vasomotor rhinitis is a highly reactive nasal disease caused by neuroendocrine imbalance in regulating the function of blood vessels and glands in nasal mucosa. The pathological mechanism of this disease is complicated, and many links are still unclear, which brings certain difficulties to the accurate diagnosis and effective treatment in clinic. There is no significant gender difference in the incidence, and vasomotor rhinitis rarely occurs in children. Almost everyone will have occasional nasal symptoms, so it is sometimes difficult to distinguish between a normal nose and a diseased nose. However, as long as the medical history is inquired in detail, carefully examined and the inducing factors are carefully analyzed, those who have accumulated nasal symptoms for more than one hour every day and have a course of more than one month can be diagnosed as vasomotor rhinitis after excluding the following diseases. 1. Allergen skin test of allergic rhinitis is positive, and there are eosinophils and basophils in nasal secretions. Seasonal rhinitis attacks are seasonal. 2. Infectious rhinitis can be divided into acute rhinitis and chronic rhinitis. Nasal secretions are often mucinous or purulent, and most of them are neutrophils. 3. There are a lot of eosinophils in nasal secretions of very allergic eosinophilic rhinitis, but there is no other allergic basis. 4. Aspirin intolerance triad Although there may be a large number of eosinophils in nasal secretions, patients have allergic history and asthma history of salicylic acid preparations or other antipyretic and analgesic drugs, and nasal polyps. 5. Excessive reverse rhinitis is caused by excessive reverse axons of sensory nerves in the nose, with sudden sneezing as the main symptom, sudden onset and rapid disappearance. Treatment measures Because of many inducing factors and complicated pathogenesis, comprehensive measures should be taken in the treatment. (1) Avoid or remove inducing factors to improve working conditions and environment, master the rhythm of life, stabilize emotions, and avoid excessive fatigue and tension. Necessary psychotherapy or suggestive language can sometimes achieve obvious results. If it is caused by endocrine factors, an endocrinologist should be invited to assist in the treatment as appropriate. (two) drug treatment should be based on the changes in the condition, timely choice of drugs. 1. The nasal decongestant can be selected for those with nasal congestion as the main symptom. However, attention should be paid to the occurrence of drug-induced rhinitis in application. Intermittent or alternating administration can be adopted. Sodium adenosine triphosphate (ATP), 4mg each time, three times a day, has a significant effect on relieving nasal congestion. Recently it has been confirmed that ATP may be another sympathomimetic drug. 2. Many non-immune factors of antihistamines can cause mast cells to release histamine, so antihistamines are still effective in many cases, and those with obvious symptoms of nasal itching and sneezing can be selected first. 3. Anticholinergic drugs are suitable for patients with rhinorrhea as the main symptom. Iparatropium bromide aerosol, 8μg per nostril, four times a day, can effectively control rhinorrhea. 4. Adrenal cortical hormone plays a non-specific anti-inflammatory role at all levels inside and outside the cell, so it has a significant effect on some cases of vasomotor rhinitis with obvious sneezing symptoms, more watery nasal mucus and obvious nasal mucosal edema. (3) Surgical treatment may be considered if one of the following circumstances occurs: ① After conservative treatment for more than one year, the symptoms are uncontrollable and tend to worsen; ② Anatomical deformity of nasal structure obviously affects ventilation or sinus drainage; ③ Irreversible pathological tissues such as proliferative changes of nasal mucosa or large polyps. 1. Correction of anatomical deformities The nasal structural deformities that can aggravate the symptoms of vasomotor rhinitis are mainly deviated nasal septum, and the severe ones often contact or even press against the turbinate. This long-term stimulation can not only aggravate the local inflammatory reaction, but also often cause headaches. Narrow nasal bore is also a common anatomical deformity, which mainly causes nasal congestion. Narrow nasal foramen is often caused by the collapse of lateral cartilage of nose. Some people call it structural rhinitis because of nasal symptoms caused by nasal anatomical malformation. Early correction of the above deformities can obviously alleviate the symptoms and even cure them. 2. The excision of irreversible tissue obviously causes the hyperplasia and hypertrophy of nasal congestion, and nasal polyps formed by long-term edema of nasal mucosa should be removed in time. 3. Reduce the excitability of intranasal nerve. Cut off the control of parasympathetic nerve fibers to the nasal cavity to reduce its excitability. This kind of operation includes: (1) Superficial petrosal nerve transection, which was first advocated by Ziegelman(1934) to treat vasomotor rhinitis. Fan Zhong (1987) treated 11 cases of vasomotor rhinitis with this operation, and all of them had obvious short-term and long-term effects. However, because the operation requires craniotomy, it is not easy for ordinary patients to accept. The superficial petrosal nerve is a simple parasympathetic nerve fiber, which comes from the lacrimal gland nucleus of pons, enters the internal auditory canal and is called the intermediate nerve. It descends to the geniculate segment of the facial nerve, then enters the petrosal canal and goes forward. After the facial nerve canal breaks, it goes outside the dura mater in the groove of the greater superficial petrosal nerve in front of the petrosal part, passes under the trigeminal ganglion or mandibular nerve to the rupture hole, and merges with the deep petrosal nerve emitted by the sympathetic nerve around the internal carotid artery to form the pterygoid canal nerve. According to