A model for experimental vasomotor rhinitis

Autonomic nervous system evaluation in allergic rhinitis

OBJECTIVES: To evaluate the relationship between allergic rhinitis (AR) and autonomic nervous system (ANS) dysfunction.

METHODS: Quantitative ANS testing was completed in 10 patients with AR confirmed by clinical findings and allergy testing. This data was compared to 16 age-matched controls.

RESULTS: ANS scores were significantly abnormal in AR patients when compared to normal controls. The composite autonomic scale score for the AR group was significantly impaired when compared to controls (1.6 vs 0.63, P < 0.0001). Additionally, subscore values quantifying the level of dysfunction within the sympathetic nervous system (1.0 for sudomotor and 0.5 adrenergic) were found to be significantly different ( P < 0.0001 and 0.018). The mean subscore value quantifying the level of dysfunction within the parasympathetic system (cardiovagal) was not found to be significantly different from controls ( P = 0.38).

CONCLUSIONS: ANS dysfunction, specifically sympathetic hypofunction, was identified in all of the allergic rhinitis patients studied. Further characterization of the type of ANS abnormality may allow the development of novel pharmacologic therapies for these disorders.

© 2007 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.

Autonomic dysfunction, allergy and the upper airway

PURPOSE OF REVIEW

The autonomic nervous system has been implicated in the pathophysiology of chronic upper airway inflammatory disease for decades. We discuss the most recent literature with regard to autonomic nervous system dysfunction and chronic upper airway disease.

RECENT FINDINGS

Recently, state of the art autonomic nervous system testing has demonstrated autonomic nervous system dysfunction in patients with chronic upper airway inflammatory disease. This dysfunction has been characterized as hypoadrenergic.

SUMMARY

Autonomic nervous system dysfunction likely plays a role in chronic upper airway inflammatory disease. Further investigation may lead to a better understanding of the role of autonomic nervous system dysfunction in these disorders and, hence, opportunities for novel therapeutic modalities.

Autonomic function and dysfunction of the nose and sinuses

Patients with inflammatory disorders of the upper airway exhibit varying degrees of ANS dysfunction, including the sympathetic, parasympathetic,and sensory components. Current evidence is insufficient with regard to the exact role of ANS dysfunction and its relationship to these disorders.Thus, the interaction of the ANS and sinonasal inflammation deserves further study.

Autonomic nervous system evaluation of patients with vasomotor rhinitis

OBJECTIVE

To demonstrate the utility of quantitative neurological laboratory testing of autonomic nervous system dysfunction and to apply this methodology to further study the relation of chronic vasomotor (nonallergic) rhinitis to the autonomic nervous system.

METHODS

It has been suspected that vasomotor rhinitis is due either to a hyperactive parasympathetic nervous system or an imbalance between it and the sympathetic nervous system. The exact relation has not been determined. Recently neurological laboratories have been developed in which a battery of tests can be performed to determine reactivity of the autonomic nervous system.

RESULTS

Autonomic nervous system testing was performed on 19 patients with symptoms fulfilling the diagnostic criteria for vasomotor rhinitis and the results were compared with 75 sex- and age-matched control subjects. Patients with vasomotor rhinitis had significant abnormalities of their sudomotor, cardiovagal, and adrenergic subscores. Their composite autonomic scale score was significantly impaired at 2.43, as compared with 0.11 for controls (P < .005).

CONCLUSION

Autonomic nervous system dysfunction is significant in patients with vasomotor rhinitis. Possible factors that trigger this dysfunction including nasal trauma and extraesophageal manifestations of gastroesophageal reflux are discussed.

Vasomotor rhinitis following trauma to the nose

Complaints of nasal obstruction following nasal trauma without any deformation have been noticed by rhinologists for many years. However, neither an epidemiologic nor a pathophysiologic connection has ever been established. The complaints and physical examination findings of these patients resemble those of vasomotor rhinitis. Only very few articles suggesting nasal trauma as a possible cause for vasomotor rhinitis have ever been published. We present a retrospective study that found 87 of 802 patients to suffer from vasomotor rhinitis following nasal trauma. No other factors known to cause vasomotor rhinitis were present in these patients. None had any previous nasal problems. We therefore suggest that nasal trauma was the causative factor in their vasomotor rhinitis.

Pseudo-cerebrospinal fluid rhinorrhea

Because of its potentially serious sequelae, cerebrospinal fluid (CSF) leakage following surgery for lesions of the cranial base is given immediate attention by neurosurgeons. Despite a multitude of approaches used to prevent its occurrence, CSF leakage complicates up to 30% of difficult skull-base tumor operations. The authors describe the cases of 11 patients who developed a syndrome, not previously described in the literature, termed "pseudo-CSF rhinorrhea." This syndrome occurs after surgery of the cranial base, usually involving dissection or removal of the petrous or cavernous carotid artery, the greater superficial petrosal nerve, and the pericarotid sympathetic plexus. It is characterized by nasal stuffiness and nasal hypersecretion and is sometimes accompanied by facial flushing. The symptoms are characteristically exacerbated by exertion or by elevated ambient room temperatures. Lacrimation is typically absent ipsilateral to the pseudo-CSF rhinorrhea. It is believed that pseudo-CSF rhinorrhea developed in these patients because of a relative imbalance of the regulatory autonomic supply of the nasal mucosa.

A comparative evaluation of oral decongestants in the treatment of vasomotor rhinitis

In a seven-week double-blind crossover study, Disofrol (dexbrompheniramine maleate +d-isoephedrine sulphate) was compared with Lunerin (brompheniramine + 2-amino-1-phenyl-propanol-(1)-hydrochloride) and with placebo in the treatment of vasomotor rhinitis in thirty-one patients. From the patients' evaluations on diary cards Disofrol reduced the symptom running nose to a higher degree than Lunerin, an effect possibly ascribable to a greater anticholinergic activity. Both preparations had equal ability to relieve nasal blockage and both combinations were found to be more effective than placebo.

Selective denervation of the autonomic nerve supply of the nasal mucosa

The autonomic innervation of the nasal mucosa has been studied in normal rats and in rats in which the supplying nerves had seen selectively transected; postoperative survival times varied from 2 weeks up to 18 months. The vascular structures appeared to be innervated both by acetylcholinesterase- and noradrenalin-containing fibres. Furthermore a nerve plexus consisting of both types of fibres was observed in the subepithelial region. The nasal glands however showed only a cholinergic innervation. The pattern of the autonomic nerve supply deduced from these selective denervation experiments does not differ fundamentally from the generally accepted scheme of this system in the nose of other mammals. Denervation occurred within 2 weeks after transection of the supplying nerves, but after longer survival times reinnervation was observed.