Clinical Features, Investigations, and Management of Vasomotor Rhinitis

Introduction

Vasomotor rhinitis is a chronic non-allergic condition characterized by intermittent nasal congestion, rhinorrhea, and postnasal drip without an identifiable allergic or infectious cause.

Clinical Presentation

Patients with vasomotor rhinitis typically experience symptoms such as:

• Persistent or episodic nasal congestion
• Watery rhinorrhea
• Postnasal drip
• Frequent sneezing without an allergic trigger
• Hypersensitivity to strong odors, weather changes, or temperature fluctuations

Differential Diagnosis

Vasomotor rhinitis must be distinguished from allergic rhinitis, infectious rhinitis, and structural nasal conditions. The absence of allergy markers and identifiable allergens helps in differentiation.

Investigations

Diagnosis is primarily clinical, but certain tests can help rule out other causes:

• Skin or serum allergy testing (to exclude allergic rhinitis)
• Nasal endoscopy (to assess for structural abnormalities)
• CT scan if chronic sinus involvement is suspected

Management Strategies

Non-Pharmacologic Approaches

• Avoiding triggers such as strong smells and temperature extremes
• Using nasal saline irrigation
• Humidification therapy

Pharmacologic Treatment

• Intranasal antihistamines (e.g., azelastine)
• Intranasal corticosteroids (e.g., fluticasone, budesonide)
• Anticholinergic nasal sprays (e.g., ipratropium bromide)

Surgical Options

In refractory cases, procedures such as vidian neurectomy or turbinate reduction may be considered.

Conclusion

Vasomotor rhinitis remains a challenging condition with no definitive cure. Management focuses on symptom relief and improving patients' quality of life.