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Di Ponio AP, Samad MN, Pellizzari R, Mackie H, Deeb RH, Craig JR. Outcomes after Functional Nasal Surgery in Patients with Versus without Rhinitis Medicamentosa. Laryngoscope 2024. [PMID: 39387236 DOI: 10.1002/lary.31839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 09/17/2024] [Accepted: 09/26/2024] [Indexed: 10/15/2024]
Abstract
OBJECTIVE Topical nasal decongestants (TNDs) are used to reduce nasal soft tissue edema and obstruction. However, after frequent TND use, patients can develop rhinitis medicamentosa (RM) with rebound nasal edema and obstruction. Management of RM has centered largely on TND cessation ± intranasal corticosteroids. The purpose of this study was to compare nasal obstruction outcomes following nasal obstruction surgery in patients with versus without RM. METHODS A retrospective case-control study was conducted with adult patients who underwent bilateral inferior turbinate reduction (ITR) with or without septoplasty and nasal valve repair. Patients with versus without RM were assessed. RM was defined as at least daily TND use for ≥4 weeks. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores, and long-term TND cessation rates were collected. NOSE score changes were compared between patients with versus without RM. RESULTS Of the 36 RM patients, mean age was 52.0 years, and 63.9% were male. Of 116 non-RM patients, mean age was 41.6 years, and 46.6% were male. Postoperative NOSE scores were collected at a mean 972.1 days postoperatively for RM patients, and 565.0 days for non-RM patients. Mean NOSE score reductions were - 9.8 for RM and - 8.6 for non-RM patients, both of which were significant (p < 0.0001). NOSE score reductions were not significantly between the two groups (p = 0.2438). Long-term TND cessation was maintained in 86.1% of RM patients. CONCLUSION Patients with and without RM achieved similar long-term significant NOSE score reductions following nasal obstruction surgery, and 86.1% of RM patients maintained long-term TND cessation. LEVEL OF EVIDENCE Level 3 evidence Laryngoscope, 2024.
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Affiliation(s)
- Anthony P Di Ponio
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Mohammad-Nadim Samad
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Richard Pellizzari
- Michigan State University College of Human Medicine, East Lansing, Michigan, U.S.A
| | - Hussein Mackie
- Michigan State University College of Human Medicine, East Lansing, Michigan, U.S.A
| | - Robert H Deeb
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
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Wang J, Mao ZF, Cheng L. Rise and fall of decongestants in treating nasal congestion related diseases. Expert Opin Pharmacother 2024; 25:1943-1951. [PMID: 39344778 DOI: 10.1080/14656566.2024.2411009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 09/26/2024] [Indexed: 10/01/2024]
Abstract
INTRODUCTION Decongestants are commonly used drugs in clinical practice, and they can relieve nasal congestion caused by factors like influenza, rhinitis, and acute upper respiratory tract infection. AREAS COVERED In this article, we review the research outcomes about decongestants, which aim to provide beneficial information that can guide the clinical application of decongestants for clinicians. EXPERT OPINION Although the use of nasal decongestants is increasingly limited, caution rather than prohibition is now advocated. Scientific and accurate use of nasal decongestants can achieve satisfactory clinical effectiveness on nasal congestion, and it is not easy to produce adverse reactions. Patients with severe nasal congestion may use nasal decongestants solely or in combination with nasal corticosteroids or nasal antihistamines to exert a synergistic effect. The concentration, dose, frequency, and time of nasal decongestants determine whether drug-induced rhinitis will occur. Additionally, we recommend patients not to buy nasal sprays with unknown ingredients on the internet or in pharmacy, so as to avoid the risk of rhinitis medicamentosa. For patients with rhinitis medicamentosa, the use of nasal decongestants should be stopped immediately. However, more evidence is still needed to standardize the clinical use of nasal decongestants.
