The main reason is the long—term (from 7-10 days to several months) use of such sprays / drops, which leads to the formation of dependence. This is one of the most "unpleasant" diagnoses for both the doctor and the patient, since the success of treatment directly depends on strict adherence to the recommendations and high motivation of the patient.
A little bit of statistics
According to some reports, drug–induced rhinitis is found in 6.7-8.5% of the population. It is also reported that the incidence of this disease has increased from 2.3% to 8.5%.
Mechanism of development
It is associated with the effect of vasoconstrictor drops / sprays on the mucous membrane of the nasal cavity, namely on the lower nasal concha (structures that help to warm, moisten and purify the air). With prolonged (on average from 7-10 days) intake, the so-called "rebound" effect occurs (or rebound congestion in English literature). The bottom line is that you should stop instilling the drug, and severe nasal congestion occurs.
The question arises: if, according to statistics, on average up to 9% of people suffer from drug-induced rhinitis, why do we hear so often about this "addiction"?
The answer is simple: in most cases, a persistent violation of nasal breathing (and hence the desire to relieve it with drops) occurs against the background of an already altered anatomy of the nasal cavity — for example, with curvature of the nasal septum (the most common cause), diseases of the paranasal sinuses (chronic inflammatory sinusitis, polyps, cysts, "silent sinus" syndrome, etc.) allergic rhinitis, hypertrophy of the adenoid tissue (including in adults) and other factors. Any persistent violation of the aeration of the nasal passages contributes to the swelling of the lower nasal concha and, as a result, the constant desire to use vasoconstrictor drops.
What to do?
First of all, consult an ENT doctor to find out the root cause. The specialist will perform an examination, endoscopic examination of the nose and nasopharynx, prescribe a CT scan of the paranasal sinuses, and possibly take a nasal swab. The results will make it clear why persistent mucosal edema occurs.
If the diagnosis of drug-induced rhinitis is confirmed (without other disorders of the structures of the nose and sinuses), treatment begins with the withdrawal of vasoconstrictor drugs. Unfortunately, not everyone can completely abandon the drops in one day, therefore, a gradual withdrawal regimen is most often recommended with the selection of nasal glucocorticosteroids (topical action), as well as irrigation therapy (rinsing) of the nasal cavity with isotonic solutions of sea salt.
In the absence of the effect of conservative therapy, surgical intervention is indicated — vasotomy to reduce the volume of the lower nasal concha. In our clinic, the operation is performed under endoscopic control using modern methods (the doctor selects a specific technique and discusses it with the patient individually). The procedure lasts about 20-30 minutes. General anesthesia is more often used, but in some cases local anesthesia is also possible. The intervention is usually well tolerated, nasal tampons are not required, and often the patient goes home the same evening with the necessary recommendations.
If left untreated…
Firstly, it is a violation of the quality of life. Nasal breathing is physiological and beneficial for our body. With its prolonged violation, gas exchange in the lungs worsens, the concentration of carbon dioxide in the blood increases, and the cardiovascular system begins to work with more stress. This leads to rapid fatigue, which can be compared to a prolonged stay in a stuffy room, as well as headaches, drowsiness, impaired sleep quality, decreased mood and increased anxiety. Switching to mouth breathing during sleep provokes snoring, dryness and more frequent throat diseases, which patients have been trying unsuccessfully to treat for a long time. Oral breathing can also lead to malocclusion and a feeling of mucus running down the back of the pharynx. The psychological consequences include the constant anxiety of being left without drops, especially before bedtime or on vacation. In patients suffering from hypertension, there may be insufficient effectiveness of therapy for high blood pressure.
Secondly, there are changes in the nasal mucosa. With prolonged and systematic exposure to vasoconstrictor drugs, atrophy begins, which can later lead to atrophic rhinitis and loss of all the basic functions of the nasal mucosa (moisturizing, cleansing, immune), nosebleeds often occur. Against the background of dryness, crusts appear, and infection often joins.
Do not delay contacting a specialist if you suspect that you have medical rhinitis or notice that you cannot do without vasoconstrictor drops. The sooner the problem is diagnosed and treatment begins, the easier it will be to restore normal nasal breathing and avoid serious complications.
Authors: Pugacheva E.N., Filin N.A.