GROUP 3

SCENARIO 3
 a 21st years old woman came to the puskesmas
with a blocked nose accompanied by olfactory
3rd Scenario reduction since 1 year ago. Blocked nose happens
especially during cold.
 1. Female 21st years old
2. Olfactory reduction since 1 year ago
Keywords 3. Complaints of a blocked nose
4. Complaints arise during the cold
Mind Mapping
Patient Data

Clinical Manifestations

Differensial Diagnosis

Physical & Supportive Examination

Rhinitis Vasomotor Prognosis & Complication

Etiopathogenesis Pathophysiology Risk Factors Treatment & Prevention

Anatomy of
the Nose
Physiology of the Nose
Based on structural theory, revolutionary theory and functional theory, the physiological functions
of the nasal and paranasal sinuses are:
1) respiratory function for regulating air conditioning, air filter, humidification, balancing in
exchange pressure and local immunologic mechanisms;
2) the smell function, due to the absorption of olfactory (olfactory) and air reservoirs to
accommodate a stimulating stimulus;
3) phonetic functions useful for sound resonance, aiding the process of speaking and preventing
the conduction of the sound itself through bone conduction;
4) statistical and mechanical functions to relieve head load, protection against trauma and heat
shielding;
5) nasal reflex.
Differential Diagnose
Nasal polyp Allergic Rhinitis Vasomotor Allergic Rhinitis hiperemika/
medicaments

Etiology Soft mass containing a lot inflammation of the nasal the presence of due to the long and
of fluid in the nasal cavity mucous membrane physiologic disorders of excessive use of
caused by exposure of the nasal mucosal lining vasoconstrictor (nasal
inhaled material then caused by increased drops / nasal sprays)
triggers a specific nerve-parasympathetic
immunologic response activity
mediated IgE
family history -/+ + - -
nasal congestion and continuous and worsening lost and arisen lost and arisen settle but not worsening
watery

given decongestants edema concha deflate edema konka deflate edema konka deflate edema concha not deflate
concha hypertrophy and + - - -
dark color

Skin test +/- + - -

nasal secretions ↑ eusinofil / - ↑ eusinofil - -
difficult to swallow + - - -
 Physical and Clinical
Examination of
Vasomotor Rhinitis

• History
• Physical / nasal examination
• Nasal smear for eosinophils, WBC, bacteria
• Skin prick test (in vivo)
• Blood: IgE levels
Exact Diagnosis
Non-allergic rhinitis is a syndrome and a combination of several
diseases related to the symptoms of nasal inflammation without the
presence of allergic triggers that can be found.

The symptoms of sneezing and itchiness in the eyes, nose or palate

may also be accompanied but are not so common than those seen in
allergic rhinitis. Various environmental irritants, drug side effects,
autonomic dysfunction, autoimmune disease, and hormonal influences
are the potential etiologies of non-allergic Rhinitis. (Dilorenzo, 2011)
 Etiology
The etymology of vasomotor rhinitis is not known
and suspected as a result of a disturbance of the
Etiology and autonomic nervous system balance triggered by
certain substances.
Pathogenesis Several factors affect the vasomotor balance: (1)
drugs that suppress and inhibit sympathetic
nervous work, (2) physical factors, (3) endocrine
factors, (4) psychic factors
Pathogenesis
Vasomotor rhinitis is a neurovascular disorder of the blood vessels in the nasal mucosa,
mainly involving the parasympathetic nervous system. No allergens are found against
specific antibodies such as those found in allergic rhinitis. It is a non-specific nasal reflux
hypersensitivity. Attacks can arise due to the influence of several trigger factors.
Pathophysiology
• The autonomic nervous system controls the flow of blood to the nasal mucosa and
secretionsof the gland.
• The diameter of the blood vessel resistance in the nose is governed by the nervous
systemsympathetic whereas parasympathetic control gland secretion.
• In vasomotor rhinitisthere is autonomic nervous system dysfunction that leads to
increased workparasympathetic accompanied by decreased sympathetic nerve work.
• Both the sympathetic systemhypoactive or hyperactive parasympathetic systems, both
can causedilatation of arterioles and capillaries along with increased capillary
permeability, whichwill eventually lead to fluid transudation, edema and congestion.
 Rhinitis vasomotor is a neurovascular disorder of the blood
vessels in the nasal mucosa involving the parasympathetic
nervous system.
The risk factors of vasomotor rhinitis include:
• Alcohol
Risk factor of • Changes in temprature or humidity
Rhinitis • Spicy and hot food

vasomotor • Stinging smells

• Cigarette smoke or other air pollution
• Psychic factors such as stress, anxiety
• Endocrine diseases
• Drugs such as anti-hypertension, oral contraceptives
 - Chronic intermittent nasal obstruction
C l i n i c a l - Rhinorhea (thin, watery)
Manifestations - Mucosa and turbinates : swollen, pale between
exposure

of Rhinitis we have 2 types : eosinophilic and non

eosinophilic (according to the number of
Vasomotor eosinophils found in the nasal secretion)
 1. morning exercise outside home 4. Operative therapy (done when
conservative treatment fails):
2. Avoiding causes / triggers (Avoidance
therapy) - Konka hypertrophic cancers with 25%
AgNO3 or concentrated trichloracetate
3. Conservative treatment (chemical cautery) as well as electric
(Pharmacotherapy): (electrical cautery) solutions.
Treatment of vasomotor
- Decongestants or sympathomimetic drugs - Diathermy submucosa conka inferior
rhinitis varies, depending are used to reduce nasal congestion (submucosal diathermy of the inferior
complaints. For example: Pseudoephedrine
on prominent factors and and Phenylpropanolamine (oral) and
turbinate)
- Konka inferior frozen (cryosurgery) -
symptoms. Phenylephrine and Oxymetazoline (nasal
spray). Resection of partial or total conjuction
Broadly speaking, the - Anti histamine: best for rinore group.
(partial or total turbinate resection)
- Turbinectomy with laser (laser
treatment is divided into: - Topical corticosteroids reduce clogged nasal turbinectomy)
complaints, rhinorrhea and sneezing by
suppressing the local inflammatory - Neurectomy n. vidianus (vidian
response caused by vasoactive mediators. neurectomy), ie by cutting on n.
Usually used for at least 1 or 2 weeks vidianus, if by the way above does not
before achieving satisfactory results. give results. Surgery should be
Examples of topical steroids: Budesonide, performed in patients with severe
Fluticasone, Flunisolide or Beclomethasone rinore complaints. This therapy is
difficult to do, with a high recurrence
- Anti-cholinergic is also effective in patients rate and can cause various
with rinorrhea as its main complaint. complications
Example: Ipratropium bromide (nasal spray)
 SINUSITIS
Sinusitis is a disease that very easy to
find, such as inflammation of
paranasal sinus mucous, and usually
accompanied with rhinitis.
• Hiperemi of external nose
• Face edema

Complication
 There are so many prognosis of
vasomotor rhinitis.
This disease sometimes can be treat
and can be persist of medicine.

Prognosis
Prognosis of medicine with obstructive
type is better then rhinore type,
because rhinore type is similar with
allergic rhinitis, it will need an
anamnesis and treatment that match to
the disease
 Islamic view
This is Some Verse in the Qur’an

And We sent down from the Qur'an an an antidote and a mercy to

those who believe and the Quran does not add to the wrongdoers
other than loss. (Q.S.Al-Israa ': 82)
The Lord has come to you a lesson from your Lord and a healer
for the diseases (that are) in the breast and the guidance and
mercy for those who believe. (Q.S. Yunus: 57)