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Affiliation(s)
- Jiang Wang
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Ze-Fan Mao
- Department of Otorhinolaryngology, Jiangsu Province Official Hospital & Geriatrics Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
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Birinci M, Ozdemir D, Pusuroglu M, Sevim Ö, Yemiş T, Cihan SN, Yılmaz E, Çeliker M, Çelebi Erdivanlı Ö. Rhinitis medicomentosa and substance addiction. Eur Arch Otorhinolaryngol 2024; 281:5255-5259. [PMID: 38740578 PMCID: PMC11416358 DOI: 10.1007/s00405-024-08723-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Rhinitis medicomentosa (RM) is a form of non-allergic rhinitis caused by the use of nasal decongestants for longer than the recommended duration. Because of this problem of use, addiction to the drug occurs in individuals. In our study, we aimed to evaluate the susceptibility of RM patients to substance addiction. METHODS The study was planned as a prospective, multicentric study between September 2022 and September 2023. Patients diagnosed with RM were included in the study. Beck depression scale, Drug use disorders identification test, Substance Abuse Proclivity Scale were applied to the patients participating in the study. The research data were analyzed electronically with SPSS program version 25. RESULTS The study included 86 patients with an average age of 31 years. The average duration of medication use was 22 months. Age, gender, duration of nasal congestion, duration of drug use and smoking were not independent predictors for depression and substance use tendency. CONCLUSION The relationship between RM and addictive substances is not clear. The tendency to use drugs did not increase in RM patients. In the light of these data, we think that there is no need for a practice other than routine functioning in the use of drugs and similar substances that are likely to cause addiction in RM patients.
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Affiliation(s)
- Mehmet Birinci
- Faculty of Medicine, Department of Otorhinolaryngology, Recep Tayyip Erdogan University, Rize, Turkey.
| | - Dogukan Ozdemir
- Faculty of Medicine, Department of Otorhinolaryngology, Samsun University, Samsun, Turkey
| | - Meltem Pusuroglu
- Faculty of Medicine, Department of Psychiatry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Ömer Sevim
- Faculty of Medicine, Department of Otorhinolaryngology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Tuğba Yemiş
- Faculty of Medicine, Department of Otorhinolaryngology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Seda Nur Cihan
- Faculty of Medicine, Department of Otorhinolaryngology, Samsun University, Samsun, Turkey
| | - Esra Yılmaz
- Faculty of Medicine, Department of Otorhinolaryngology, Samsun University, Samsun, Turkey
| | - Metin Çeliker
- Faculty of Medicine, Department of Otorhinolaryngology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Özlem Çelebi Erdivanlı
- Faculty of Medicine, Department of Otorhinolaryngology, Recep Tayyip Erdogan University, Rize, Turkey
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Margulis I, Jrbashyan J, Bitterman Fisher S, Feibish N, Stein N, Cohen-Kerem R. Rhinitis medicamentosa - comparing two treatment strategies: a retrospective analysis. J Laryngol Otol 2024:1-7. [PMID: 38311332 DOI: 10.1017/s0022215124000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Rhinitis medicamentosa poses a therapeutic challenge for both patients and physicians. Treatment strategies vary, starting with avoidance of decongestants, followed by medications or surgical intervention. This study aimed to compare two treatment strategies for this condition. METHODS A review was conducted of patients diagnosed with rhinitis medicamentosa from 2013 to 2021, who were managed conservatively with medications or surgically by inferior turbinate reduction. RESULTS Forty-seven patients were included: 21 patients were treated conservatively and 26 underwent turbinate reduction. Following surgical therapy, the frequency of using decongestants was significantly reduced (p < 0.001), with a significant improvement in Sino-Nasal Outcome Test-22 scores (p < 0.001). The conservative treatment group was significantly older with more co-morbidities. Following medical therapy, the conservative treatment group had a significant decrease in the frequency of decongestant use, but there was no significant improvement in their Sino-Nasal Outcome Test-22 scores. CONCLUSION Compared to conservative treatment, inferior turbinate reduction for rhinitis medicamentosa resulted in reduced decongestant use and improved quality of life.
