Chronic vasomotor rhinitis: treatment, symptoms
The content of the article:
- The reasons for the development of the disease
- Symptoms of chronic vasomotor rhinitis
- Diagnostics
- Treatment of chronic vasomotor rhinitis
- Prevention
- Video
Why should a doctor prescribe treatment for chronic vasomotor rhinitis? What are the causes of the development of the disease and its main symptoms? What prevention methods can be used?
In recent years, among diseases of the ENT organs, a significant increase in the prevalence of chronic rhinitis has been noted. Among the chronic forms of rhinitis, vasomotor rhinitis occupies a large place. What it is?
Chronic vasomotor rhinitis is a disease that affects the nasal mucosa due to dysregulation of general or local vascular tone.
Vasomotor rhinitis is characterized by nasal congestion and difficulty in nasal breathing.
ICD-10 code (International Classification of Diseases 10 revision) - J30.0.
According to the etiological factor, an allergic or neurovegetative form of the disease is distinguished.
The disease can be caused by physical, chemical or toxic factors. Other types of vasomotor rhinitis:
- psychogenic, in which vascular imbalance develops in connection with the lability of the autonomic nervous system;
- idiopathic;
- mixed.
The reasons for the development of the disease
The pathogenesis of the neurovegetative form of vasomotor rhinitis is based on dysfunction of the autonomic nervous system, both the autonomic nervous system of the nasal cavity, and general vegetative-vascular dystonia.
The imbalance between the departments of the autonomic nervous system in vasomotor rhinitis occurs due to an increase in the tone of one or a decrease in the tone of another of its departments. This pathological process can be initiated by many external and internal factors.
The trigger factor is often a previous respiratory viral infection. Nonspecific reasons may be: tobacco smoke, strong odors, ozone, pollutants, alcohol intake, a sharp change in the temperature of the inhaled air.
Cold air is the main nonspecific trigger of the chronic form of the disease. The increased ozone content in the inhaled air damages the epithelium, increases the permeability of blood vessels. Leukocytes and mast cells begin to migrate into the mucous membrane, stimulating the production of neuropeptides - mediators that are involved in the formation of nasal hyperreactivity in vasomotor rhinitis.
Curvature of the nasal septum can lead to the development of the disease.
Mechanical factors that can cause symptoms of pathology, provided there is nasal hyperreactivity:
- trauma to the nose, including surgery;
- deformities of the nasal septum, the presence of sharp ridges and spines that are in contact with the side wall of the nasal cavity;
- forced exhalation through the nose;
- increased blowing out.
An imbalance in the autonomic nervous system can result in gastroesophageal or laryngopharyngeal reflux, which is also a trigger factor for the disease.
The allergic form of rhinitis is based on a specific IgE-dependent reaction between the allergen and tissue antibodies
The allergic form of vasomotor rhinitis occurs as a result of exposure to various allergens:
- pollen of plants during their flowering period;
- book and house dust;
- feather of birds;
- hair, pet dander;
- daphnia (dry food for fish);
- food products: citrus fruits, honey, strawberries, milk, fish;
- perfumery.
In the pathogenesis of allergic rhinitis, there is a specific IgE-dependent reaction between the allergen and tissue antibodies, as a result of which mediators of the allergic reaction (histamine, serotonin, tryptase) are released, which are involved in the formation of nasal hyperreactivity and the development of clinical signs.
Symptoms of chronic vasomotor rhinitis
The main symptoms of the disease are:
- prolonged difficulty in nasal breathing;
- nasal congestion;
- persistent or recurring clear nasal discharge;
- a feeling of mucus flowing down the back of the throat;
- headache and decreased sense of smell, lacrimation.
The disease is characterized by an increase in the volume of the lower turbinates.
As a result of increased permeability of blood vessels, the volume of the inferior turbinates increases, which leads to nasal congestion. This symptom occurs in the form of seizures and is characterized by the occurrence of profuse mucous or watery nasal discharge and paroxysmal sneezing.
When turning and changing the position of the head, nasal congestion can alternately change from one half to the other. Persistent obstruction of nasal breathing occurs as a result of turbinate hypertrophy, which develops in chronic rhinitis. Also, patients may have signs of vascular dystonia:
- acrocyanosis;
- bradycardia;
- low blood pressure;
- drowsiness;
- neurasthenia.
Diagnostics
Basic and additional diagnostic measures aimed at identifying the disease:
- detailed collection of complaints and anamnesis;
- anterior, posterior rhinoscopy;
- clinical blood test;
- X-ray examination of the nose and paranasal sinuses;
- functional examination of the nose;
- endoscopic examination of the nasal cavity;
- bacterioscopic and bacteriological examination of discharge from the nasal cavity, determination of sensitivity to antibiotics;
- cytological examination of the nasal mucosa;
- computed tomography according to indications;
- blood chemistry;
- determination of IgE;
- conducting an allergy test.
X-rays may be prescribed to diagnose the disease.
During rhinoscopy, depending on the form of vasomotor rhinitis, the following symptoms may be visualized:
- hyperemia and edema of the mucous membrane of the nasal cavity, its pallor or cyanosis, polyposis changes;
- pathological discharge, mucus;
- crust;
- thinning of the bone structures of the nasal cavity;
- false hypertrophy of the shells;
- vitreous edema.
