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rebound rhinitisJoe Segen2016-12-25T08:36:09+00:00
Definition A noninfectious nonallergic rhinitis caused by rebound vasodilation linked to the use of topical vasoconstricting decongestant sprays for more than 4-6 days.
Clinical findings Nasal congestion, which responds poorly to increased use of decongestants; patients may snore.
Endoscopy Nasal mucosa is often beefy-red with punctate bleeding, granular, or boggy, with patchy tissue friability and profuse stringy mucoid discharge.
Differential diagnosis Allergic rhinitis, continuous positive airway pressure–CPAP rhinitis, nasal polyps, non-allergic rhinitis, rhinosinusitis
Reasons, use of decongestants Allergy, nonallergic rhinoplasty, chronic rhinosinusitis, nasal polyps, night-time continuous positive airway pressure–CPAP, upper respiratory tract infection.
Management Discontinue decongestants ASAP, oral corticosteroids.
Pathology Nasociliary loss, squamous cell metaplasia, epithelial oedema, epithelial cell denudation, goblet cell hyperplasia, increase in epidermal growth factor receptor, and inflammation.
Synonyms Chemical rhinitis, rhinitis medicamentosa*
*Whilst the term rhinitis medicamentosa is widely used for the rebound phenomenon, the term is also used for nasal congestion due to non-decongestants–e.g., oral contraceptives, psychotropic medications, and antihypertensive medications, even though different mechanisms are involved. To differentiate between the two, the latter is called drug-induced rhinitis.