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ORGAN SYSTEMS Otolaryngeal system (ENT)

Rhinitis medicamentosa

Rebound nasal congestion brought on by extended use of topical decongestants and certain oral medications that vasoconstrict the blood vessels in the lining of the nose.

Rebound congestion is a worsening of your nasal congestion due to nasal decongestants such as Afrin (oxymetazoline), Sudafed (pseudoephedrine), or Sudafed PE (phenylephrine). Rebound congestion is also known as rhinitis medicamentosa, chemical rhinits, nasal spray addiction. Your nasal passages can develop a dependence to these medications in as little as 3 days; for this reason, the boxes and your doctors will tell you to only take these medications for no more than 3 days. | Burger/Getty Images

Rebound nasal congestion brought on by extended use of topical decongestants and certain oral medications that vasoconstrict the blood vessels in the lining of the nose.

  • Topical decongestants:
    • Oxymetazoline
    • Phenylephrine
    • Xylometazoline
    • Naphazoline nasal sprays
  • Oral medications:
    • Sympathomimetic amines
    • Various 2-imidazolines
640px-nasal-vasoconstrictor
Oxymetazoline HCL, two types of nasal vasoconstrictors brand Afrin ®, Schering-Plough laboratories. The prolonged use of nasal vasoconstrictors cause rhinitis medicamentosa.

Clinical features

  • Nasal congestion without rhinorrhea, postnasal drip, or sneezing
    • Following several days of decongestant use (typically after 5–7 days of use)
  • Turbinate hypertrophy: Swelling of the nasal passages caused by rebound congestion may eventually result in permanent turbinate hypertrophy, which may block nasal breathing until surgically removed.

Management

Withdrawal of the offending nasal spray or oral medication.

  • Cold turkey approach: M/effective treatment method as it directly removes the cause of the condition
  • Gradual weaning approach: Helps preserve normal nasal airflow during the withdrawal process

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