Rhinitis medicamentosa Rhinitis medicamentosa is a condition of rebound nasal congestion suspected to be brought on by extended use of topical decongestants and certain oral medications that constrict blood vessels in the lining of the nose although evidence has been contradictory.Presentation The characteristic presentation of RM involves nasal congestion without rhinorrhea , postnasal drip , or sneezing following several days of decongestant use. This condition typically occurs after 5–7 days of use of topical decongestants. Patients often try increasing both the dose and the frequency of nasal sprays upon the onset of RM, worsening the condition. The swelling of the nasal passages caused by rebound congestion may eventually result in permanent turbinate hypertrophy , which may block nasal breathing until surgically removed.Causes Common issues that lead to overuse of topical decongestants: The pathophysiology of RM is unclear, although several mechanisms involving norepinephrine signaling have been proposed. RM is associated with histological changes that include: an increase in the number of lymphocytes and fibroblasts , epithelial cell denudation, epithelial edema , goblet cell hyperplasia, increased expression of the epidermal growth factor receptor , increased mucus production, nasociliary loss, inflammatory cell infiltration , and squamous cell metaplasia. Direct acting sympathomimetic amines, such as phenylephrine stimulate alpha adrenergic receptors , while mixed-acting agents, such as pseudoephedrine can stimulate both alpha and beta adrenergic receptors directly and indirectly by releasing norepinephrine from sympathetic nerve terminals. At first, the vasoconstrictive effect of alpha-receptors dominates, but with continued use of an alpha agonist , this effect fades first, allowing the vasodilation due to beta-receptor stimulation to emerge.2-Imidazoline derivatives, such as oxymetazoline , may participate in negative feedback on endogenous norepinephrine production. Therefore, after cessation of prolonged use, there will be inadequate sympathetic vasoconstriction in the nasal mucosa , and domination of parasympathetic activity can result in increased secretions and nasal edema. Evidence suggests that if oxymetazoline is used only nightly for allergic rhinitis , it may be used longer than one week without high risk of rhinitis medicamentosa especially with use of intranasal steroid like fluticasone furoate .Treatment The treatment of RM involves withdrawal of the offending nasal spray or oral medication . Both a "cold turkey" and a "weaning" approach can be used. Cold turkey is the most effective treatment method, as it directly removes the cause of the condition, yet the time period between the discontinuation of the drug and the relief of symptoms may be too long and uncomfortable for some individuals. A benefit of the gradual “weaning” approach is that it helps preserve normal nasal airflow during the withdrawal process. United States Patent Number 5,988,870 was issued for a method and apparatus used to facilitate the precise titration and gradual withdrawal of decongestant nasal sprays containing physical dependence causing compounds. The system is sold under the brand name Rhinostat. The use of over-the-counter saline nasal sprays may help open the nose without causing RM if the spray does not contain a decongestant. Symptoms of congestion and runny nose can often be treated with corticosteroid nasal sprays under the supervision of a physician. For very severe cases, oral steroids or nasal surgery may be necessary. For RM caused by topical decongestants, there are anecdotal reports of persons having success by withdrawing treatment from one nostril at a time. A study has shown that the anti-infective agent benzalkonium chloride , which is frequently added to topical nasal sprays as a preservative, aggravates the condition by further increasing the rebound swelling.
