Vasomotor Rhinitis

Vidian neurectomy was first described for the treatment of intractable vasomotor rhinitis in the 1960s but fell into disrepute because of the recurrence of symptoms and significant complications.

With subsequent improvements in the understanding of the nasal and sinus anatomy, endoscopic vidian neurectomy can now be performed with minimal dissection and morbidity

The principle underlying vidian neurectomy is to sever the preganglionic fibers that reach the sphenopalatine ganglion through the vidian nerve. Several routes have been described to approach the deep seated vidian nerve:

• Transantral [Classic & Subperiosteal]
• Transeptal
• Transpalatal
• Trans ethmoidal and
• Transnasal

The most popular approach to the vidian nerve is the Transantral route.

• Rhinoscleroma is caused by the gram-negative coccobacillus K rhinoscleromatis.

The disease begins in areas of epithelial transition such as the vestibule of the nose, the subglottic area of the larynx. It resembles atrophic rhinitis in atrophic stage. Subdermal infiltration of lower part of external nose and upper lip gives a ‘woody’ feel. 

Continuous use of nasal decongestants for a long period of time result in severe mucosal edema, hyperemia, and nasal obstruction.

On physical examination, the nasal mucosa will be thickened, erythematous, and edematous and will lack appreciable decongestion on topical decongestant application.

Ans. A: Atrophic rhinitis

Young’s operation is a surgery designed for the treatment of atrophic rhinitis.

The surgical procedure involves closure of the nasal cavity affected with atrophic rhinitis by creating mucocutaneous flaps. These flaps are sutured together in two layers: first the mucosal layer, then the skin layer. The nasal cavity is kept closed for a period of 6 months or later; then an examination is done – if the crusts have disappeared, a revision surgery is performed and the nasal cavity is reopened

Ans. is ‘a’ i.e., Vasomotor rhinitis

Treatment of vasomotor rhinitis includes : ‑

1) Conservative treatment

• Avoidance of physical factors which provoke symptoms.
• Antihistaminics and oral or nasal decongestants.
• Topical or systemic steroids

2) Surgical treatment

• Nasal obstruction can be relieved by measures which reduce the size of hypertrophied nasal turbinate : -Cryosurgery, submucosal diathermy, Linear cauterization, partial or total turbinectomy, submucosal resection of turbinate.
• Excessive rhinorrhoea in vasomotor Rhinitis not corrected by medical therapy and bothersome to thepatient, is relieved by sectioning the parasympathetic secretomotorfibres to nose i.e., vidian neurectomy.

Vasomotor Rhinitis

• It is a non allergic rhinitis clinically simulating nasal allergy.

Symptoms

• Paroxysmal sneezing : Bouts of sneezing start just after getting out of the bed in the morning. 
• Excessive rhinorrhoea : This accompanies sneezing and may be the only predominant symptom. It is profuse and watery and may even wet several handkerchiefs. The nose may drip when the patient leans forward, and this may need to be differentiated from CSF rhinorrhoea.
• Nasal obstruction : This alternates from side to side. Usually more marked at night. It is the dependent side of nose which is often blocked when lying on one side.
• Postnasal drip.

Following are the indications of cryotherapy

• Vasomotor rhinitis
• Leukoplakia
• Mucous cysts
• Aphthous ulcers
• Hemangiomas
• Pappilomas
• Granulation tissue
• Epistaxis
• Carcinomas
• Adhesions