vasomotor rhinitis
Introduction
Introduction to vasomotor rhinitis Vasomotorrhinitis is a highly reactive nasal disease caused by neuroendocrine secretion of blood vessels in the nasal mucosa and imbalance of gland function. The pathological mechanism of this disease is complicated, and many links are still unclear, which brings certain difficulties to the clinical diagnosis and effective treatment. There was no significant gender difference in the onset of the disease, and few vasomotor rhinitis occurred in children. basic knowledge The proportion of the disease: the probability of the population is 12% Susceptible people: no specific population Mode of infection: non-infectious Complications: nasal polyps
Cause
Causes of vasomotor rhinitis
The nasal mucosa contains a large number of glands, rich vascular beds and many sources of innervation, forming a fine, sensitive and active terminal organ, exercising various physiological functions of the respiratory tract, relying on nerve-vessels, nerve-endocrine, etc. Activity, maintaining the balance between the nasal cavity and the internal and external environment, this equilibrium surface depends on two pathways from the hypothalamus: one is to regulate the function of the nasal mucosa through the pituitary gland by means of the endocrine chain, and the other is directly through the autonomic nervous system. In the implementation of neuromodulation, if one of the above-mentioned pathways changes in function, it can cause blood vessels in the nasal mucosa, gland dysfunction, and increased reactivity, which is the main pathophysiological basis of the pathogenesis of vasomotor rhinitis.
(1) Autonomic dysfunction
Under normal circumstances, when the sympathetic nerve is excited, the distal part releases norepinephrine and neuropeptide y. When the corresponding receptor on the blood vessel wall is used to maintain the vascular tension of the nasal mucosa and stimulate the parasympathetic nerve, the distal part releases acetylcholine and passes through the blood vessel. M receptors on the wall and glands to cause vasodilation and glandular secretion, recent studies have found that there are vasoactive intestinal peptide (VIP) immunoreactive fibers in the parasympathetic nerve of the nasal mucosa, stimulating the wing nerves (mainly contained) In the parasympathetic nerve, the VIP immunoreactive fiber releases VIP, which causes vasodilation, and this vasodilation cannot be blocked by atropine. Uddman (1987) believes that glandular secretion caused by parasympathetic excitation is caused by acetylcholine. Vasodilation is derived from the non-choline-like vasodilator, VIP.
Repeated sympathetic stimulation (overwork, irritability, anxiety, nervousness, etc.) can consume excessive amounts of neurotransmitter synthase and transmitters that have been synthesized and stored at the nerve endings, resulting in a corresponding reduction in the number of alpha 1 and beta receptors. Can cause sympathetic tone reduction, some antihypertensive drugs, non-selective beta blockers and antidepressants are sympathetic blockers, repeated application can also cause sympathetic tension reduction, in sympathetic tension When reduced, the parasympathetic nerve excitability is increased, which can cause vasodilation, glandular secretion, and the clinical symptoms of vasomotor rhinitis. As early as 1943, Fowler discovered that cervical sympathectomy can cause vasomotor rhinitis in patients. Removal of the cervical sympathetic ganglia can lead to vascular dilatation of the nasal mucosa, submucosal edema, glandular hyperplasia, and activity of cholinesterase with increased activity around the gland. These changes and mucosal histopathology in patients with vasomotor rhinitis See exactly the same.
(two) endocrine disorders
Endocrine disorders can also cause changes in the nasal mucosa. Hypothyroidism can cause a decrease in autonomic sympathetic tone. These patients often have nasal congestion as the main symptom. Changes in estrogen levels can also cause nasal symptoms. Many clinical data prove that some women Patients have obvious nasal symptoms in premenstrual or gestational period, such as nasal congestion, multiple sneezing, clearing, and animal experiments have confirmed that increasing the level of estradiol in the body can significantly enhance the nasal mucosal reactivity of the animal, showing thickening of the nasal mucosa epithelium. Tissue edema, small blood vessel dilation, glandular hyperplasia, etc., the mechanism of action of estradiol is still unclear, but it has been found that when the level of estradiol in the body is increased, the cholinergic M-receptor in the nasal mucosa can be increased. Alpha 1-adrenergic receptors are reduced, and estradiol can also enhance non-immune histamine release from mast cells.
(3) inflammatory mediators such as histamine
The non-immune release of the substance causes a variety of factors such as non-immune release of histamine and other media, such as chemical (anaesthetic, salicylic acid preparation), physical (sudden temperature, humidity, climate, dust), nerve Sexual (emotional changes), etc., the specific mechanism of non-immune release of histamine is still unclear, but regardless of the exact mechanism, it is regulated by intracellular cAMP levels, as long as it can cause a decrease in intracellular cAMP levels, it can cause mast cells to release media. .