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Affiliation(s)
- Itai Margulis
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
| | - Jenny Jrbashyan
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
| | - Sivan Bitterman Fisher
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
| | - Nir Feibish
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Raanan Cohen-Kerem
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
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Carmel Neiderman NN, Caspi I, Eisenberg N, Halevy N, Wengier A, Shpigel I, Ziv Baran T, Ringel B, Warshavsky A, Abergel A. Quality of life after radio frequency ablation turbinate reduction (RFATR) among patients with rhinitis medicamentosa & withdrawal from decongestant topical spray abuse. Am J Otolaryngol 2023; 44:103842. [PMID: 36989755 DOI: 10.1016/j.amjoto.2023.103842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) reliefs nasal obstruction and improves quality of life (QoL) in patients suffering from inferior turbinate hypertrophy (ITH). A substantial benefit was noted among patients suffering from Rhinitis Medicamentosa (RM), enabling ending decongestant spray abuse. Our aim was to establish the benefit from RFA with respect to QoL in patients suffering from ITH, due to the presence of RM. STUDY DESIGN Prospective cohort study. METHODS Prospective Cohort study, including patients suffering from ITH undergoing RFA between 9.2017 and 9.2019 in Tel Aviv Medical Center. The cohort was divided to RM and non-RM (including allergic, non-allergic) patients. The differences between the groups were compared before and after RFA, and included patients' complaints, clinical findings and QoL questionnaires (SNOT-22 & NOSE). In the RM group, the ability to wean from decongestants was also described. RESULTS Our data demonstrated subjective QoL improvement following RFA (88.9 %, N = 90). All RM patients withdrawaled from nasal decongestant spray. NOSE questionnaire demonstrated a significant improvement in QoL after RFA in the RM group (PV = 0.025). SNOT-22 did not demonstrate significant difference in QoL between RM and the reference group (PV = 0.1). Rates of MCID>8.3 were high, without significant difference between the groups (PV = 0.2). CONCLUSION RFA demonstrated effectiveness in achieving of withdrawal from decongestant spray in RM patients and may be a possible definitive treatment option for this group. The nasal obstruction component in SNOT-22 questionnaire & NOSE questionnaire showed improved QoL in comparison to controls. High QoL after RFA was established in our entire cohort.
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Avdeeva KS, Fokkens WJ, Segboer CL, Reitsma S. The prevalence of non-allergic rhinitis phenotypes in the general population: A cross-sectional study. Allergy 2022; 77:2163-2174. [PMID: 35038765 PMCID: PMC9306544 DOI: 10.1111/all.15223] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/01/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022]
Abstract
Background Non‐allergic rhinitis (NAR) can be subdivided into several phenotypes: rhinorrhea of the elderly, rhinitis medicamentosa, smokers', occupational, hormonal, drug‐induced, gustatory, and idiopathic rhinitis. There are two pathophysiological endotypes of NAR: inflammatory and neurogenic. Phenotypes may serve as an indicator of an underlying endotype and, therefore, help to guide the treatment. The prevalence of each phenotype in the general population is currently unknown. Methodology/Principal Cross‐sectional questionnaire‐based study in the general population of the Netherlands. Results The prevalence of chronic rhinitis in the general population was 40% (N = 558, of those, 65% had NAR and 28% AR, in 7% allergy status is unknown). Individuals with NAR (N = 363) had significantly more complaints in October–February. Those with AR (N = 159) had significantly more complaints in April–August. The most common NAR phenotypes were idiopathic (39%) and rhinitis medicamentosa (14%), followed by occupational (8%), smokers' (6%), hormonal (4%), gustatory (4%), and rhinorrhea of the elderly (4%). The least prevalent phenotype was drug induced (1%). Nineteen percent of the NAR group could not be classified into any of the phenotypes. Conclusions This is the first study to describe the prevalences of NAR phenotypes in the general population. AR and NAR have a distinct seasonality pattern with NAR being more prevalent in autumn/winter and AR in spring/summer. Our data on the prevalence of phenotypes may help clinicians to anticipate the type of patients at their clinic and help guide a tailored treatment approach. The high prevalence of rhinitis medicamentosa is alarming, since this is a potentially preventable phenotype.
