An oral or topically sprayed agent that ↓ swollen nasal mucosa, and facilitates breathing; NDs often cause a rebound effect, in which the Sx worsen when the ND is discontinued, due to tissue dependence on the drug
(4) This recommendation is based on the lack of evidence regarding efficacy and the known rebound congestion associated with topical decongestants. If a decongestant is prescribed, the oral route is preferred, with the understanding of potential significant side effects of nervousness, insomnia, tachycardia, and hypertension.
Finding purulent secretions in the nasal cavity is highly specific for acute bacterial rhinosinusitis (specificity 79%-100%) (1, 2, 3) but is uncommon and difficult to assess, requiring the use of a nasal speculum and possibly topical decongestants. The primary care physician's overall clinical impression was accurate in Williams' study but not in others.