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Clinical Challenges
May 2003

Vasomotor Rhinitis Is Not a Wastebasket Diagnosis

Author Affiliations




Arch Otolaryngol Head Neck Surg. 2003;129(5):584-587. doi:10.1001/archotol.129.5.584

Hypothesis: Vasomotor rhinitis is best conceptualized as a distinct entity in a continuum of chronic sinonasal disease.

The impact of chronic rhinitis on patients, health care systems, and resources is substantial, resulting in more than 25 million office visits per year and resulting in total indirect and direct costs of $6 billion annually.1,2 It is estimated that more than 10% of the population has chronic or recurrent nasal obstruction or congestion, rhinorrhea, sneezing, and pruritus. Approximately half of these patients are classified as having allergic rhinitis and half as having nonallergic rhinitis, including vasomotor rhinitis.3,4 These forms of chronic, noninfectious rhinitis represent a spectrum of nasal disorders that are best categorized as a hyperreactivity of the nasal mucosa to a variety of stimuli.5 Allergic rhinitis is diagnosed when specific antigens can be identified and is often subclassified as seasonal or perennial allergic rhinitis.6 When specific antigens are not identifiable, chronic rhinitis is often classified as vasomotor or nonallergic. These nonallergic forms of chronic rhinitis can be further evaluated by nasal cytology. Nasal scrapings of the inferior turbinate can yield epithelial lining, and detailed analysis of different cell types can be made. Patients with nonallergic rhinitis and abundant eosinophils on nasal cytology have the so-called nonallergic rhinitis with eosinophilia syndrome, which is sometimes associated with aspirin intolerance. Patients with nonallergic rhinitis and unremarkable nasal smear findings could have rhinitis medicamentosa, pregnancy, or hypothyroidism, but most are thought to have vasomotor rhinitis.

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