Vasomotor Rhinitis - Types, Causes, Symptoms, Prevention, and Treatment

Introduction:

The term vaso refers to blood vessels and motor refers to nerves that supply the tissues of the nose and the blood vessels. Rhinitis is the inflammation of the nasal tissues. Vasomotor rhinitis is also called non-infectious or irritant rhinitis. There are different types of non-allergic rhinitis of which vasomotor rhinitis is the most common. The symptoms may come on and off throughout the year. Proper diagnosis should be made only after omitting the other causes.

What Are the Types of Non-allergic Rhinitis?

Different types of non-allergic rhinitis include:

• Infectious Rhinitis: It is also called viral rhinitis which is caused by infections such as the common cold or flu. The virus attacks the lining of the nose and throat which becomes inflamed and this results in mucus production resulting in a runny nose and sneezing.

• Vasomotor Rhinitis: Vasomotor rhinitis occurs as a result of abnormal control of nerves over the blood vessels making them over-sensitive.

• Atrophic Rhinitis: The membranes inside the nose are called turbinate tissues. When these become thin and hard, the nasal passages tend to widen and become dry. Turbinate tissue covers three ridges inside the nose and aids in keeping the noise moist, regulates air pressure while breathing, offers protection from bacterial infections, and has nerve endings that induce a smell. Thinning of the turbinate tissue encourages the growth of bacteria. The person can experience loss of smell due to the formation of crusts inside the nose which can bleed when trying to remove. The turbinate tissue can thin out with age or due to infection or complicated surgery. Atrophic rhinitis presents in individuals who have undergone multiple nose surgeries.

• Rhinitis Medicamentosa: Rhinitis medicamentosa occurs as a consequence of overuse of drugs like nasal decongestants, aspirin, beta-blockers (medications that reduce blood pressure), or cocaine. Nasal decongestants work initially by reducing the inflammation of blood vessels in the nose. If used continuously for more than a week, it can cause the inflammation to recur again even if the original cause has subsided.

What Are the Reasons for Vasomotor Rhinitis?

The blood vessels inside the nose are controlled by a part of the nervous system called the sympathetic nervous system and mucus secretion is controlled by the parasympathetic nervous system. When the nervous control over the blood vessels is poor, it can cause the blood vessels to expand or dilate resulting in inflammation. Mucus secretion is regulated by the contraction and expansion of blood vessels in the nose. Improper control of the nerves can dilate the blood vessels resulting in increased mucus production. The cause for this remains unknown. Certain factors can trigger vasomotor rhinitis. Children and adults are affected but adults above 20 years of age may be affected the most. The majority of the diagnoses are in those between 30 to 60 years of age. Women are more prone to vasomotor rhinitis. Allergic and non-allergic rhinitis affects about half of the population in industrialized countries and non-allergic rhinitis contributes about 15 % to half of this population.

What Factors Trigger Vasomotor Rhinitis?

Many factors can trigger vasomotor rhinitis such as:

• Environmental irritants like perfume, smog, secondhand smoke, or other odors.

• Seasonal changes, especially dry weather.

• Viral infections like the common cold or flu.

• Overuse of nasal decongestant.

• Hot, spicy food or drinks.

• Medications such as aspirin, sedatives, beta-blockers, antidepressants, Ibuprofen, drugs to treat erectile dysfunction, oral contraceptives, and so on.

• Hypothyroidism (insufficient production of thyroid hormone).

• Hormonal changes during menstruation or pregnancy.

• Stress.

• Exposure to irritants or allergens like grains, wood dust, and chemicals like bleach or chlorine (occupational rhinitis).

• Air pollution.

• Alcohol consumption.

What Are the Symptoms of Vasomotor Rhinitis?

The symptoms of vasomotor can occur in several episodes throughout the year and can last for several weeks. Common symptoms are as follows:

• Runny and stuffy nose.

• Presence of mucus in the throat.

• Secretions from the nose that enter the throat are postnasal drip.

• Sneezing.

• Cough.

Differentiation of Allergic and Non-allergic Rhinitis:

Allergic reactions can trigger symptoms like an itchy nose, itchy or watery eyes, and sore throat. These are the classic signs of allergic rhinitis and are not present in non-allergic rhinitis.

How Is Vasomotor Rhinitis Diagnosed?