Prevention
Vascular motor rhinitis prevention
Improve working conditions and environment, master the pace of life, stabilize your mood, and not be overly tired and nervous. Implementing the necessary psychotherapy or suggestive language for the patient can sometimes have a noticeable effect. If caused by endocrine factors, the endocrinologist should be assisted if necessary.
Complication
Vascular motor rhinitis complications Complications, nasal polyps
Patients often have watery nose, edema of the nasal mucosa, mucosal polyps or nasal polyps.
Symptom
Vasomotor rhinitis symptoms Common symptoms Mucosal congestion, dizziness, nasal congestion, polyps, allergic rhinitis, unilateral nasal obstruction, excessive reverse rhinitis
[clinical manifestations]
According to the onset factors, Goldman (1987) classifies vasomotor rhinitis into three clinical types, which have implications for diagnosis and treatment.
(1) Physical reaction type
Some patients often develop specific nasal reactions for certain rational stimuli, such as sudden exposure to cold air, sudden changes in temperature, humidity, etc., that is, episodes of sneezing, accompanied by more watery nose, patients can often clearly state The cause of the disease, this type may also be reverse hypertensive rhinitis.
(2) Mental reaction type
Stress, fear or resentment, frustration and other repeated stimuli, causing nasal reactions in patients, changes in the content of modern neural life and the acceleration of rhythm and traditional concepts, the number of such patients increased.
(three) idiopathic response
This type of patient often can not find any suspicious predisposing factors, accounting for the majority of cases of vasomotor rhinitis, patients often have watery nose, edema of nasal mucosa, mucosal polyps or nasal polyps, endocrine dysfunction may be the cause One.
Type:
Nasal type
This type of symptoms is mainly nasal congestion, mostly intermittent. Some patients have severe nasal congestion in the morning, and the daytime is relieved or disappeared. Some patients are exacerbated every night, often accompanied by alternating nasal congestion with changes in body position, such as polyps in the nasal mucosa. Variants or nasal polyps can have varying degrees of persistent nasal congestion, sometimes sneezing, but to a lesser extent, the nasal can be relieved after sneezing, patients are often very sensitive to changes in climate and environmental temperature.
2. Nasal spill
The increase of watery nose is the main symptom, and it is often accompanied by episode sneezing. The onset is often for several days. Washing several handkerchiefs per day or using a lot of toilet paper, itching in the nose, but there are few conjunctival involvement, itching and other symptoms. Symptoms can be relieved or disappeared after several days or weeks. After a certain period of time, they can be affected by certain incentives. This type is more common in women aged 20 to 40, and the mental type is unstable.
Other symptoms are still caused by persistent swelling and congestion of the mucous membrane, edema caused by edema, dizziness and other symptoms.
Nasal examination showed no change in the color of the nasal mucosa, dark red produced by congestion, or light blue caused by volume expansion, or pale white by mucosal edema, and one side of the nasal mucosa was dark red, another The side is pale edema, the nose is swollen and the general response to ephedrine contraction is good, but the elderly with the long course of disease or repeated use of "drip nose net", the contraction response is poor, the long course of the disease can show mucosal edema and polypoid changes, after The nose can be seen to increase, the edema of the inferior turbinate back.
Examine
Examination of vasomotor rhinitis
1. Front nose examination.
2. X-ray nasal photos have clear sinus infection.
Diagnosis
Diagnosis and diagnosis of vasomotor rhinitis
Almost everyone has occasional nasal symptoms, so it is sometimes difficult to distinguish between normal nose and sick nose, but as long as the medical history is detailed, carefully examine and carefully analyze the predisposing factors. The nasal symptoms accumulate more than 1 hour per day for up to one month. In the above, vascular motility rhinitis can be diagnosed after the following diseases are excluded.
1. Allergic rhinitis allergen skin test positive, nasal secretions have eosinophils and basophils, seasonal rhinitis episodes are seasonal.
2. Infectious rhinitis has acute rhinitis and chronic rhinitis, nasal secretions are often mucinous or mucopurulent, and most of the secretions are neutrophils.
3. Very allergic eosinophilic rhinitis There are a large number of eosinophils in the nasal secretions, but there is no other basis for allergic reactions.
4. Aspirin intolerance triad Although there may be a large number of eosinophils in the nasal secretions, the patient has a history of allergy to salicylic acid or other antipyretic analgesics and a history of asthma, and nasal polyps in the nose.
5. Excessive reverse rhinitis is caused by the reverse of the intranasal sensory nerve axon, with sudden sneezing as the main symptom, sudden onset and disappearing quickly.