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Affiliation(s)
- Klementina S. Avdeeva
- Department of Otorhinolaryngology Amsterdam UMC Location Academic Medical Centre Amsterdam The Netherlands
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Amsterdam UMC Location Academic Medical Centre Amsterdam The Netherlands
| | | | - Sietze Reitsma
- Department of Otorhinolaryngology Amsterdam UMC Location Academic Medical Centre Amsterdam The Netherlands
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Almutairi H, Almutairi A, Althwiny F, Almutairi A, Alwasil S, Albadrani N, Aljeri Y, Alawad M. Awareness of the Unaizah populations in Al-Qassim province in Saudi Arabia regarding nasal decongestant use for allergic rhinitis and their side effect. J Family Med Prim Care 2022; 11:1070-1076. [PMID: 35495803 PMCID: PMC9051680 DOI: 10.4103/jfmpc.jfmpc_1258_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/24/2021] [Accepted: 10/23/2021] [Indexed: 11/07/2022] Open
Abstract
Background: Nasal decongestant drugs are widely used as potent vasoconstrictive agents to reduce congestion of nasal and ocular mucous membranes in disease such as allergic rhinitis. These drugs are easily accessible to the people over the counter without prescription. The ease in access may lead the population in believing that the drugs are risk free and free from side effects. The purpose of this study was to determine the level of awareness of the people in Unaizah Al-Qassim province in Saudi Arabia on the use of nasal decongestants ad their side effects. Methodology: After gaining the Institutional Review Board (IRB) approval, the study was a questionnaire-based cross-sectional study conducted on the people Unaizah Al-Qassim province in Saudi Arabia. It was explorative in nature as such a study has never been done in Unaizah before and hence descriptive statistics was mainly used to establish significance and reference. The questionnaires assessed the demographical characteristics of the population, participants’ history on the usage of nasal decongestants, health condition of the participants, and knowledge on nasal congestion and use nasal decongestants. Results: Out of 385 participants, 54% were male and 46% are female. With regards to age, majority of the participants were between the age of 20 and 40 years 56%, followed by 40--60 years old (33%). 79% of the participants had acquired a baccalaureus level in education. When assessed on the usage of nasal decongestants, 32.5% currently use the decongestants, 64.4% have ever used the drugs now and in the past. In terms of knowledge of the drugs, 16.6% of the participants are aware of the side effects, 25.2% are aware of the medically recommended period to use the drugs, 21.3% have heard of the nasal congestion addiction, and 21.6% are aware of the medication that may cause nasal congestion. Conclusion: The study established that the level of awareness on the use nasal decongestants and the side effects is not significant. There needs to be a sensitization campaign to educate the population on the use of nasal decongestants.
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Rossi A, Caro G, Fortuna MC, Pigliacelli F, D'Arino A, Carlesimo M. Prevention and Treatment of Chemotherapy-Induced Alopecia. Dermatol Pract Concept 2020; 10:e2020074. [PMID: 32642317 DOI: 10.5826/dpc.1003a74] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2020] [Indexed: 10/31/2022] Open
Abstract
Background Chemotherapy-induced alopecia (CIA) is one of the most dramatic side effects of chemotherapy. Currently no guidelines are available for its prevention and treatment. Several devices and drugs are used, but results are often disappointing. Aims Our aim is to analyze drugs and devices proposed in the literature for prevention and treatment of CIA induced by cytotoxic drugs and to discuss the evidenced-based opinion. Methods and Results Scalp cooling is the only agent that has been approved by the US Food and Drug Administration for CIA prevention. Minoxidil and bimatoprost should not be used during chemotherapy administration, but they can be used after chemotherapy discontinuation to obtain greater regrowth. Conclusions Therapy should always be modulated for the patient and no fixed protocol should be used. Trichoscopy and trichogram could be useful tools in supporting this treatment.
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Affiliation(s)
- Alfredo Rossi
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
| | - Gemma Caro
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
| | | | - Flavia Pigliacelli
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
| | - Andrea D'Arino
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
| | - Marta Carlesimo
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
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