The diagnosis of vasomotor rhinitis is confirmed only after making sure that the symptoms are not a consequence of allergies. A complete history of the patient is asked and a physical examination of the nose and throat is done. An allergy test will be suggested to detect the presence or absence of allergies. Allergy tests include:

1. Skin Test: In this test, a needle containing a small quantity of the allergy-causing substance like pollens, mold, or dander is introduced into the skin. If there is swelling at the site of the prick, then allergy is confirmed.
2. Blood Test: The level of Immunoglobulin E (Ig E) is checked to see as these are involved in fighting against infections and if their presence indicates an infectious agent. A complete blood count (CBC) can detect the eosinophil (allergy-type white blood cells).
3. Other diagnostic tests:

• Computed tomography (CT) scan of the sinuses to identify whether any growth called polyps or a deviated septum are the cause of rhinitis.

• A narrow fiber-optic tube called an endoscope may be inserted to study the nasal passages and the sinuses.

• Nasal blockages can be detected through nasal inspiratory flow tests.

How Does Non-allergic Rhinitis Affect Pregnant Women?

Non-allergic rhinitis affects pregnant women in the following ways:

• Pregnancy rhinitis or pregnancy nose occurs during the second and third trimesters of pregnancy. Increased blood flow to the nasal passages and the growth of nasal veins can cause inflammation of the nasal lining.

• The symptoms can cause discomfort and can worsen at night when one lies down thus disturbing sleep.

• Long-term congestion can lead to sinus or ear infections. A physician should be consulted in case of facial or ear pain. Lack of sleep can cause tiredness and can affect the baby’s growth.

• Over-the-counter nasal decongestants can worsen nasal congestion. It is better to use a room humidifier, take plenty of fluids, raise the head of the bed with pillows, and stay away from the triggering factors. With the doctor’s recommendation, nasal strips or saline drops can be used. Pregnancy rhinitis usually goes off two weeks after delivery.

How Is Vasomotor Rhinitis Treated?

People with vasomotor rhinitis should avoid exposure to triggering agents. Over-the-counter nasal sprays, nasal decongestants, or corticosteroid nasal sprays can be used to relieve the symptoms initially. Severe symptoms require the undermentioned treatment options:

• Antihistamine (a drug to treat allergy) sprays like Azelastine or Olopatadine Hydrochloride can be beneficial to a few patients when the main symptom is a runny nose or those with a combination of allergic and vasomotor rhinitis. Oral antihistamines are not efficient to treat vasomotor rhinitis.

• Corticosteroid nasal sprays like Mometasone.

• Anti-drip nasal sprays like Ipratropium.

• Nasal decongestants should be used by following the dosage and duration prescribed by the physician.

The surgical option is very rare and is indicated in individuals with other underlying conditions like nasal polyps or deviated septum that aggravates the symptoms. Allergy shots (regular injections taken over a period of time to stop or reduce allergy attacks) cannot help those with vasomotor rhinitis.

What Is the Differential Diagnosis of Non-allergic Rhinitis?

Differential diagnoses are:

• Nasal polyps (soft, painless, non-cancerous masses on the lining of nasal passages or sinuses).

• Previous trauma or injury to the nose.

• Structural abnormalities like a deviated septum.

How to Treat Vasomotor Rhinitis at Home?

At-home treatment options are:

• Rinsing the nose with a saline solution or saline drops instead of decongestant sprays.

• Steam inhalation from a bowl of hot water containing tea tree oil.

• Room humidifier to keep the environment moist and to prevent the nose from becoming dry.

• Avoiding exposure to environmental triggers.

What Are the Complications of Vasomotor Rhinitis?

The complications are similar to allergic rhinitis.

• Sinusitis (inflammation of the tissues or the lining of the sinuses).

• Interference of eustachian tube function (eustachian tube connects the middle ear to the posterior part of the throat).

• Long-standing ear infection (otitis media).

• Asthma.

• Loss of smell.

• Obstructive sleep apnea (relaxation of the muscles that control the airway causing the throat to narrow).

Conclusion:

Vasomotor rhinitis is a type of non-allergic rhinitis that occurs without any cause and can affect productivity at work, difficulty in socializing, increased visits to the doctor, and related side effects from the treatment. Side effects include drowsiness, nasal dryness, and nosebleed. Vasomotor rhinitis can be prevented by avoiding exposure to the triggering factors. It is better to consult a physician if over-the-counter medications do not work or if the symptoms get worse. Prolonged use of over-the-counter medications can worsen the symptoms.