Rhinitis Medicamentosa – Causes & Treatment
About Rebound Congestion & Rhinitis Medicamentosa
The addiction to over the counter decongestant nasal sprays is referred to as “Rhinitis Medicamentosa” or “RM”. As the name implies, RM refers to rhinitis (congestion) caused by medication (medicamentosa). Prolonged use of over-the-counter (OTC) decongestant nasal sprays which contain topical vasoconstrictors such as Oxmetazoline hcl, Phenylephrine hcl and Xylometazoline hcl are known to cause Rhinitis Medicamentosa.
When these topical decongestants are used for more than 4-5 consecutive days, rebound congestion quickly develops, leading to the prolonged use of the sprays. Rebound congestion is the result of abnormal swelling and enlargement (hypertrophy) of the nasal mucosa, which completely blocks the nasal airway and causes extreme discomfort. The congestion is temporarily relieved by the administration of another dose of the decongestant nasal spray.
Rhinitis Medicamentosa occurs at the cellular level and involves the swelling of the nasal mucosa, which are tissues at the surface of the nasal turbinates. The cells of the nasal mucosa react to the topical vasoconstrictors by shrinking, which temporarily opens the nasal airway. Normally, when the medication wears off, the nasal mucosa return to their normal size and position. In Rhinitis Medicamentosa patients, the mucosa swell to the point where they obstruct the nasal cavity and block the airflow.
Implications for addicted persons:
Only those who have been addicted to these sprays are able to understand the impact that Rhinitis Medicamentosa has on their lives.
Rhinostat has documented many cases of individuals who have been addicted to decongestant nasal sprays for more than forty years. Because the nasal spray itself is the root cause of the problem, the only effective way to eliminate rebound congestion it is to discontinue the use of the sprays. Due to the extreme discomfort associated with the abrupt withdrawal, very few individuals are able to bear it. Unable to sleep, eat, work or socialize comfortably, the large majority of these individuals simply return to their use of the sprays.
The prospect of things such as surgical anesthesia or a trip to an isolated location (where they have no easy and immediate access to the nasal sprays) is a nightmare. RM patients often describe a feeling of suffocation, claustrophobia and panic. This entire physiologic and psychological phenomenon is something that Rhinostat is intimately familiar with and it remains the subject of our focused research. Since 1999 we have worked with tens of thousands of individuals and helped them overcome this addiction without suffering.
It is not uncommon for these people to keep their problem a secret from their families, co-workers, friends and even their physicians. They excuse themselves from social settings and often wake up in the middle of the night to administer a dose. They have learned how to integrate the use of the sprays into their daily routines. They keep a bottle of decongestant in their pocket, purse, nightstand, glove box, backpack, attaché case and anywhere else necessary to ensure that it is readily available when needed, just so they can comfortably breathe again.
Treatment for Rhinitis Medicamentosa Patients:
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.
There are no FDA approved drugs nor therapies specifically approved for the treatment of RM patients. Typically, 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 or actually remove the turbinates is performed.
The use of the steroid nasal sprays in treating rhinitis medicamentosa was studied by Drs. Graf, Hallen, Enerdal and Juto in 1997. Their landmark study published in the Journal of Clinical and Experimental Allergy forms the basis of the use of steroid nasal sprays in treating rhinitis medicamentosa. A copy of this study is available on our medical research page. From the perspective of the rhinitis medicamentosa patient, the single most important aspect of treatment is the ability to continue to move air (breathe) during the withdrawal process. The 1997 RM study (see Figure 3 – Inspiratory Flow vs. Placebo) concluded that the use of the steroid nasal sprays offered no improvement in air movement when compared to placebo during the first 4-7 days.
A rhinomanometer is a medical device which is capable of measuring nasal inspiratory flow. Although these instruments are essential for measuring flow rates and pressures, very few physicians’ offices are equipped with them. These instruments are essential tools for quantifying the efficacy of rhinitis medicamentosa treatments. Success rates are at their highest when near normal inspiratory flow is maintained during the treatment (the Rhinostat method).
The Rhinostat Difference:
At Rhinostat, we understand that maintaining normal nasal airflow during the withdrawal process makes all the difference to rhinitis medicamentosa patients and their success rates.
When the decongestants are abruptly withdrawn, the resulting rebound congestion completely blocks the nasal airway. However, when the decongestants are withdrawn in a very gradual and precise manner over several weeks, the rebound swelling gradually subsides and the nasal mucosa return to their pre-RM state.
The Rhinostat apparatus, diluent solution and method allow patients to precisely titrate the dosage strength of the topical decongestants. In addition, medical research has implicated the benzylkonium chloride preservatives commonly found in decongestant nasal sprays as exacerbating rhinitis medicamentosa. The Rhinostat diluent solution is free of these preservatives.
Patients who are gradually and precisely weaned from decongestant sprays using the Rhinostat System are able to maintain comfortable and near normal inspiratory nasal airflow. The period of suffering, misery, sleep deprivation and anxiety is entirely unnecessary and can be eliminated via precise dosage titration.
For additional information about how Rhinostat preserves nasal airflow during the withdrawal process, please visit the “How It Works” page on our website.
To learn the specific mechanism of action and how decongestant dosage titration (the Rhinostat System) works, please refer to our page entitled How Does Rhinostat Work?