Rhinitis Medicamentosa - Symptoms, Causes, Diagnosis, and Treatment

What Is Rhinitis Medicamentosa?

Rhinitis medicamentosa is a condition that is induced by misuse or overuse of nasal decongestants that results in irritation and inflammation of the nasal mucosa. Nasal decongestants are medicine that is used to relieve swelling of the nasal mucosa seen in conditions like allergic and non-allergic rhinitis, acute or chronic rhinosinusitis, nasal polyps, or upper respiratory tract infection. In some patients, the continuous use of nasal decongestants for three days or more is shown to develop rhinitis medicamentosa. The management of this condition is mainly by withdrawing the use of decongestants and treating the underlying cause of congestion.

What Are the Causes of Rhinitis Medicamentosa?

The conditions which demand the use of nasal decongestants are:

• Deviated nasal septum.

• Upper respiratory tract infection.

• Cocaine and other drug abuse.

• Chronic rhinosinusitis.

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• Hypertrophy of the inferior turbinates.

• Nasal polyps.

• Allergic and non-allergic rhinitis.

What Are the Symptoms of Rhinitis Medicamentosa?

The only symptom present in patients with rhinitis medicamentosa is nasal congestion. The symptoms present do not vary according to season or months and are generally not aggravated by any external factors. These patients do not have itchy eyes, nose, or throat, unlike in other conditions. The symptoms are restricted to the nose only generally. These patients have chronic nasal congestion that lasts for several weeks or months and is relieved on withdrawal of the use of the nasal decongestant.

How Long Does Rhinitis Medicamentosa Last?

The duration of the treatment for the rhinitis medicamentosa will vary from patient to patient. However, it will take at least two weeks for the edema and the histamine sensitivity to subside.

How Is Rhinitis Medicamentosa Diagnosed?

The diagnosis of this condition can be made by the intervention of a doctor and requires taking the history of the condition. The doctor is supposed to ask for the use of nasal decongestants as the patients might not consider this a significant cause of the condition present. The diagnosis of this condition is difficult to make as there are no specific tests to diagnose this. If the condition is caused due to the use of nasal decongestants, then stopping the medicine will relieve the symptoms. The intervention by a specialist will help to arrive at a diagnosis.

How Is Rhinitis Medicamentosa Treated?

The first step in treating rhinitis medicamentosa is stopping the use of nasal decongestants. Also, the patient needs to be educated about the side effects of using this medication and should be provided with other alternative methods to treat the condition.

Like in the case of allergic rhinitis, rather than using nasal decongestants, avoid the triggering factor.

• Saline Nasal Sprays - In case of mild congestion, the doctors might advise the use of saline nasal sprays, which will help to clear the nasal passage, and hence, the symptoms will be decreased; these sprays contain only salt water, and there are no medications that can irritate the nasal mucosa.

• Nasal Glucocorticoids - In severe cases, doctors may recommend the use of nasal Glucocorticosteroids that will reduce inflammation and congestion.

• Pain Killers - Pain relieving drugs can be prescribed for patients who experience headaches during the withdrawal period.

• Surgery - In the case of patients having rhinitis due to the presence of deviated nasal septum or nasal polyp, surgical correction is recommended so as to avoid the cause, which needs the use of nasal decongestants.

Also, oral decongestants can be advised as intranasal decongestants cannot be further used.

Pregnant Patients:

During the pregnancy period, most women experience rhinitis. The treatment for pregnant patients with rhinitis medicamentosa is the same as mentioned above, except that the use of oral decongestants is not advised.

How to Wean From the Use of Nasal Decongestants?

Suddenly stopping the use of the medication can worsen the condition. This may lead to increased swelling and congestion. Hence, the doctor will advise to gradually stop the medicine.

The first week of withdrawal from the use of the decongestant spray is the most difficult phase during which the patient will feel an increase in the existing symptoms. In such times, nasal Corticosteroids are found to be effective. Short-term use of oral Corticosteroids is found to be effective in stopping the use of topical vasoconstrictor drugs. Oral Corticosteroids are used along with nasal Corticosteroids for around five to ten days and may continue for more days until the condition is corrected.

The weaning from the use of intranasal decongestants can be attained gradually by allowing the patients to use only at night in one nostril and alternating the left and right nostrils until the congestion is relieved.

Can Rhinitis Medicamentosa Be Prevented?

Yes, rhinitis medicamentosa can be prevented to some extent by the proper use of drugs that cause this condition. Before using any medicine, carefully go through the label, which clearly mentions how the medicine needs to be used and for how long. Until and unless suggested by a doctor, intranasal decongestants should not be used continuously for a longer time. Also, observe if the symptoms are getting better with the use of decongestant sprays; if not, report to the doctor so that you can discontinue the use of decongestants and prevent the development of rhinitis medicamentosa.

Conclusion

Rhinitis medicamentosa is the inflammation and congestion caused due to overuse of topical vasoconstrictors like intranasal decongestants. In this condition, unlike other rhinitis, the patients will have to present symptoms only pertaining to the nose, not the eye and throat. Patients with other types of rhinitis, such as allergic and non-allergic rhinitis, will have itchy eyes, nose, and throat. These patients generally do not experience this. The main complaint of these patients will be nasal congestion that will rebound when the use of the intranasal decongestant is stopped. The diagnosis of this condition is a bit difficult as there are no specific tests or other findings specific to it. In case you suspect rhinitis medicamentosa, consult a doctor, and they will work on your case and find the diagnosis, and then the treatment can be started.

The use of intranasal decongestants should not be avoided in fear of rhinitis medicamentosa if recommended by a doctor. If the use is as prescribed by the doctor or as mentioned on the label, the chance of developing rhinitis medicamentosa is less.