Rhinitis medicamentosa

Abstract

The diagnosis of rhinitis medicamentosa was made in 130 patients seen over a 10 year period from July 1967 to June 1977. There was an incidence of 1% in our otolaryngological practice. Patients had been taking the causal medication for an average of 21.4 months. There were 73 males and 57 females with the peak incidence in young and middle-age adults. The primary offending medications were decongestant nasal sprays in 85 patients, decongestant drops in 33, and a combination of these drugs in 12 patients. The major reasons for self-medication were 1. deviated nasal septum in 40 patients, 2. an acute upper respiratory infection in 33, 3. allergy in 18, 4. miscellaneous causes in 24 and 5. unknown in 15 patients. The initial management in addition to avoidance of the medication consisted of systemic antibiotics, decongestants, antihistamines, and sedatives depending on the severity of the rhinitis and the presence of secondary infection. Later treatment consisted of correction of the deviated septums, allergic management, and supportive care. Eight patients were considered to have complications of the disease by development of chronic ethmoiditis and nasal polyposis. The pharmacologic properties of the causal agents are thoroughly reviewed as they relate to the pathogenesis of this disease. It is felt that the ready commercial availability and limited clinical value of the topical nasal sprays and drops represents a certain risk to all patients using them.

Decongestion Effect and Rebound Swelling of the Nasal Mucosa during 4-Week Use of Oxymetazoline

“…Other authors argue that the nose drop addicts increase the dose of decongestants because the nasal mucosa 159 becomes more resistant to the effect of the drug [12,13,15]. The results of this trial show, however, that the decongestion effect did not decrease with time, and the results are in line with those reported by others [5,11].…”

Funktionen und Funktionsstörungen der respiratorischen Schleimhaut der Nase und der Nasennebenhöhlen

“…Als Komplikation kann es zur Ausbildung einer Septumperforation kommen [264] . Das Krankheitsbild f ü hrt unbehandelt zur Ausbildung einer sekund ä ren atrophischen Rhinitis bis zum Vollbild der Ozaena [265] . Entscheidend ist die sorgf ä ltige Anamnese zur Diagnosestellung mit Erfragung der letzten topischen und vollst ä ndigen regelm ä ß igen Medikamenteneinnahme.…”

Nasal Airflow in Health and Disease

“…Repeated application of topical sympathomimetics can cause a rebound vasodilation and nasal congestion (124,125) which may be related to tissue hypoxia cause by pronounced vasoconstriction. Rhinitis medicamentosa can occur after prolonged abuse of topical nasal decongestants (126,127) and this condition may be more related to chronic exposure to the preservatives used in topical nasal decongestants than to vasoconstriction (125).…”