Vasomotor Rhinitis

  • Non allergic rhinitis
  • Overactivity of parasympathetic system – excessive secretion from the nasal glands, vasodilation and engorgement of nasal mucosa
  • Nasal mucosa is hyper-reactive and responds to non-specific stimuli like change in temperature, dust, smoke etc
  1. Paroxysmal sneezing – bouts of sneezing just after getting out of bed in the morning
  2. Excessive rhinorrhea – profuse, watery
  3. Nasal obstruction – more marked at night, alternates from side to side
  4. Post nasal drip
Signs:nasal mucosa is congested and hypertrophic
Complications: nasal polyp, hypertrophic rhinitis, sinusitis
  • Medical treatment: antihistaminic, oral nasal decongestants
  • Surgical: vidian neurectomy
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]
  1. Transeptal
  2. Transpalatal
  3. Trans ethmoidal and
  4. Transnasal
The most popular approach to the vidian nerve is the Transantral route.
Exam Question
  • Non allergic rhinitis
  • Symptoms:
  • Paroxysmal sneezing – bouts of sneezing just after getting out of bed in the morning
  • Surgical treatment: vidian neurectomy

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