Vasomotor rhinitis (non-allergic rhinitis) is diagnosed in a patient with perennial rhinorrhea and nasal congestion. Skin prick tests and serum IgE are normal. The neural mechanism involves an imbalance characterized by:

• A Excessive sympathetic stimulation causing vasoconstriction and dry nasal mucosa
• B Elevated nasal IgA leading to mast cell degranulation without systemic allergy
• C Deficiency of nasal nitric oxide causing impaired mucociliary clearance
• D Dominant parasympathetic tone via vidian nerve (greater petrosal nerve + deep petrosal nerve) leading to excessive glandular secretion and vascular engorgement; vidian neurectomy can provide relief ✓

Explanation

Vasomotor rhinitis results from autonomic imbalance with dominant parasympathetic tone in the nasal mucosa. Parasympathetic secretomotor fibers travel via the vidian nerve (nerve of the pterygoid canal, formed by the greater superficial petrosal nerve from VII and deep petrosal nerve from ICA sympathetic plexus) to the sphenopalatine ganglion, then to nasal glands and vessels. Excessive parasympathetic activity causes watery rhinorrhea and congestion. Vidian neurectomy (division at the pterygoid canal) was historically performed but largely replaced by topical ipratropium bromide (anticholinergic) as first-line medical therapy.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.