By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER'S VASOMOTOR RHINITIS MIMICS ALLERGY OR INFECTION

Question: My doctor recently diagnosed me with a condition she called vasomotor rhinitis. She didn’t give me much information about it, but said it wasn’t an allergy and wasn’t a sinus infection, which is what I thought I had. My major symptoms are a feeling of sinus pressure, a runny nose and headaches. Sometimes I have sneezing fits. It’s worse during cold weather. I had a bad time recently when I made a trip to southern Chile. It’s winter there. Can you tell me more about this condition?

Answer: Well, I’m envious of your recent foreign travel, but I can also sympathize with the nasal problems you’ve been experiencing. Your pain is due to the fact that the tissues of the nose and sinus areas have abundant nerve endings. As a result, any condition that causes swelling or irritation in the nose and sinuses can also produce pain.

The symptoms you describe -- facial pressure and pain -- certainly can be the result of a sinus infection, but blockage of the sinus openings is more common. There are several possible causes of this type of blockage, including allergy-induced nasal swelling, the common cold, tumors and cysts. Vasomotor rhinitis is also on the list. It mimics an allergy or infection in some ways but is actually a distinct disorder.

Before I tell you more about vasomotor rhinitis, I need give you a brief anatomy lesson. The bones and cartilage that make up your nasal passages and sinuses are covered with nerve-rich mucus membranes. Beneath some sections of the mucus membrane there is a special tissue that can engorge with blood, thereby causing that common experience of having one's nose suddenly become "stopped up." Functioning of this complex system is under the control of the nervous system. Therefore, any conditions that interfere with the nerves, blood supply, mucus membranes or the bones themselves can produce symptoms similar to those you describe.

Also contributing to "sinus problems" is the fact that nasal and sinus bones can be shaped in ways that are not optimal and, thereby, increase the risk of sinus infection or cause pain in other ways. These problems can include sinus openings that are too small or too large as well as irregularly shaped nasal bones that reduce space for air passages.

While it can be difficult to determine the exact cause of nasal swelling, discharge and pain, your doctor undoubtedly used your history to help narrow down the possibilities. A key clue is that cold temperatures bring on an attack. Infections and allergies do not work this way, but your doctor’s prime suspect -- vasomotor rhinitis -- can be triggered by cold exposure.

Vasomotor rhinitis is an incompletely understood disorder that involves a disturbance in the way the parasympathetic nervous system controls the blood vessels in the nose. An attack produces swelling in the nose with resultant "sinus" pressure and pain. The glands of the nose become overactive. This produces the runny nose and the sneezing. In addition to cold exposure, attacks can be triggered by polluted air, bright light, spicy foods and even, sometimes, emotions.

There are effective treatments for vasomotor rhinitis, but there is currently no cure. Many family doctors are skillful at treating this disorder. If your family doctor isn't well versed in treating it, however, he or she can refer you to an ear, nose and throat specialist who can help you.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.