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Rhinitis Medicamentosa: Are You Overusing Nasal Spray?

Updated: Sep 27


Nasal sprays offer quick relief for congestion, allergies, and sinus discomfort. However, frequent use can lead to a condition known as rhinitis medicamentosa (RM), or "rebound congestion," a phenomenon many aren’t aware of until they experience it firsthand. If you've been relying on nasal sprays regularly, this post will help you understand the risks and how to avoid falling into the cycle of overuse.



A box of tissues next to a bottle of nasal spray

What Is Rhinitis Medicamentosa?

Rhinitis medicamentosa occurs when nasal decongestant sprays, like oxymetazoline or phenylephrine, are used for longer than the recommended 3-5 days.


These sprays work by constricting blood vessels in the nasal passages, reducing swelling and providing quick relief from congestion. However, prolonged use can lead to dependency, where the blood vessels in your nose stop responding to the medication properly. As a result, you may find yourself more congested than before, leading to a vicious cycle of spray use and worsening congestion.



Signs You Might Be Overusing Nasal Spray

Excessive nasal spray use can lead to a rebound effect, making the congestion you're trying to treat even worse. Common signs of nasal spray overuse include:


  • Frequent congestion, especially within a few hours of using nasal spray

  • Increased nasal spray use more than once or twice a day to get relief

  • Dependence or difficulty breathing without nasal spray

  • Itchy nasal passages

  • Rhinorrhea or runny nose

  • Sneezing



Differential Diagnosis

The primary differential diagnoses include allergic rhinitisnon-allergic rhinitisCPAP-related rhinitis, and rhinosinusitis


Allergic rhinitis is characterized by nasal congestion, sneezing, and itching due to exposure to allergens. Non-allergic rhinitis, on the other hand, is similar to allergic rhinitis but lacks an allergic trigger. CPAP-related rhinitis occurs in individuals using continuous positive airway pressure (CPAP) machines and is often associated with nasal congestion, dryness, and irritation. Rhinosinusitis, a condition involving inflammation of the nasal sinuses, can also present with nasal congestion, but it is typically accompanied by facial pressure, pain, and fever.



Treatment

Providing a detailed medical history, including symptoms, medication usage, and any recent illnesses, can help your doctor determine the most appropriate treatment plan. Treating rebound congestion focuses on reducing inflammation, breaking the dependence on nasal sprays, and addressing underlying causes of congestion.


Gradually stopping the use of certain over-the-counter nasal decongestants is often the first step towards a full recovery from RM. This can be done gradually by tapering off one nostril at a time.


Prescription nasal corticosteroids can also help reduce inflammation and congestion while you wean off the decongestants. These are non-addictive and safe for long-term use. In some cases, oral decongestants may be prescribed for a short period to manage severe symptoms while discontinuing nasal sprays.


In more severe or persistent cases, it may be necessary to seek help from an ENT specialist to manage symptoms and ensure there are no underlying issues such as structural abnormalities or chronic sinusitis.



Avoiding Rhinitis Medicamentosa

Here’s how you can avoid developing rhinitis medicamentosa in the first place:


  • Follow usage instructions carefully: Most nasal decongestants should not be used for more than 3-5 days. Stick to this guideline to prevent dependency.

  • Opt for alternative treatments: Try nasal saline rinses, steam inhalation, or oral decongestants for relief.

  • Know when to seek help: If you frequently experience congestion, talk to a healthcare provider to identify underlying causes and alternative treatments.




REFERENCES

Cleveland Clinic Medical. (2024, May 1). Rhinitis medicamentosa: How long it lasts & treatment options. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/23393-rhinitis-medicamentosa


Wahid NWB, Shermetaro C. Rhinitis Medicamentosa. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538318/


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Dr. David Eleff, Otolaryngologist/Ear, Nose, and Throat Specialist at ENT Family in Hollywood, Florida.

This article has been medically reviewed by otolaryngologist, David Eleff, M.D.

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