rhinitis medicamentosa


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rhi·ni·tis me·di·ca·men·to·sa

inflammation of the nasal mucous membrane secondary to excessive or improper topical medication.

rebound rhinitis

A noninfectious, nonallergic rhinitis caused by rebound vasodilation linked to the use of topical vasoconstricting decongestant sprays for more than 4–6 days.

Clinical findings
Nasal congestion, which responds poorly to increased use of decongestants; patients may snore.

Endoscopy
Nasal mucosa is often beefy-red with punctate bleeding, granular or boggy, with patchy tissue friability and profuse stringy mucoid discharge.
 
DiffDx
Allergic rhinitis, continuous positive airway pressure (CPAP) rhinitis, nasal polyps, non-allergic rhinitis, rhinosinusitis.

Reasons for use of decongestants
Allergy, nonallergic rhinoplasty, chronic rhinosinusitis, nasal polyps, night-time continuous positive airway pressure (CPAP), upper respiratory tract infection.
 
Management
Discontinue decongestants ASAP; oral corticosteroids. 

Pathology
Nasociliary loss, squamous cell metaplasia, epithelial oedema, epithelial cell denudation, goblet cell hyperplasia, increase in epidermal growth factor receptor, inflammation.

rhinitis medicamentosa

ENT A complication of chronic topical nasal decongestant use, in which there is a progressive shortening of therapeutic efficacy, coupled with rebound rhinitis after treatment is discontinued. See Allergic rhinitis, Decongestant.
References in periodicals archive ?
Additionally, the prolonged use of these drugs can induce rhinitis medicamentosa (Black and Remsen, 1980; Suleimani and Walker, 2007).
However, the benefit of topical decongestants often leads to the overuse of this form of therapy, which may lead to rebound or rhinitis medicamentosa.
Nasal turbinate congestion could indicate a viral aetiology, allergic or irritative rhinitis or rhinitis medicamentosa due to decongestant abuse.
Patients in this group have conditions of varying etiologies, such as vasomotor rhinitis, atrophic rhinitis, rhinitis medicamentosa, nonallergic rhinitis with eosinophilia, chronic rhinosinusitis, metabolic conditions, structural obstruction, and physical or chemical irritation of the nose.
11) While the intranasal agents are faster than the oral formulations, the duration of treatment is limited to less than 10 days to prevent rhinitis medicamentosa (11); intranasal decongestants are not used as long-term therapy except during severe symptoms.
Patients can use preservative-free drugs in PFP N and not worry about the potential side effects of some preservatives or the short- and long-term consequences, such as rhinitis medicamentosa ("rebound nasal congestion").
However, their use may produce rhinitis medicamentosa, which may occur as early as day 3 in some patients.
a history of atrophic rhinitis or rhinitis medicamentosa within 60 days of screening;
Rhinitis medicamentosa is a complication of chronic use of vasoconstrictor nasal sprays or intranasal cocaine abuse.
Nasal septal perforation is a rarely reported complication of rhinitis medicamentosa.
oxymetazoline and phenylephrine) may also be used for relief of nasal congestion, but they carry a risk of causing rebound rhinitis medicamentosa.
Rhinitis medicamentosa is the most commonly recognized type of drug-induced congestion.