What Is Rebound Nasal Congestion and Rhinitis Medicamentosa? 2023
Nearly everybody gets a cold or even the flu every now and then. Sometimes we get sinus infections with green, yucky nasal mucous, and headache. The incidence of allergic rhinitis (hay fever) in the United States for adults and children is 10-30%. Allergic rhinitis produces clear nasal fluid, sneezing, itchy eyes and nasal congestion.
So, most of us use oral, pills or decongestants to treat these symptoms. But then sometimes we see an Afrin ad at the drugstore and we buy that and start using it without knowing that now we are riding the wind with a very dangerous and near addictive drug that can produce Rebound Nasal Congestion, and Rhinitis Medicamentosa.
Rhinitis Medicamentosa (nasal spray addiction as a result of rebound congestion) is caused by the prolonged use of Afrin and other over-the-counter decongestant nasal sprays.
The condition is caused by extended use of topical decongestants (oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays) and oral drugs, (sympathomimetic amines and 2-imidazolines) that constrict the blood vessels in the nose.
The active ingredient in these sprays is a topical vasoconstrictor that temporarily reduces the size of the nasal turbinates, opens the nasal airway and provides decongestant relief from the rebound congestion. But after using the drug for 5-7 days it causes rebound congestion—a miserable nasal type of suffering with a severely stopped up nose.
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This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.
When the decongestants are used for more than 3 consecutive days, it provokes a condition known as rebound congestion.
Rebound congestion is the result of abnormal swelling and enlargement (hypertrophy) of the nasal mucosa, which blocks the nasal airway completely and causes extreme discomfort. This rebound congestion is temporarily relieved once again by the administration of another dose of Afrin or other nasal spray.
As soon as the temporary effect of the last dose of spray wears off, the swollen nasal mucosa again block the airway and another dose of spray is required to provide relief. The commencement of this cycle represents the initiation of the addiction which can last a lifetime..
Because the nasal spray itself is the root cause of the problem, the only effective way to eliminate it is to discontinue the use of the sprays.
As any person that has suffered with rhinitis medicamentosa will tell you, this is much easier said than done. Breaking this addiction is not simply a matter of will power. The ability to breathe comfortably is essential to normal human functionality.
Only less than 4% of these people are able to endure the misery associated with "cold turkey" withdrawal. These affected persons are not able to sleep, eat, or work comfortably. Many of them just go back to taking their Afrin to not be in such misery.
Many of these people state that nasal spray addiction is the most miserable and frustrating problem they have ever dealt with.
And if the patient were to develop a migraine headache during the time of severe nasal congestion, there may confusion with sinus headache, allergic rhinitis, or migraine. If this happens to you then read my website article on “Sinus, Allergy, or Migraine Headache?” on my website, doctormigraine.com. Click here to read.
How Physicians Treat Rebound Congestion & Rhinitis Medicamentosa
In search of an answer, many of these patients turn to their physicians for help in ending nasal spray addiction.
Rhinitis Medicamentosa is a very frustrating problem for physicians to effectively treat. There are no FDA approved drugs nor therapies specifically for the treatment of RM patients. Most commonly, these patients are given a course of intranasal and/or systemic steroids and are told to discontinue their use of the decongestants. In some cases, surgery to reduce the turbinates or to correct a deviated septum is performed.
Regardless of what treatment is prescribed, the cornerstone of the therapy is always the same. Patients must discontinue their use of the sprays. It is this aspect of the treatment that presents the problem for these patients.
Medical Treatment. The patient has to get off of the offending nasal spray. This is best done by tapering off over a week or 2 with a decreasing dose of the chemical nasal spray and substituting saline nasal spray.
It is okay to use oral decongestants and NSAIDS because they don’t provoke nasal congestion. Some persons use hot towels over the nose and humidifiers.
See an Otolaryngologist for further help and good luck.
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Britt Talley Daniel MD