Abstract: Introduction: Vasomotor rhinitis cause nasal symptoms that occur in response to environmental
conditions, such as changes in temperature or relative humidity, odours (e.g., perfumes or cleaning materials),
passive tobacco smoke, alcohol, sexual arousal, and emotional factors. Such hyper-reactivity to nonallergic triggers
is not mediated by increased neural efferent traffic to the blood vessels supplying the nasal mucosa. It can also occur
in allergic rhinitis, when the term mixed rhinitis is applied. Objectives: The present study aimed to study the
pathogenesis of VMR by electron microscopy to see if there is another cause for this disease. Material and
Methods: It was a prospective randomised study which was held at Benha Faculty of Medicine, in the period from
January 2009 to November 2011. It was conducted on 45 patients divided into two groups. The study was carried
out in a group of 39 patients (21 males, 18 females; age range 25- 38 years) with VMR and 6 control patients (4
males, 2 females; age range 22- 34 years). Study Group The patients were affected by typical symptoms of VMR,
consisting of nasal obstruction and profuse watery rhinorrhoea. Based on the personal history of the patients, these
symptoms had been present for a period of at least 2 years (range 2-6 years). At anterior rhinoscopy, the turbinate
were hypertrophied causing significant obstruction of the nasal cavities .Control Group Six patients who were doing
other ENT operations with no nasal complaints nor diseases. Methodology: Electron microscopy was done for them.
Specimens were fixed in cacodylate buffered formaldehyde glutraraldehyde-R. Post fixed in buffered 1%osomium
tetraoxide, dehydrated and embedded in spurris resin. Ultrathin section were double stained by 10 % Reynolds lead
citrate. Examination was done by TEM (philipo400). Results: The electron microscopic sections of patients with
VMR showed loss of intercellular junction with separated cells, cilia are shorter, sparce and deformed, apoptic cells
in the epithelial layer, the epithelial cells are full of vesicles and goblet cells. Another type of secretory glands are
also seen, loss of the smooth surface of endothelial cells and the basal lamina is thickened. Conclusion: The
pathology of the vasomotor rhinitis starts first in the submucosal vessels with angiopathy similar to the diabetic
angiopathy then the epithelial changes take place. Surgical or Medical treatment directed to the sympathetic system
may or may not improve the case depending mainly on how much the submucosal blood vessels are
affected.Presence of another type of secretory granules in the submucosal glands need more histochemical studies.
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