Rhinitis Medicamentosa

Rhinitis medicamentosa is a type of nasal congestion that occurs when you overuse nasal decongestant sprays. It irritates and inflames your nasal passages. Another name for it is “rebound congestion.”

Nasal decongestant sprays can provide much-needed, short-term relief when a cold, flu or allergies leave your nose feeling blocked. But it’s important not to use them for longer than it says on the package. Usually, the limit is three days. Overuse can make your nasal congestion worse than it was to start with.

Drugs that cause rebound congestion

Nasal decongestants that can lead to rebound congestion come in all kinds of forms, including gels and drops. But most cases involve overusing sprays. Check the bottle or box for ingredients like:

• Oxymetazoline, found in common brands like Afrin® and Zicam®
• Phenylephrine, found in common brands like Neo-Synephrine®

Symptoms of rhinitis medicamentosa

The main symptom is nasal congestion or a blocked feeling in your nose that makes it hard to breathe.

Most types of rhinitis cause other symptoms that affect your eyes, ears or throat. But rhinitis medicamentosa only affects your nasal passages.

Rhinitis medicamentosa causes

To understand what causes rhinitis medicamentosa, it may help to know how decongestant sprays work.

Nasal decongestant sprays cause the blood vessels inside your nose to shrink. This reduces blood flow to the tissues in your nasal cavity. Less blood flow means less inflammation and swelling. Air moves more freely through your nasal passages so you can breathe better.

But using the sprays too much can deprive your nasal tissue of the nutrient-rich blood it needs. This can lead to tissue damage and (in response) inflammation. Here comes the rebound part. The inflammation causes a return of the symptom you were trying to relieve — nasal congestion. At the same time, the sprays start working less and less, so it takes more sprays to unblock your nose.

Rebound congestion can cause a vicious cycle. You might keep using the spray to breathe more easily, but this can lead to overuse. At this point, not using the spray can lead to headaches or even the feeling that you’re suffocating.

If this sounds like you, see a healthcare provider. It’s important to stop using the spray so it doesn’t cause long-term damage to the tissue lining your nose.

Risk factors

You may be more at risk of rebound congestion if you deal with a stuffy nose all the time, like from allergies or a deviated septum. This happens to about 10 out of every 100 people. The need to feel unblocked may make you more likely to buy a nasal decongestant spray.

If you don’t read the package, you may not know the medicine carries the risk of rhinitis medicamentosa if you keep using it.

How to lower your risk

You can reduce your risk of rebound congestion by using nasal sprays only as directed. Reading the instructions on a new medicine may be the last thing most of us feel like doing when we just want to take the medicine and feel relief fast.

But when it comes to nasal decongestant sprays, taking the time to learn how much to use and how often can keep you from having to deal with long-term stuffiness.

How doctors diagnose this condition

Healthcare providers can often diagnose rhinitis medicamentosa by asking about your symptoms and whether you use nasal sprays. Your provider may examine your nasal passages and throat to confirm or rule out a sinus infection or other conditions.

It’s important to be honest with your healthcare provider about how often you’re using nasal decongestant sprays.

How is rhinitis medicamentosa treated?

The first step in treatment is gradually reducing your use of nasal sprays. Stopping abruptly or going “cold turkey” can worsen your symptoms. Your healthcare provider will help you wean off the medications slowly.

When you’re no longer using nasal sprays, your provider may recommend other treatments to ease rebound congestion, like:

• Intranasal steroid sprays: These medicines contain steroids that reduce inflammation in your nose. You can take them daily for several months or even year-round. Ask your provider what’s safe for you. A common example is fluticasone (Flonase®).
• Antihistamine nose sprays: These medicines block the effects of histamine, which can lead to a stuffed-up nose.
• Saline sprays: These nasal sprays can help clear out mucus and crusting that’s blocking your nose. They don’t contain the chemicals that cause rhinitis medicamentosa.
• Oral decongestants: You can take decongestants by mouth to treat nasal obstruction. A common example is pseudophedrine (Sudafed®). They don’t carry the same risks of rebound congestion. Still, overusing these meds can lead to other problems. It’s essential to take them only as directed on the label.

You may need surgery if you’ve used nasal decongestant sprays for so long that the tissue inside your nose is severely damaged and inflamed.

Recovery time

It may take anywhere from a few days to several weeks for your nose to feel unblocked again after weaning off the sprays. In the meantime, your provider will work with you to find safe treatments to get you through.

When should I see my healthcare provider?

See your healthcare provider if you’ve tried nasal decongestant sprays for as long as directed, but you still have symptoms. They can recommend other treatments that don’t lead to rhinitis medicamentosa.

What’s the outlook for rhinitis medicamentosa?

The good news is that rhinitis medicamentosa is reversible. Most people experience symptom relief after they stop overusing nasal sprays.

After your symptoms go away, speak with your healthcare provider about alternate treatments for congestion.