To identify changes in the mucous membrane of the nasal cavity, a test is performed with anemization with adrenergic agonists. After lubricating the mucous membrane of the nasal concha with a 0.1% solution of adrenaline, they decrease to normal size with edema. If the turbinates are enlarged due to hyperplasia of the bone skeleton, their size does not change significantly.
In a clinical analysis of blood with an allergic form of vasomotor rhinitis, eosinophilia is detected, leukocytosis is possible when a secondary infection is attached.
To exclude concomitant acute and chronic pathologies of the ENT organs (the presence of sinusitis, adenoids, curvature of the nasal septum, etc.), an X-ray examination of the nose and paranasal sinuses is performed.
The cause of nasal hyperreactivity must be established. In cases where it is not possible to establish an association of symptoms with a specific trigger factor, vasomotor rhinitis is defined as idiopathic.
According to the testimony of the patient is sent for consultation to an allergist, pulmonologist, neurologist.
Vasomotor rhinitis should be differentiated from hypertrophic rhinitis.
Treatment of chronic vasomotor rhinitis
The approach to the treatment of the disease should be comprehensive, taking into account the concomitant diseases and the general condition of the body. The goal of therapy is to restore nasal breathing and improve the quality of life.
With rhinitis, drugs are prescribed for intranasal administration with antiallergic and vasoconstrictor action
Drug treatment includes:
- systemic antihistamines (Zyrtec, Loratadin);
- local antiallergic agents in the form of drops, spray or gel (Azelastine, Levocabastine);
- decongestants (vasoconstrictor drugs - Tizine, Oxymetazoline) in a short course, no more than 7–8 days;
- endonasal blockade with procaine;
- intramucosal administration of glucocorticoids (Nasobek, Avamis, Fliksonase).
A rational approach to the use of vasoconstrictor drops is very important, since their long-term use necessitates an increase in their dose to achieve a greater effect. This, in turn, can lead to the following undesirable phenomena:
- tachycardia;
- sleep disturbance;
- headaches;
- increased blood pressure;
- angina pectoris;
- reactive hyperplasia of the nasal mucosa, especially of the inferior turbinates;
- bone hyperplasia;
- aggravation of the imbalance of the autonomic nervous system;
- obstruction of the lumen of the nasal cavity, which can no longer be eliminated with decongestants.
To restore the state of the epithelium of the nasal mucosa, it is recommended to use special immunomodulatory drugs (IRS 19).
Irrigation of the nasal cavity with saline, sea water or antiseptic solutions (Miramistin, Octenisept) has a positive effect.
Physiotherapeutic methods have a normalizing effect on microcirculation in the mucous membrane in chronic rhinitis:
- exposure to UHF currents (ultra-high-frequency therapy) or microwaves endonasally;
- endonasal ultraviolet irradiation through the tube;
- exposure to a helium-neon laser;
- endonasal electrophoresis of 0.25–0.5% solution of Zinc sulfate, 2% solution of Calcium chloride;
- ultraphonophoresis with hydrocortisone ointment, Splenin;
- insufflation (inhalation) of Rinofluimucil, Octenisept (diluted 1: 6) into the nose;
- acupuncture.
How to cure chronic vasomotor rhinitis if conservative therapy is ineffective? The solution to the problem may be surgery. According to the indications, it is performed:
- submucosal vagotomy of the inferior turbinates;
- ultrasonic or microwave disintegration of the inferior turbinates;
- submucous laser destruction of the inferior turbinates;
- sparing lower conchotomy.
In some cases, it is possible to use laser technology
Laser technologies make it possible to optimize surgical procedures in the treatment of vasomotor rhinitis and shorten the rehabilitation period for patients. A low-power high-energy laser is used. Upon contact, it does not cause extensive tissue necrosis, which has a positive effect on the timing of laser wound healing.
In the chronic course of vasomotor rhinitis, periodic examination by an otorhinolaryngologist is necessary. This is associated with a high risk of developing chronic inflammatory diseases of the paranasal sinuses, middle ear, pharynx, and larynx.
Respiratory gymnastics is considered an effective method of treatment and prevention.
Patients are advised to follow a diet with restriction of spicy foods, sweet, overly hot foods. Non-drug treatment also includes breathing exercises, which are aimed at preventing the common cold and upper respiratory tract diseases. Based on the positive reviews, regular exercise can improve your overall physical and psychological well-being.
It is necessary to treat general diseases (neuroses, endocrine dysfunction, diseases of internal organs). Provoking factors, active and passive smoking are eliminated.
Prevention
Main preventive measures:
- elimination of exogenous and endogenous factors supporting the disease;
- rehabilitation of purulent-inflammatory diseases of the oral cavity, nasopharynx, paranasal sinuses;
- therapy of somatic diseases: pathologies of the cardiovascular system, kidneys, diabetes mellitus, obesity, etc.;
- improving the hygienic conditions of life;
- spa treatment;
- maintaining a healthy lifestyle;
- hardening procedures, impact on reflex zones (contrast shower, short-term dousing with cold water on the soles of the feet);
- vitamin therapy and rinsing of the nasal cavity with saline or antiseptic solutions at home in the autumn-spring period;
- breathing exercises.
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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