What happens in the nose
The inferior nasal turbinates are covered with mucous membrane with a dense network of vessels, which normally warms and humidifies the air, alternately swelling in one or the other half of the nose. With vasomotor rhinitis, the regulation of these vessels is disrupted, and they dilate in response to harmless stimuli. Vasoconstrictor drops provide quick relief, but after a few hours they cause repeated, more severe swelling. If you use them for longer than 5-7 days, a vicious circle is formed: the more often you drip, the stronger the congestion - this is medicinal rhinitis.
- Vasomotor rhinitis - excessive vascular response to irritants
- Drug-induced rhinitis - a consequence of overuse of drops
- Rhinitis in pregnant women is a temporary form associated with hormones
- Rhinitis due to taking certain pills, for example for blood pressure
- Rhinitis in the elderly - watery discharge when eating and in the cold
Causes and provoking factors
The mechanism of vasomotor rhinitis is associated with an imbalance of the autonomic nervous system, which controls the tone of the mucosal vessels. Congestion can be triggered by temperature changes, air conditioning, perfumes, tobacco smoke, alcohol, hot and spicy foods, and emotional stress. Hormonal changes during pregnancy and thyroid diseases increase swelling of the mucous membrane. The cause of drug-induced rhinitis is always the long-term use of vasoconstrictor drops and sprays, often started with a common cold. A deviated nasal septum aggravates both forms.
- Cold or dry air, air conditioning
- Strong odors, smoke, exhaust fumes
- Spicy and hot food, alcohol
- Stress and overwork
- Pregnancy, hypothyroidism
- Taking certain blood pressure medications
- Using vasoconstrictor drops for longer than a week
Symptoms
The main complaint is nasal congestion, which can move from one side to the other and worsens when lying down and at night. The discharge is usually clear and watery, sometimes there is almost no discharge, but there is a sensation of mucus draining into the throat. Unlike allergic rhinitis, itchy nose, frequent sneezing and lacrimation are mild, and the symptoms do not depend on the season of flowering and contact with animals. With drug-induced rhinitis, a person cannot fall asleep without drops, constantly carries the bottle with him and notices that the effect of each dose becomes shorter and shorter.
- Constant or intermittent nasal congestion
- Clear watery discharge
- Drip of mucus down the back of the throat
- Snoring and mouth breathing during sleep
- Decreased sense of smell
- Headache and dry mouth in the morning
- Need drops every few hours
Diagnostics
The diagnosis of vasomotor rhinitis is made by exclusion: you need to make sure that the runny nose is not associated with allergies, infection, polyps or anatomical defects. The ENT doctor finds out what medications the patient has been using and for how long, and performs an endoscopy of the nose, assessing the septum, nasal turbinates and mucous membrane. A test with a vasoconstrictor helps to distinguish reversible edema from the proliferation of shell tissue. To exclude allergies, general and specific IgE are determined or skin tests are performed by an allergist. CT scanning of the sinuses is prescribed for suspected sinusitis and before surgery.
- Endoscopic examination of the nasal cavity
- Test with a vasoconstrictor drug
- General and specific IgE, allergy panels
- Skin tests with an allergist
- Anterior active rhinomanometry
- CT scan of the paranasal sinuses - according to indications
Treatment and cessation of drops
For drug-induced rhinitis, the first step is to discontinue vasoconstrictor drops. Refusal is carried out immediately or gradually, for example, at first only in one half of the nose, and the difficult period is alleviated by nasal glucocorticosteroids prescribed by the doctor. Congestion usually goes away within a few weeks. Vasomotor rhinitis is treated with nasal lavages, nasal glucocorticosteroids, antihistamines and anticholinergic sprays, avoiding provoking factors. If medications do not help or the conchae are irreversibly enlarged, gentle operations are performed: radio wave or laser vasotomy, plastic surgery of the inferior conchae, septoplasty.
- Refusal from vasoconstrictor drops under the supervision of an ENT doctor
- Nasal glucocorticosteroids
- Antihistamine and anticholinergic nasal sprays
- Rinsing the nose with saline solutions
- Air humidification, smoking cessation
- Vasotomy and plastic surgery of the inferior turbinates
- Septoplasty for deviated septum
