General Medical Information

Vasomotor Rhinitis

Shawn D. Newlands

Vasomotor rhinitis also is called perennial nonallergic rhinitis, idiopathic rhinitis, or nonallergic rhinitis without eosinophilia. Patients have rhinitis that is neither immunologic nor infectious. Primary symptoms include congestion and rhinorrhea, usually without sneezing or pruritus. Patients have low nasal eosinophil counts and negative skin test results for allergy. Vasomotor rhinitis can represent a heterogeneous group of pathologic conditions. Despite the implication of the name vasomotor rhinitis, no definitive mechanism has been elucidated. One theory is that vasomotor rhinitis is caused by abnormal functioning of parasympathetic input to the turbinate and septal mucosa. Parasympathetic input to the turbinates and septum originates in the hypothalamus and travels with the fifth and seventh cranial nerves. This cholinergic pathway ends in dilatation of nasal mucosal vessels, which produces a boggy, edematous mucosa in the lateral nasal wall, septum, and especially the turbinates. For most patients, rhinitis develops in response to environmental conditions, including cold air, high humidity, stress, or irritants such as alcohol, bleach, solvents, air pollution, and smoke. This disease may account for the large number of cigarette smokers who have rhinitis but are refractory to treatment.

Surgical procedures to correct vasomotor rhinitis are designed to eliminate turbinate edema and hypersecretion by means of targeting the suspected neurologic source (e.g., vidian neurectomy) or the affected mucosa of the inferior or middle turbinates (e.g., partial turbinectomy or turbinate ablation). Although vidian neurectomy has been associated with symptom alleviation, the efficacy of this controversial procedure has not been proved.