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Outpatient Assessment
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Martyn L. Barnes, Paul S. White
Many drugs have common nasal side effects, especially those with anti-muscarinic effects, such as medications for prostatism, epilepsy, hypertension, sedatives, depression, psychiatric illness and Parkinson's disease. Nasal obstruction (with vasomotor rhinitis) is a side effect of many of these drugs as well as oral contraceptives and medicines used to treat erectile dysfunction. Overuse of sympathomimetic decongestant nasal sprays can cause rhinitis medicamentosa.
Rhinitis
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Vinay Mehta, Srinivasan Ramanuja, Pramod S Kelkar
Intranasal decongestants include phenylephrine, oxymetazoline, xylometazoline and naphazoline. Although available over-the-counter, they are not meant to be used as monotherapy or for long-term use, as downregulation of alpha-adrenergic receptor develops after 3 to 7 days, and can result in rebound nasal congestion. In contrast, the combination of a topical nasal decongestant and topical corticosteroid may effectively treat symptoms without causing rhinitis medicamentosa.
Outpatient Assessment
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Martyn L. Barnes, Paul S. White
Previous and current therapeutic trials of medication and their efficacy should be recorded. Many drugs exacerbate nasal symptoms, especially common are those with anti-muscarinic effects, such as anti-prostatic medications, anti-epileptics, antidepressants, antipsychotics, antihistamines, and drugs for Parkinson’s. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen in patients who have Samter’s triad (nasal polyposis, asthma and NSAID intolerance) can trigger non-infective rhinitis and rhinosinusitis. Nasal obstruction associated with vasomotor rhinitis is a side effect of a number of drugs, including antihypertensives (such as beta blockers and calcium channel blockers), sedatives, phenothiazines, antidepressants, oral contraceptives and drugs used to treat erectile dysfunction. Overuse of sympathomimetic decongestant nasal sprays can cause rhinitis medicamentosa.
Current and emerging treatment modalities for bacterial rhinosinusitis in adults: a comprehensive review
Published in Expert Opinion on Pharmacotherapy, 2022
Maria Gabriella Matera, Barbara Rinaldi, Vito de Novellis, Paola Rogliani, Mario Cazzola
A systemic decongestant (such as pseudoephedrine or phenylephrine) or topical nasal decongestant (such as xylometazoline) are commonly used in patients with ABRS to minimize nasal congestion and improve patient symptoms [27]. Still, there are side effects to be aware of, including the possibility of developing rhinitis medicamentosa with prolonged topical use and hypertension with oral decongestants, as well as irritability, palpitations, and insomnia [3]. Nasal decongestants should not be taken for more than ten days precisely because of the risk of rebound rhinitis [27]. Canadian guidelines recommend not using them for more than three days [4]. However, not enough data are available for a recommendation based on evidence. The EPOS 2020 steering group did not recommend using decongestants, at least in post-viral ARS, due to the lack of clinically relevant data [14]. However, due to the effectiveness of oral decongestants in reducing nasal congestion, Canadian guidelines advise patients without contraindications to consider these medications a treatment option [4].
Effect of Hypertonic Saline during Flexible Nasopharyngeal Laryngoscopy: A Double-Blinded, Randomized, Controlled Trial
Published in Journal of Investigative Surgery, 2021
Merih Onal, Bahar Keles, Omer Erdur, Necat Alatas, Ozkan Onal
In the present study, xylometazoline was found to be the second-best agent in terms of quality of the field of view and postoperative pain scores. Moreover, it was the best agent with regard to post-operative discomfort, congruent with some previous findings. Sahin et al8 reported that xylometazoline not only provided the best image quality but also decreased the pain experienced during the procedure. In another study, Sadek et al4 reported that in NPL procedures where only xylometazoline was used, low pain scores and high image quality associated with vasoconstriction were achieved irrespective of the use of local anesthetics. They also demonstrated that the use of xylometazoline generally reduced the dissatisfaction and discomfort associated with vasoconstriction and increased the patients’ tolerance level.4 By contrast, intranasal decongestant usage may result in rebound congestion and may lead to long-term mucosal changes and rhinitis medicamentosa, especially after recurrent applications. Moreover, topical decongestants may cause local ischemia in the nasal mucosa through arteriolar vasoconstriction, along with other minor side effects such as itching, stinging sensation, irritation, edema, and dryness of the mucosa.23
Management of adult asthma and chronic rhinitis as one airway disease
Published in Expert Review of Respiratory Medicine, 2021
Angelica Tiotiu, Plamena Novakova, Guidos Guillermo, Jaime Correira de Sousa, Fulvio Braido
Drug-induced rhinitis could be an adverse event of systemic treatment (e.g. nonsteroidal anti-inflammatory drugs, beta-blockers, sedatives, antidepressants, oral contraceptives, drugs used to treat erectile dysfunction) or secondary to prolonged use of decongestive nasal therapy (rhinitis medicamentosa). For the rhinitis medicamentosa, the predominant symptom is nasal obstruction [1]. The presumed mechanism is the neuronal imbalance via mast cell activation through the Mas-related G-protein-coupled receptor X2 [120]. Usually, the arrest of offending treatments allows to improve outcomes [1]. The most recognized form of drug-induced rhinitis associated with asthma is due to the administration of aspirin or other nonsteroidal anti-inflammatory drugs. In about 10–15% of adults with asthma, an acute asthma attack could occur within 3 hours after the ingestion of aspirin or other nonsteroidal anti-inflammatory drugs, usually accompanied by profuse rhinorrhea, conjunctival congestion, periorbital edema and sometimes a scarlet flushing of the head and neck. This distinct clinical syndrome, called aspirin-induced asthma, is associated with an intense systemic and local (nasal and bronchial) eosinophilic inflammation combined with an overproduction of cysteinyl leukotrienes and other prostanoids. Despite the avoidance of aspirin and cross-reacting drugs, asthma could persist and associate a nasal polyposis development [2].