewing a video on the topic of the article.
Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
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