Popular articles Javier Milei - Argentine libertarian economist, author, radio conductor and public speaker sympathetic to the Austrian School of economic thought. He became widely known for his regular ...Jimmy Carter - American politician, philanthropist, and former farmer who served as the 39th president of the United States from 1977 to 1981. A member of the Democratic Party, he previ...UEFA Euro 2024 - The 2024 UEFA European Football Championship , commonly referred to as UEFA Euro 2024 or simply Euro 2024 , will be the 17th edition of the UEFA European Championship, the quadrennial internationa...Argentina - country located mostly in the southern half of South America. Sharing the bulk of the Southern Cone with Chile to the west, the country is also b...Sam Altman - American entrepreneur, investor, programmer, and blogger. He is the former president of Y Combinator and now the CEO of OpenAI. Early life and education. ...Rosalynn Carter - American who served as First Lady of the United States from 1977 to 1981 as the wife of President Jimmy Carter. For decades, she has been a leading advocate for numerou...Next Argentine presidential election - Next Argentine presidential election - presidential election in Argentina....Popular movies The Hunger Games (film) - 2012 American dystopian action thriller science fiction-adventure film directed by Gary Ross and based on Suzanne Collins’s 2008 novel of the same name. It is the first insta...untitled Captain Marvel sequel - part of Marvel Cinematic Universe....Killers of the Flower Moon (film project) - Killers of the Flower Moon - film project in United States of America. It was presented as drama, detective fiction, thriller. The film project starred Leonardo Dicaprio, Robert De Niro. Director of...Five Nights at Freddy's (film) - Five Nights at Freddy's - film published in 2017 in United States of America. Scenarist of the film - Scott Cawthon....Popular video games Minecraft - sandbox video game developed by Mojang Studios. Created by Markus "Notch" Persson in the Java programming language and released as a public alpha for personal computers in 2...Grand Theft Auto V - 2013 action-adventure game developed by Rockstar North and published by Rockstar Games. It is the first main entry in the Grand Theft Auto series since 2008's Grand Theft ...Roblox - online game platform and game creation system that allows users to program games and play games created by other users. Founded by David Baszucki and Erik Cassel in 2004 and released in...Baldur's Gate III - upcoming role-playing video game developed and published by Larian Studios for Microsoft Windows and the Stadia streaming service. It is the third main game in the Baldur's ...Alan Wake - action-adventure video game developed by Remedy Entertainment and published by Microsoft Studios, released for the Xbox 360 and Microsoft Windows. The story follows best-selling thri...Fortnite - online video game developed by Epic Games and released in 2017. It is available in three distinct game mode versions that otherwise share the same general gameplay and game engine: ...Super Mario RPG - is a role-playing video game developed by Square and published by Nintendo for the Super Nintendo Entertainment System in 1996. It was directed by Yoshihiko Maekawa and Chihiro Fujioka and produced by...Popular books Book of Revelation - The Book of Revelation is the final book of the New Testament, and consequently is also the final book of the Christian Bible. Its title is derived from the first word of the Koine Greek text: apok...Book of Genesis - account of the creation of the world, the early history of humanity, Israel's ancestors and the origins...Gospel of Matthew - The Gospel According to Matthew is the first book of the New Testament and one of the three synoptic gospels. It tells how Israel's Messiah, rejected and executed in Israel, pronounces judgement on ...Michelin Guide - Michelin Guides are a series of guide books published by the French tyre company Michelin for more than a century. The term normally refers to the annually published Michelin Red Guide , the oldest...Psalms - The Book of Psalms , commonly referred to simply as Psalms , the Psalter or "the Psalms", is the first book of the Ketuvim , the third section of the Hebrew Bible, and thus a book of th...Ecclesiastes - Ecclesiastes is one of 24 books of the Tanakh , where it is classified as one of the Ketuvim . Originally written c. 450–200 BCE, it is also among the canonical Wisdom literature of the Old Tes...The 48 Laws of Power - non-fiction book by American author Robert Greene. The book...Popular television series The Crown (TV series) - historical drama web television series about the reign of Queen Elizabeth II, created and principally written by Peter Morgan, and produced by Left Bank Pictures and Sony Pictures Tel...Friends - American sitcom television series, created by David Crane and Marta Kauffman, which aired on NBC from September 22, 1994, to May 6, 2004, lasting ten seasons. With an ensemble cast sta...Young Sheldon - spin-off prequel to The Big Bang Theory and begins with the character Sheldon...Modern Family - American television mockumentary family sitcom created by Christopher Lloyd and Steven Levitan for the American Broadcasting Company. It ran for eleven seasons, from September 23...Loki (TV series) - upcoming American web television miniseries created for Disney+ by Michael Waldron, based on the Marvel Comics character of the same name. It is set in the Marvel Cinematic Universe, shar...Game of Thrones - American fantasy drama television series created by David Benioff and D. B. Weiss for HBO. It...Shameless (American TV series) - American comedy-drama television series developed by John Wells which debuted on Showtime on January 9, 2011. It...
OWIKI.org . Text is available under the Creative Commons Attribution-ShareAlike License.