Vasomotor rhinitis (a form of non-Allergic rhinitis) is a common ailment that has been notoriously difficult to treat. This is a kind of runny nose and “congestion” that is due to overactive nerve endings in the nose (specifically a type of nerve ending called the parasympathetics). The typical vasomotor rhinitis patient will notice clear watery drip that increases with physical activity, with speaking, eating, cool air, or spicy foods (in fact most of us will get a little watery nose with spices!). Many patients will eat with a fork in one hand and tissue in the other – some patients even avoid eating in public! Patients may or may not have allergies and nasal blockage on top of all this, but the essence of the vasomotor complaint is runny nose. Pregnancy is also a cause. The nose just doesn’t stop running until the patient falls asleep.
Most patients are told they have this problem after their allergy testing and CT scans are negative – a “diagnosis of exclusion”. We doctors have a bad habit of only diagnosing things that we do a good job at treating. And this form of drippy nose has been tough to cure. (Now this paradigm may change)
Nasal steroids like Flonase (fluticasone) or Nasacort (triamcinolone) usually do not work at all. Antihistamines like Astelin (azelastine) and Patanase (olopatadine) will often help SOME for a short time. My favorite is old-fashioned Atrovent (ipratropium bromide) which I think has the strongest effect but only lasts about four hours before it needs re-dosing.
Surgery to cut the vidian nerve where it exits the brain at the sphenoid bone has been performed but carries procedural risks of damage to nearby structures and risks of drying the eye. More recently botulinum toxin treatment has been used within the nose (repeated needle injections at a couple sites on each side) to paralyze the nerve endings shows some promise but is limited by cost and the need to repeat treatment frequently. But now we have something new (or new-again anyway)…
I have recently revisited an old procedure to use sub-freezing temperatures (nitrous oxide or liquid nitrogen) to cause a disconnect of certain nerve endings in the nose. This CRYOTHERAPY is a procedure pioneered in the 1970s then abandoned essentially because it was ahead of its time and the nasal scopes we use for seeing now did not exist yet. With this procedure the nerves responsible for stimulating the nasal mucous are stunned and they disconnect from the mucous glands. Most patients see a 60-70% reduction in the use of nasal medications and symptoms after 6 weeks. The effects are thought to last years or longer. The procedure is usually done in the office under local anesthesia and takes about 20 minutes. 80% of patients do not need any pain medication. We expect patients to drive themselves home afterward (unless a mild sedative like Xanax is used to calm the nerves).
Interestingly these same nerve centers in the nose can responsible for headaches, or vague facial pain, or even vague ear pressure that many have chalked up to migraines or “TMJ disease”. Many patients have also reported less complaints of facial pain, headache and nasal blockage.
Certainly it is exciting to have a safe quick treatment that offers a long term “cure” to patients with such a frustrating problem! I would imagine soon the indications will be expanding offer an adjunct treatment for typical allergies (while allergies may the trigger for many people, part of the end result depends upon these nerve connections that we can now address).
I you are tired of rotating through a grocery bag of all the nasal sprays to stop your runny nose, then it is likely that vasomotor rhinitis is the culprit. And now we finally might be on to a good long term cure.