This protocol applies to patients with vasomotor rhinitis presenting with nasal obstruction and congestion as the dominant complaints, without rhinorrhea, whose congestion has not adequately improved after a first course of therapy.
The patient has vasomotor rhinitis characterised by nasal obstruction and nasal congestion, with no rhinorrhea. The presentation is congestion-predominant, and first-line treatment aimed at relieving that congestion has not achieved the desired improvement.
An initial regimen — which may have included empiric use of topical decongestants (oxymetazoline), oral decongestants (pseudoephedrine), or oral antihistamines — was trialled with the goal of achieving improvement in congestion. When that goal is not reached, the protocol moves to a next step reserved for more seriously affected patients.
For patients who are seriously affected and have not responded to the initial approach, the next step involves otolaryngologist-performed interventions directed at the nasal region. The complete selection criteria, procedural sequence, and clinical conditions for each option are available in the full protocol.
With nasal congestion and obstruction only, topical corticosteroids would be a wise starting point for therapy.
These therapies include topical decongestants, oral decongestants, and local application of silver nitrate solutions by an otolaryngologist.
Sphenopalatine blocks, also performed by otolaryngologists, are reserved for seriously affected patients who do not respond to other interventions and whose lives are altered significantly by their symptoms.
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