Symptom >> Otorhinolaryngology >> ENT

Excessive reverse rhinitis

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Vasomotor rhinitis is divided into three clinical types, and some patients with physical response often develop specific nasal responses to certain rational stimuli. Such as episodes of sneezing, accompanied by more watery noses, such as exposure to cold air, sudden changes in temperature, humidity, etc. Patients often have a clear indication of the cause of the disease. This type may also be reverse hypertensive rhinitis. Vasomotor rhinitis is a highly reactive nasal disease caused by neuroendocrine imbalance in the regulation of blood vessels and glands in the nasal mucosa. 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.

Cause

Cause

The nasal mucosa contains a large number of glands, abundant vascular beds and many sources of innervation, forming a fine, sensitive and active terminal organ that exercises various physiological functions of the respiratory tract. It relies on nerve-blood, neuro-endocrine and other activities to maintain the balance between the nasal cavity and the internal and external environment. This equilibrium surface relies on two pathways from the hypothalamus: one is the regulation of nasal mucosal function by the pituitary gland by means of the endocrine chain, and the other is directly performed by the autonomic nervous system. If one of the above pathways changes its function, it can cause dysfunction of blood vessels and glands in the nasal mucosa, and the reactivity is enhanced. This is the main pathophysiological basis of the pathogenesis of vasomotor rhinitis.

(1) Autonomic dysfunction

Normally, when the sympathetic nerve is excited, the distal part releases norepinephrine and neuropeptide y, and the corresponding receptor on the blood vessel wall is used to maintain the nasal mucosal vascular tone. When the parasympathetic nerve is stimulated, its distal end releases acetylcholine, which causes vasodilation and glandular secretion through the M receptor on the vessel wall and gland. Recent studies have found that vasoactive intestinal peptide (VIP) immunoreactive fibers are present in the parasympathetic nerves of the nasal mucosa. When the pterygoid nerve (mainly containing the parasympathetic nerve) is stimulated, 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, while vasodilation is derived from non-choline-like vasodilator-VIP.

Repeated sympathetic stimulation (overwork, irritability, anxiety, nervousness, etc.) can consume excessive neurotransmitter synthase and transmitters that have been synthesized and stored at the nerve endings, resulting in a corresponding decrease in the number of alpha 1 and beta receptors. Can cause sympathetic tension to decrease. Some antihypertensive drugs, non-selective beta blockers and antidepressants are sympathetic blockers, and repeated use can also cause a decrease in sympathetic tone. When the sympathetic tone is lowered, the parasympathetic nerve excitability is increased, which can cause vasodilation and glandular secretion, and produce 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, submucosal edema, and glandular hyperplasia in the nasal mucosa of the animal, and an activity-enhancing cholinesterase is found around the gland. These changes are identical to those seen in mucosal histopathology in patients with vasomotor rhinitis.

(two) endocrine disorders

Endocrine disorders can also cause reactive 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 have shown that some female patients have obvious nasal symptoms during premenstrual or pregnancy, such as nasal congestion, multiple sneezing, and clearing. 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, and glandular hyperplasia. The mechanism of action of estradiol is unclear. However, it has been found that when the level of estradiol in the body is increased, the cholinergic M-receptor and the 1-adrenergic receptor are decreased in the nasal mucosa. Estradiol also enhances non-immune histamine release from mast cells.

(3) inflammatory mediators such as histamine

Qualitative non-immune release 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 Sex (emotional change) and so on. The specific mechanism of non-immune release of histamine is 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, the mast cells can release the medium.

Examine

an examination

Related inspection

Otolaryngology CT examination Nasopharyngeal MRI endoscopy

According to the onset factors, Goldman (1987) classifies vasomotor rhinitis into three clinical types, which have implications for diagnosis and treatment.

(A) physical response type Some patients often produce specific nasal reactions for certain rational stimuli. Such as episodes of sneezing, accompanied by more watery noses, such as exposure to cold air, sudden changes in temperature, humidity, etc. Patients often have a clear indication of the cause of the disease. This type may also be reverse hypertensive rhinitis.

(2) Mentally-responsive mental stress, fear or resentment, depression and other repeated stimulation, causing nasal reactions in patients. The contradiction between the changes in the content of modern neural life and the acceleration of rhythm and traditional concepts has increased the number of such patients.

(C) idiopathic response type 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 the nasal mucosa, mucosal polyps or nasal polyps. Endocrine dysfunction may be one of its causes.

According to clinical features, they can be divided into two types:

1. Nasal type This type of symptoms is mainly nasal congestion, mostly intermittent. Some patients have severe nasal congestion in the morning and reduce or disappear during the day. Some patients are exacerbated every night, often accompanied by alternating nasal congestion with changes in body position. If a polypoid or nasal polyp occurs in the nasal mucosa, there may be varying degrees of persistent nasal congestion. There is sneezing, but to a lesser extent. After the sneeze, the nose can be relieved briefly. Patients are often extremely sensitive to changes in climate and ambient temperature.

2. Nasal spillage of watery nose is the main symptom, accompanied by episodic sneezing. The onset is often several days in a row, changing a few handkerchiefs per day or using a lot of toilet paper. Itchy in the nose, but there are few symptoms such as conjunctival involvement and itchy eyes. Symptoms can be alleviated 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 constant change in the color of the nasal mucosa. There is a dark red color produced by congestion, or a light blue color caused by expansion of the volume of blood vessels, or paleness caused by mucosal edema. Some of the nasal mucosa were dark red and the other side was pale and edematous. Those with enlarged noses generally have a good response to ephedrine contraction, but those with long course of disease or repeated use of "drip nose" have poor contraction response. Elderly patients with long-term disease can show mucosal edema and polypoid changes. The posterior nasal cannula can be seen in the posterior turbinate of the enlarged, edematous.

Diagnosis

Differential diagnosis

Differential diagnosis of excessive reverse rhinitis:

Allergic rhinitis

The allergen skin test was positive, and there were eosinophils and basophils in the nasal secretions. Seasonal rhinitis episodes are seasonal.

2. Infectious rhinitis

There are points of 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 preparations or other antipyretic analgesics and a history of asthma, and nasal polyps in the nose.