the study of 3 adult cadavers (6 sides) by Lin Yuanwen et al. (1985), the total length of the superficial petrosal nerve was 15.38 1.91 mm. The proximal end is 3.64±14mm； long; The distal part is the sulcus segment, which is 11.73±2.69mm long. The transverse diameter of the whole segment is thin, about .42±.9mm, accompanied by tiny blood vessels, and most of the arteries come from the posterior branch of the middle dural artery. The sulcus of this nerve varies in depth, and 7 sides (11.6%) of the nerve trunk are completely hidden in the sulcus. The two edges of the sulcus form a narrow bone seam on the superficial surface of the nerve trunk, which makes it difficult to cut off the nerve trunk in the sulcus. On the lateral side of the greater superficial petrosal nerve, there is the lesser superficial petrosal nerve, which is basically arranged in parallel, with an average transverse diameter of .36±.9mm, most of which run in the bone canal and a few in the sulcus. During the operation, we should pay attention not to mistake the greater superficial petrosal nerve. The distance between the facial nerve canal hiatus and the anterior spinous foramen and the posterior arcuate protuberance is about 1cm, and they are in a straight line. There is a silver-white dense connective tissue membrane and dura mater adhesion at the hiatus of facial nerve canal, which is an important anatomical sign of operation. The operation method is the same as that of Spiller-Frazier trigeminal nerve rhizotomy, and the middle cranial fossa of temporal bone can be used. The operating field is large. The patient takes a semi-sitting position in order to reduce intracranial pressure and reduce bleeding in the operating area. Anesthesia with intratracheal ether or local intensive anesthesia with procaine. 3cm from the front of tragus, cut the skin 7cm longitudinally from the zygomatic arch to the back of the temporal bone, separate the temporal muscle and periosteum, use a mastoid retractor to pull it left and right, use an electric drill and rongeur to cut off a circular window hole with a diameter of 4 ~ 5 cm, and the lower part should reach the skull base as low as possible, and separate the dura mater of the skull base from the outside to the inside. First, you can see the arcuate protuberance, and then follow the middle dura artery to find the spinous hole. The meridian of the shallow petrosal great god is located between the arch protuberance and the spinous foramen, and its running direction is roughly parallel to the long axis of petrous bone, about 1cm away from these two marks. After that, the outer segment enters the petrous bone and touches the geniculate ganglion; Its anterior and medial segment runs under the semilunar ganglion of trigeminal nerve and enters the rupture hole. At this time, red nerve fibers can be seen by separating the arch protuberance slightly forward and inward with the stripper. Fibrous tissue often adheres between the greater superficial petrosal nerve and the dura mater, so the separation operation must be careful, so as not to tear it forcibly, so as not to damage the knee joint and cause facial paralysis. After determining the superficial petrosal nerve, it is best to cut it off or electrocautery in its groove in situ, and it is not advisable to provoke traction to avoid facial paralysis. Gardner and Nosik(1951) advocated cutting off the nerve trunk by 2 ~ 4 mm to prevent the recurrence of symptoms caused by regeneration. In case of extra-deep groove type cases, microelectrodes can be inserted from the cracks in the groove to destroy the nerve trunk by electrocautery. Be careful not to approach the facial nerve canal hiatus, so as not to damage the facial nerve. If there is oozing blood, electrocautery can be used to stop bleeding, and then the incision should be sutured in layers, and antibiotics should be used to prevent infection after operation. (2) The pterygoid canal nerve contains parasympathetic nerve fibers that enter the nasal cavity. Malcomson(1959) first proposed transection of pterygoid nerve through nasal septum. Since then, various surgical operations have been reported one after another, all of which claim to have good curative effect, but the evaluation of long-term curative effect is different. The operation can control sneezing and watery nasal discharge, but the improvement of nasal congestion is poor. Postoperative dry eye discomfort is a common complication. The pterygoid canal nerve contains preganglionic fibers from parasympathetic nerves of the greater superficial petrosal nerve and postganglionic fibers from sympathetic nerves of the deeper petrosal nerve. The two kinds of nerve fibers meet at the rupture hole and move forward in the pterygoid canal, which is renamed pterygoid canal nerve. This nerve passes through the pterygopalatine canal from back to front to the inside of pterygopalatine fossa, and the sphenopalatine ganglion is added above its deep part, from which the postganglionic fibers of parasympathetic nerve and sympathetic nerve are emitted, which are added to lacrimal nerve through zygomatic branch of maxillary nerve and communicating branch for secretion by lacrimal gland. The external orifice of pterygoid canal nerve is funnel-shaped, located at the outer lower part of sphenoid bone, the top of pterygoid process inner plate, the inner lower part of circular hole and the outer lower part of sphenoid sinus natural hole. There is a bone ridge between the round hole and the outer opening of the pterygoid tube. The author found that if a round-headed probe was inserted from the anterior nostril along the middle nasal passage, and it was about 1cm above the posterior nostril, it would be a sign of surgical location to touch the funnel depression, that is, the external hole of the pterygoid tube. The relationship between sphenopalatine foramen and the posterior end of middle turbinate: in 1 cases, the sphenopalatine foramen was behind the middle turbinate, accounting for 95%; 5% of them are located behind and above the middle turbinate.