Conditions: Rhinitis Medicamentosa

Rhinitis medicamentosa is a condition of tolerance or addiction to the use of nasal decongestant sprays, such as oxymetazoline (Afrin, Sinex) or phenylephrine (Neosynephrine)

 

WHAT IS Rhinitis medicamentosa?

Rhinitis medicamentosa is a condition characterized by rebound nasal congestion that occurs after the prolonged use of topical nasal decongestants. These medications are often used to relieve nasal blockage due to conditions like allergic rhinitis or sinusitis. However, when used for more than a few days, these decongestants can lead to a cycle of dependency.

The overuse of these medications can result in the nasal mucosa becoming less responsive to the medication itself, causing patients to use stronger or more frequent doses in an attempt to alleviate their symptoms. This cycle perpetuates the issue, leading to chronic nasal congestion once the medication is discontinued.

Symptoms of rhinitis medicamentosa typically include nasal stuffiness, difficulty breathing through the nose, and a persistent need for decongestants to achieve relief. Treatment primarily involves the cessation of the overused nasal decongestants, which can lead to an initial worsening of symptoms. This withdrawal phase typically resolves over time, with alternative therapies such as saline nasal sprays, intranasal corticosteroids, oral antihistamines, or nasal surgery to help manage symptoms.

Rhinitis medicamentosa is a reversible condition, and awareness of its potential can help prevent its development in individuals using nasal decongestants.

What are examples of topical nasal decongestants?

The term topical refers to medicine that is placed on the surface to be treated, such as with a spray to the lining of the nose.

  1. oxymetazoline (Afrin®, Dristan®, Sinex®, Nasal Relief Spray®, Zicam®)

  2. phenylephrine (Neo-Synephrine®)

WhAT are the symptoms of rhinitis medicamentosa?

The symptoms of rhinitis medicamentosa include:

  • Persistent nasal airway resistance and mouth breathing

  • Runny nose

  • Sneezing

  • Nasal itching

  • Reduced sense of smell

  • Pressure in the nasal passages

Typically, these symptoms worsen when the effects of the decongestant wear off, prompting individuals to use the medication more frequently, which can perpetuate the cycle of symptoms. Over time, this can lead to chronic nasal obstruction.

how is rhinitis medicamentosa diagnosed?

Rhinitis medicamentosa is diagnosed when someone has used a nasal decongestant repeatedly over several days with diminishing effect and increased rebound nasal congestion. Rhinitis medicamentosa can occur after as few as four days of use of a nasal decongestant. .

 

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