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Rhinitis medicamentosa
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  1. Lok-Yee Joyce Li1,2,
  2. Shin-Yi Wang3,
  3. Cheng-Yu Tsai4 and
  4. Cheng-Jung Wu2,5,6
  1. 1Department of Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
  2. 2Department of Otolaryngology, School of Medicine, College of Medicine,Taipei Medical University, Taipei, Taiwan
  3. 3Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
  4. 4Department of Civil and Environmental Engineering, Imperial College London, London, London, UK
  5. 5Department of Otolaryngology, Shuang Ho Hospital Ministry of Health and Welfare, Taipei Medical University, New Taipei City, Taiwan
  6. 6PhD Degree Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
  1. Correspondence to Dr Cheng-Jung Wu; B101090126{at}tmu.edu.tw

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Description

A 34-year-old male with a history of allergic rhinitis presented with nasal obstruction for 2 months. According to him, he is allergic to the most common indoor allergens such as dust mites, cat and dog dander. The main symptoms were associated with difficulty in nasal breathing. He also suffered from other minor associated symptoms such as rhinorrhoea, postnasal drip, palatial itch and throat itch. Two months prior to presentation, he suffered from rhinorrhoea and was prescribed topical decongestant nasal spray. Physical examination revealed inferior turbinate hypertrophy with crust formation (figure 1). This symptom of nasal obstruction typically resolved 3–5 days after the use of intranasal decongestants. However, the patient increased both the dose and the frequency of the application of nasal sprays in the hope of relieving the symptoms, which in turn worsened the situation. Rhinitis medicamentosa is a condition characterised by nasal congestion triggered by the extensive use of intranasal decongestants.1 2 As the patient was not on any concomitant antihypertensives, nonsteroidal anti-inflammatory drugs or cocaine, immediate cessation of the use of topical nasal decongestants was suggested. One day after cessation of the topical nasal decongestants, rhinoendoscopy showed rebound congestion of the inferior turbinate. The patient initiated immunotherapy and medication with antihistamines and topical steroid nasal spray. The patient reported alleviation of both rhinorrhoea and difficulty in nasal breathing after 3 months (figure 2). However, the patient still complained of nasal obstruction at sleep. Thus, inferior turbinate reduction operation was done. Follow-up rhinoendoscopy 1 month after operation showed increased volume of inferior nasal meatus (figure 3). The patient has become asymptomatic with no recurrent nasal obstruction.

Figure 1

Physical examination revealed inferior turbinate hypertrophy with crust formation.

Figure 2

Physical examination revealed alleviation of both rhinorrhoea and difficulty in nasal breathing after 3 months.

Figure 3

Rhinoendoscopy 1 month after operation showed increased volume of inferior nasal meatus.

Learning points

  • Rhinitis medicamentosa is a drug-induced and non-allergic form of rhinitis.

  • Rhinitis medicamentosa is associated with prolonged use of topical vasoconstrictors, for example, local decongestants.

  • Over-the-counter topical decongestants have a general warning that they should be discontinued after 3 days of use.

Ethics statements

Patient consent for publication

References

Footnotes

  • Contributors C-JW and L-YJL performed the experiments. L-YJL, S-YW and C-YT contributed reagents/materials/analysis tools. L-YJL wrote the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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