Do Not Use Any Nasal Spray Freely Without Consulting Your Doctor!

Long-Term Nasal Decongestant Use and Rhinitis Medicamentosa (RM)

chemical rhinitis,Rhinitis Medicamentosa,decongestant nasal spray
In some cases, when your nose is very congested, you should not use nasal decongestant sprays for a long time, which you know will be very good for you and cause relaxation in the nasal air passage as soon as they are squeezed. Especially these sprays are suitable for regular use for only 3 and sometimes a maximum of 5 days. These sprays are easily available at pharmacies, and when you first use them, you might think "this is my medicine". Particularly in patients with turbinate hypertrophy or septal deviation, since the available air passage is already narrow, severe nasal congestion may occur in the case of a simple upper respiratory tract infection or mucosal inflammation due to allergic rhinitis. Unfortunately, these patients may start to use these sprays as the "fastest nasal medicine" as a medical treatment option. Nasal decongestant sprays reduce intranasal mucosal edema and increase air passage by affecting microcirculation. These effects can last for 8 hours or more, but in case of long-term use, the rebound effect may shorten the duration of the effect and patients may need to use it more frequently. An increase in nasal congestion complaints, which is called chemical rhinitis or Rhinitis Medicamentosa (RM) and vice versa, may occur. While there is very little use, such as once a week, at the beginning of the drug use; The frequency of use may increase over time and may need to be sprayed more than 10 times a day. The reason for this is that the longer the use, the shorter the effect of the drug.

What causes rhinitis medicamentosa?

The pathophysiology of RM has been attributed to two distinct classes of topical nasal decongestants, sympathomimetic amines and imidazoline derivatives. Sympathomimetic amines act on alpha-1 and beta receptors; this results in a period of vasoconstriction (decreased vessel diameter - decreased microcirculation) followed by vasodilation (increased vessel diameter - increased microcirculation) leading to nasal mucosal swelling. Imidazoline is an alpha-2 agonist that causes vasoconstriction of nasal vessels. This has a negative effect on endogenous norepinephrine. When imidazoline use is discontinued or withdrawn, it is believed that the vasomotor tone provided by the sympathetic system will not be maintained (resulting in re-widening of the vessel diameter), which increases parasympathetic activity and causes rebound congestion. Over time, chronic nasal decongestant use leads to microscopic changes in the nasal mucosa resulting in mucus-producing goblet cell hyperplasia, squamous cell metaplasia, and destruction of nasal cilia (Source >> Rhinitis medicamentosa: a nationwide survey of Canadian otolaryngologists). In old source books, a picture of an effort to clean the mucus that involuntarily drips from his nose with a napkin in his hand and bent forward is used in rhinitis medicamentaso.

Nasal decongestants that are frequently used in pharmacies include "xsilometazoline hydrochloride, oxymetazoline and tetrahydrazoline HCL".

Rhinitis medicamentosa treatment

Will you be able to discontinue the use of this drug?

A very big problem in patients who use nasal decongestant spray for a long time is "not being able to live without this drug" and the frequency of use has to be increased gradually. Our patients may be advised not to use these drugs if possible, and instead to use nasal saline irrigation and nasal cortisone sprays. However, this situation is a bit difficult and the common problem that is said in almost all of the patients who have become addicted for a long time is the sentence "I can't breathe without these sprays". Decongestant tablets can be used by mouth. While nasal saline irrigation, nasal cortisone sprays and oral decongestant drugs listed above may be beneficial for patients who want to get rid of this drug addiction in the early period; when it comes to chronic use, medical treatment option is quite difficult. It is necessary to inform our patients that "turbinate reducing procedures will be required if you continue to use it". So deliberately and slowly, the surgical treatment option seems to be the way to go.

Turbinate radiofrequency in the treatment of rhinitis medicamentosa

In patients who have used nasal decongestants for a long time, radiofrequency turbinate reduction can be performed to reduce the enlarged turbinates in order to treat the need for frequent use of the drug and the deterioration in quality of life, and after the procedure, the internal silicone splints placed in the nose are kept longer than normal (like 10 days). With the rebound effect, it can prevent the re-turbinates from contacting the septum by swelling. Generally, the turbinates start to shrink from the 10th day after the procedure. After the procedure, patients should not use nasal decongestants and should continue to breathe through the nose by cleaning the holes of the silicone splints with saline sprays.

Precautions for rhinitis medicamentosa

First of all, it is appropriate to accept nasal decongestant sprays as a "medicine" and to use this drug by reading the user manual. Please note the following recommendations regarding the use of nasal decongestant sprays:

- If your nose is blocked due to an upper respiratory tract infection or an allergic condition, nasal irrigation should be started by using sprays or waters containing natural salt water, and then appropriate medications should be arranged. If you are experiencing serious problems due to nasal congestion, it is appropriate to start with the lowest possible dose (for example, once in the evening).
- In regular use, adjust the dose to be no more than 3x1 for a maximum of 3 or 5 days.
- Do not use these sprays for every nasal congestion.
- In the minimally toxic treatment of allergic rhinitis, it may be appropriate to first use sprays containing ocean water into the nose and then use cortisone nasal sprays. Do not view nasal decongestants as first-line therapy in allergic conditions.
- Avoid continuous use of these drugs at bedtime, although it may result in an increase in your sleep quality at first; In long-term use, a shortening of the duration of action and an increase in the frequency of use are inevitable and you may need to spray these sprays after waking up from sleep.

Do not use decongestant products without consulting your doctor and reading the instructions for use.

Patients with nasal septum deviation, nasal polyp, nasal stenosis causing nasal obstruction should be careful in terms of nasal decongestant dependence. Patients may be more inclined to use these products because of the reduction in nasal congestion when they use these products. Patients with nasal septum deviation, nasal polyp, nasal stenosis causing nasal obstruction should be careful in terms of nasal decongestant dependence. Patients may be more inclined to use these products because of the reduction in nasal congestion when they use these products.

Rhinitis medicamentosa - are you addicted to nasal spray?

If you are using nasal decongestant sprays, you should try to end the medication by reducing the dose as much as possible. It is appropriate to reduce nasal decongestants by using nasal cortisone sprays and nasal salty sprays. In addition, if you have become addicted to this drug, if you cannot stop using it, you should consult an ENT specialist and be followed up. If you cannot stop using the decongestant spray, you are likely to make an appointment for an intranasal surgery in the future.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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