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Rhinitis Medicamentosa - Symptoms, Causes, Diagnosis, and Treatment

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Rhinitis medicamentosa is a condition affecting the nose in which there is inflammation of the nasal mucosa due to overuse of nasal decongestants.

Medically reviewed by

Dr. Sandeep Shrestha

Published At October 27, 2022
Reviewed AtOctober 27, 2022

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.

  • 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.

Frequently Asked Questions

1.

How Does One Acquire Rhinitis Medicamentosa?

Rhinitis medicamentosa, or rebound rhinitis, is acquired through prolonged or excessive use of nasal decongestant medications containing vasoconstrictors, such as oxymetazoline or phenylephrine.

2.

What Is The Mechanism Behind Rebound Rhinitis?

 
Rebound rhinitis is characterized by a mechanism known as "rebound vasodilation." When you stop using vasoconstrictor medication, the blood vessels in your nasal passages expand, causing increased blood flow and inflammation in the nasal tissues. This results in significant nasal congestion, worse than the original congestion the medication was meant to alleviate.

3.

What Is Considered The First-line Treatment For Rhinitis?

The first-line treatment for rhinitis depends on the type and underlying cause.
- For allergic rhinitis, intranasal corticosteroids are usually the first-line treatment.
- Intranasal corticosteroids effectively decrease inflammation in the nasal passages, relieving symptoms such as nasal congestion, sneezing, and itching.
These medications are available in different forms and can be obtained with or without a prescription.

4.

What Complications Can Arise From Rhinitis Medicamentosa?

Complications of rhinitis medicamentosa include the following:
- Chronic nasal congestion.
- Nasal dryness and irritation.
- Nasal bleeding.
- Sinusitis and sinus infections.
- Nasal polyps.
- Reduced response to medications. 
Prolonged and excessive use of nasal decongestants can lead to these issues. 

5.

Do Beta Blockers Contribute To The Development Of Rhinitis?

 
Yes, beta blockers can cause the development of rhinitis due to their potential to constrict blood vessels in the nasal passages, leading to nasal congestion. Not everyone who takes beta blockers will experience rhinitis, as individual reactions can vary. 

6.

How Can Nasal Rebound Congestion Be Alleviated?

To alleviate nasal rebound congestion: 
- Gradually reduce the use of nasal decongestant sprays.
- Use saline nasal sprays or rinses to moisturize and clear nasal passages.
- Try non-medicated nasal strips or warm compresses for temporary relief.
- Obtain personalized guidance by consulting with a healthcare professional.

7.

Is Rebound Congestion A Permanent Condition?

 
Rebound congestion is not a permanent condition. The rebound congestion can gradually improve over time with proper management and discontinuation of the offending nasal decongestant sprays or drops. It may take a few days to weeks for the nasal passages to return to normal. 

8.

Is Rhinitis Medicamentosa Considered A Chronic Condition?

Rhinitis medicamentosa is not a chronic condition but a result of long-term and excessive use of nasal decongestants. Proper management and discontinuation of the medication can lead to symptom resolution over time. Guidance from a healthcare professional and alternative treatment strategies are crucial in addressing nasal congestion and inflammation.

9.

Can One Use Only One Nostril When Experiencing Rhinitis Medicamentosa?

 
When experiencing rhinitis medicamentosa, using only one nostril for breathing is possible. However, this may lead to an imbalance in airflow and discomfort. It is advisable to seek appropriate treatment, such as discontinuing the offending medication and adopting alternative strategies, to address the underlying cause and alleviate symptoms effectively.

10.

Why Does Rhinitis Continue To Recur?

Rhinitis can recur due to:
- Allergens: Triggers like pollen, dust mites, or pet dander can cause allergic rhinitis.
- Irritants: Smoke, strong odors, or environmental irritants can lead to non-allergic rhinitis.
- Underlying Conditions: Sinusitis or hormonal changes can contribute to recurrent rhinitis.
 

11.

What Is The Most Effective Non-addictive Nasal Spray Available?

 
Fluticasone propionate, Budesonide, and Mometasone furoate are effective, non-addictive nasal sprays that reduce inflammation and relieve nasal symptoms. Consulting a healthcare professional is recommended to determine the best treatment option.

12.

What Treatment Options Are Recommended For Rhinitis Medicamentosa?

 
The recommended treatment options for rhinitis medicamentosa include gradually tapering off the use of nasal decongestant sprays or drops, utilizing saline nasal sprays or rinses to moisturize the nasal passages, and considering alternative medications or treatments for nasal congestion, such as nasal corticosteroid sprays. 

13.

Which Drug Is Associated With Medicamentosa Rhinitis?

Medicamentosa rhinitis is associated with:
- Long-term use of nasal decongestant sprays or drops.
- Common ingredients in medications such as oxymetazoline, phenylephrine, or xylometazoline.
- Prolonged usage can lead to rebound congestion and the development of rhinitis medicamentosa.
 

14.

Why Does Rhinitis Persist Despite Attempts To Treat It?

Rhinitis can persist despite treatment due to several reasons. These include inadequate identification or avoidance of triggers, underlying chronic conditions like sinusitis, and incomplete or ineffective management of inflammation and symptoms. A comprehensive approach that addresses these factors is necessary to manage persistent rhinitis successfully.

15.

How Can Chronic Rhinitis Be Permanently Cured?

While chronic rhinitis cannot be wholly cured, managing the condition and controlling its symptoms effectively is possible. Treatment options for chronic rhinitis may include:
- Identifying and avoiding triggers.
- Using medicines like nasal corticosteroids or antihistamines.
- Using immunotherapy for allergic rhinitis. 

16.

Which Foods Should Be Avoided If One Has Rhinitis?

Foods to avoid in rhinitis:
- Dairy products.
- Processed foods with preservatives and additives.
- Allergenic foods like shellfish, nuts, and eggs.

17.

What Is The Quickest Way To Alleviate Symptoms Of Rhinitis?

Quickest ways to alleviate rhinitis symptoms:
Use over-the-counter nasal decongestant sprays for immediate relief of nasal congestion.
Take over-the-counter antihistamines for sneezing, itching, and runny nose.
Follow recommended dosages of nasal sprays to avoid rebound congestion.
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Dr. Sandeep Shrestha
Dr. Sandeep Shrestha

Otolaryngology (E.N.T)

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