Christos Georgalas1, Ljiljana Jovancevic. 1. Endoscopic Skull Base Amsterdam, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. c.georgalas@amc.nl
Abstract
PURPOSE OF REVIEW: This review aims to characterize gustatory rhinitis using recent advances in pathophysiology and novel surgical and medical management strategies. RECENT FINDINGS: A significant amount of research has recently focused on the role of capsaicin and its receptors (TRPV1 and VR1), which can be found on sensory c-fibers in human nasal mucosa and play a critical role in the development of nasal hyperresponsiveness to environmental factors. Blocking the nasal sensory nerve stimulation (via the use of capsaicin desensitization) or outgoing parasympathetic innervation (via endoscopic Vidian neurectomy) may control nasal hyperresponsiveness and therefore prevent the induction of rhinitis symptoms. SUMMARY: Gustatory rhinitis is a conspicuous type of food-associated rhinorrhea, which can occasionally be associated with significant quality-of-life impairment. It results from an abnormal gustatory reflex associated with a hyperactive, nonadrenergic, noncholinergic, or peptidergic neural system. The use of nasal ipratropium bromide may be effective, if avoidance is not possible or successful. We have had excellent results with the use of intranasal capsaicin or endoscopic vidian neurectomy (including removal of 4-5 mm of the nerve between pterygopalatine fossa and the sphenoid floor) in patients with nonallergic rhinitis, and these could potentially be used as a last resort in patients with intractable gustatory rhinitis.
PURPOSE OF REVIEW: This review aims to characterize gustatory rhinitis using recent advances in pathophysiology and novel surgical and medical management strategies. RECENT FINDINGS: A significant amount of research has recently focused on the role of capsaicin and its receptors (TRPV1 and VR1), which can be found on sensory c-fibers in human nasal mucosa and play a critical role in the development of nasal hyperresponsiveness to environmental factors. Blocking the nasal sensory nerve stimulation (via the use of capsaicin desensitization) or outgoing parasympathetic innervation (via endoscopic Vidian neurectomy) may control nasal hyperresponsiveness and therefore prevent the induction of rhinitis symptoms. SUMMARY: Gustatory rhinitis is a conspicuous type of food-associated rhinorrhea, which can occasionally be associated with significant quality-of-life impairment. It results from an abnormal gustatory reflex associated with a hyperactive, nonadrenergic, noncholinergic, or peptidergic neural system. The use of nasal ipratropium bromide may be effective, if avoidance is not possible or successful. We have had excellent results with the use of intranasal capsaicin or endoscopic vidian neurectomy (including removal of 4-5 mm of the nerve between pterygopalatine fossa and the sphenoid floor) in patients with nonallergic rhinitis, and these could potentially be used as a last resort in patients with intractable gustatory rhinitis.