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Vasculomotor rhinitis

Epidemiology

Prevalence of vasculomotor rhinitis was not investigated; the disease occurs at various groups of patients.

Classification

Classification of vasculomotor rhinitis is based on the etiological principle. Allocate medicamentous, hormonal, reflex and idiopathic vasculomotor rhinitis.

Etiology and pathogeny

Vasculomotor rhinitis — a chronic disease at which dilatation of vessels of nasal sinks or nasal hyperreactivity develop under the influence of nonspecific exogenous or internal causes, but not as a result of immunological reaction. A role of starting factors can be played:
• cold;
• the increased humidity;
• hot or spicy food;
• alcohol;
• tobacco smoke;
• the factors polluting environment;
• strong smells;
• emotional stress;
• reception of some medicines;
• hormonal reorganizations of an organism.
The pathogeny of vasculomotor rhinitis is a little studied. Assume that the main pathogenetic mechanism of vasculomotor rhinitis is disturbance of activity of the efferent structures which are responsible for regulation of a tone of a vascular network of nasal sinks (this theory has no still scientific confirmation).

Medicamentous rhinitis most often develops at persons who it is long (over 7 — 10 days) used vasoconstrictive medicines for topical administration. Over time abuse of these medicines leads to development of the tachyphylaxis and medicamentous dependence demanding more and more frequent use of medicines for recovery of nasal breath. Practically all medicines for treatment of an idiopathic hypertensia cause increase of a krovenapolneniye in a nasal cavity, but to a thicket of others lead Reserpinum, phentolamine to development of vasculomotor rhinitis, guanetidin, Methyldopum, Prazozinum and APF inhibitors. Some neuroleptics (Chlorpromazinum) and peroral contraceptive medicines can cause similar effect. Apparently, at medicamentous rhinitis there is an oppression and - adrenoceptors of a mucous membrane of a nasal cavity.
The most typical example of hormonal rhinitis is rhinitis of pregnant women. It is possible that at the same time the acetylcholinesterase inhibition estrogen leads to increase of level of acetylcholine in blood that is shown by hypostasis and hypersecretion of a mucous membrane of a nose.
The similar form of vasculomotor rhinitis can develop in time of the pubertal period.
Change of character of a nasal secret (condensation) and a congestion of a nose quite often are present at hypofunction of a thyroid gland, however communication between symptoms of rhinitis and products of thyroid hormones is not clear yet.
Reflex rhinitis. The most various incentives can change reflex activity of the autonomic nerves innervating a mucous membrane of a nasal cavity and, therefore, a tone of its vessels and products of glands. One of kinds of reflex rhinitis is food rhinitis. This form of vasculomotor rhinitis develops mainly at men 50 years are more senior, its pathogeny is not clear, but it is considered that this reflex is mediated by a vagus nerve. Beer, wine and other alcoholic beverages can cause a vazodilatation and a congestion of a nose as display of vasculomotor rhinitis. Cold rhinitis is one more of forms of reflex vasculomotor rhinitis. The main role in its pathogeny is played by nonspecific nasal hyperreactivity.
It is difficult to define some forms of vasculomotor rhinitis precisely in specific category. So-called rhinitis of "honeymoon" can be both hormonal, and psychogenic by the nature.
In many cases it is not possible to establish connection between symptoms of vasculomotor rhinitis and specific starting factors, in these situations vasculomotor rhinitis is defined as idiopathic rhinitis.
In development of vasculomotor rhinitis deformations of a nasal partition, especially acute crests and thorns contacting to a lateral wall of a nasal cavity and causing hypostasis of a mucous membrane in the field of contact can play an important role.

Clinical signs and symptoms

Vasculomotor rhinitis is characterized periodic or resistant clinical by manifestations among which the main are the difficulty of nasal breath and watery allocations from a nose. Attacks of sneezing are less characteristic. At survey the lower nasal sinks look increased, are badly reduced at an anemization, their mucous membrane is stagnation hyperemic, a tsianotichna, sometimes pale, with hemorrhages. The increased nasal sinks quite often do not allow to see at a front rinoskopiya of deformation of back departments of a partition of a nose which are an actual reason of the vasculomotor phenomena.
Symptoms of vasculomotor rhinitis of pregnant women (generally a nose congestion), as a rule, appear at the beginning of the second trimester, persistirut during all pregnancy and usually disappear after the delivery.
Classical example of food vasculomotor rhinitis is the form which is characterized by plentiful watery allocations from a nose during meal (usually hot or acute).
Sudden attacks of sneezing, rhinorrhea a nose congestion which appear at sharp cooling of legs, hands, persons or on draft are characteristic a bit later of cold vasculomotor rhinitis. Quite often similar symptoms develop at contact with a bright sunlight.

The diagnosis and the recommended clinical trials

Patients have to be inspected for an exception of the allergic nature of a disease (careful collecting the anamnesis, a blood analysis and a nasal secret regarding an eosinophilia, if necessary carry out skin tests with allergens).

Differential diagnosis

Behind a mask of vasculomotor rhinitis atypical forms of allergic rhinitis with which and it is necessary to carry out differential diagnosis quite often disappear. True forms of food vasculomotor rhinitis should be differentiated with allergic rhinitis at a food sensitization, quite often meeting at children, and cross allergic reactions between the pollen of plants and vegetable foodstuff (apple, a peach, plum, an apricot, a pear, cherry, etc.) containing related allergens.

General principles of treatment

In therapy of vasculomotor rhinitis identification and elimination of starting factors is of great importance, however in practice it is not always possible.

The pharmacotherapy is begun about glucocorticoids for topical administration though their efficiency is significantly lower, than at allergic rhinitis. At medicamentous rhinitis in process of development of effect from glucocorticoids the patient has to try to lower a daily dose and then to refuse vasoconstrictive medicines:
Beclomethasone on 50 mkg in each nostril 3 r / days or
Budesonid on 100 mkg in each nostril 2 r / days or
Mometazon on 50 mkg in each nostril 1 r / days or
Flutikazon on 50 mkg in each nostril 1 r / days

In case of inefficiency of all other methods carrying out a short course of system therapy of glucocorticoids is possible:
Prednisolonum in 0,5 — 1 mg/kg/days during 14 days with a gradual dose decline from the 10th days
Apply also sparing surgical interventions on the lower nasal sinks. The preference is given to submucosal types of a turbinotomy: laser, sheyverny, osteoturbinotomies, vasotomies, ultrasonic disintegration.
Surgical correction of deformations of a partition of a nose has to be executed in an initiation of treatment.
Are empirically used physical therapy (an electrophoresis of Calcium chloratum, zinc sulfate, etc.) and acupuncture.

Assessment of efficiency of treatment

Treatment of vasculomotor rhinitis represents big difficulties, efficiency of the used methods in most cases is doubtful.

Complications and side effects of treatment

Side effects of glucocorticoids for topical administration are described above (see "allergic rhinitis").

Mistakes and unreasonable appointments

In Russia allergic rhinitis and vasculomotor rhinitis therefore for definition of the same states various terms are used quite often mix terms: "rhinopathy", "a vasculomotor, allergic rhinosinusopathy", etc., and in treatment of such "rhinosinusopathies" are often applied any methods including those which efficiency is very doubtful (homeopathic therapy, phytotherapy, fuzafungin, injections of GKS-depot in nasal sinks, etc.). There are no data on efficiency of replacement hormonal therapy concerning symptoms of vasculomotor rhinitis against hypofunction of a thyroid gland.

Forecast

Favorable.

 
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