Two Cases of Surgical Treatment for Rhinitis Medicamentosa

Abstract

Rhinitis medicamentosa is a drug-induced, non-allergic rhinitis associated with long-term use of decongestant nasal sprays. The treatment is to discontinue the offending nasal spray, but this is sometimes difficult because of lack of patient cooperation. In the present study, we report two patients who were treated by surgery while still continuing to use the decongestant nasal spray. Case 1: 25-year-old male. He had been using tramazolin hydrochloride nasal spray for nasal obstruction for 11 years, but was referred to our department due to worsening nasal obstruction. We prescribed a nasal steroid spray and advised him to discontinue the decongestant nasal spray, but he did not discontinue the medication, complaining of insomnia upon any attempt to discontinue the spray. We decided to operate on the patient after explaining the possible risk of bleeding to him, because he also had nasal septal deviation and allergic rhinitis. Case 2: 22-year-old female. This patient had been receiving conservative treatment for nasal obstruction for 3 years, but she was referred to our department when her symptoms worsened. We diagnosed the patient as having chronic sinusitis and nasal septal deviation and decided to treat her surgically. At the time of the initial consultation, the patient denied using any nasal decongestant spray, but at admission, she was found to be using a combined tetrahydrozoline hydrochloride/prednisolone nasal spray. As in Case 1, we performed surgery after explaining the risk of bleeding to the patient. In both cases, profuse bleeding occurred immediately after mucosal incision and hemostasis was difficult to achieve with 5,000-fold bosmin. In both cases, however, the nasal obstruction improved and no nasal vasoconstrictors were needed. Surgical treatment for rhinitis medicamentosa should be avoided, if possible, given the risk of bleeding. Even in patients who deny using a decongestant nasal spray at the time of the initial history-taking, the possibility of rhinitis medicamentosa should be kept in mind.