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Protect yourself this winter from… rhinitis medicamentosa

The latest article in the local press by Dr P. Symeonides regarding the unwanted side-effects from overusing nasal decongestants. The article is translated in English below:

Protect yourself this winter from… rhinitis medicamentosa

With winter around the corner, numerous adverts appeared on the media regarding the use of nasal decongestant sprays to help patients with the symptoms of the common cold. These medicated solutions contain primarily a substance called xylometazoline that acts on the nasal mucosa and causes vascular constriction, leading to the reduction of nasal obstruction and discharge. These sprays are very effective. They work within a few minutes and offer relief of symptoms for a few hours, making their frequent use almost inevitable. There is an advice on the bottle about limiting the use of the spray to 7 days but because of their effectiveness, patients sometimes chose to ignore it. Many patients will end up using the spray long term to self-treat chronic conditions that cause nasal obstruction and discharge like rhinitis, rhinosinusitis and nasal polyps etc.

The frequent and prolonged use of nasal decongestant sprays leads to rebound nasal obstruction almost instantly after their use, creating a vicious circle. The patient starts using the spray more often and applying bigger volumes each time thinking that the spray somehow is less effective than before. The truth is in fact, that this practice is only making the situation worse by increasing the dependence on the spray and leading to persistent nasal obstruction. This is called rhinitis medicamentosa.

Rhinitis medicamentosa can be a very challenging condition to manage. The doctor needs to address the dependence of the patient on the spray as well as treat the physical signs of nasal obstruction. It is certainly best to avoid reaching this point with the correct use of the nasal spray by following the prescribing doctor’s advice.

Cases of chronic nasal obstruction need to be seen by the ENT Surgeon for clinical and endoscopic examination of the nose. If Rhinitis medicamentosa is diagnosed, the successful management relies on educating the patient and convincing him or her that the spray which used to offer symptom relief a few days earlier has now become the cause for the worsening symptoms. The patient needs to be supported and aided by the clinician to stop the decongestant spray as soon as possible with the use of Corticosteroids playing a vital role in this. In advanced cases, where the inferior nasal turbinates are permanently hypertrophied and do not respond to the use of steroids, surgery might be necessary to treat the nasal obstruction.

Dr Panayiotis Symeonides MBChB MRCS DOHNS Ear, Nose and Throat – Rhinology & Anterior Skull Base Surgeon

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