Mr. Liu recently because of nasal congestion, breathing is very painful, because the fear of trouble did not go to the hospital, decided to buy their own drugs to the pharmacy. The shopkeeper recommended a supposedly miraculous rhinitis drug, after using it immediately nasal congestion disappeared, Mr. Liu used it, it was really good, nose immediately ventilated, which can make Mr. Liu happy bad. Since then Mr. Liu began to use the drug, the beginning of quite effective, and then it seems that the drug is not so effective, the effect of the maintenance time is getting shorter and shorter, the number of times to use the drug is more and more, from two or three times a day to a dozen times a day, and even in the middle of the night to get up a few times to spray the drug nasal congestion can be relieved, otherwise you can not sleep. The actual fact is that you can find a lot of people who are not able to get to the top of the list. The actual fact is that you can get a lot more than just a few of the most popular and most popular drugs.
The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. In particular, local irrational use of nasal drops is the most common, also known as “toxic rhinitis” (toxic rhinitis). Often, patients purchase their own medication without being examined and treated by a specialist, resulting in drug-induced rhinitis due to the abuse of nasal drops.
Causes
Systemic medications cause nasal congestion mainly include.
1, anti-hypertensive drugs: such as alpha-adrenergic blockers (rifampin, methyldopamine, etc.).
2, anti-sympathetic drugs.
3, anti-acetylcholinesterase drugs: such as neostigmine, methylthiazide sulfate, hydroxybenzylamine, etc. can cause dryness of the nasal mucosa.
4, contraceptive drugs or the use of estrogen replacement therapy can cause nasal congestion.
Topical medication is mainly long-term use of decongestants. Decongestants can be divided into two categories: sympathomimetic amines (such as: ephedrine, pseudoephedrine, phenylephrine, etc.) and imidazolines (such as: naphthazoline-type that is nasal drip, hydroxymetazoline, serozoline, etc.). Sympathetic amines stimulate α and β adrenergic receptors, stimulating α receptors cause strong vasoconstriction, while stimulating β receptors cause weak vasodilation, but the stimulation time of drugs on β receptors is longer than the stimulation time of α receptors, so the vasoconstriction effect stops after the vasodilation effect is still effective for a period of time, patients appear “rebound nasal congestion” ( rebound
congestion). Long-term use of imidazoline-type drugs leads to a decrease in presynaptic synthesis of endogenous norepinephrine due to negative feedback mechanisms, resulting in rebound congestion after discontinuation of the drug. Long-term use of decongestants can also lead to rapid tolerance of alpha receptors, requiring higher doses to achieve the same decongestive effect.
Pathology
The small arteries of the nasal mucosa constrict immediately after the use of vasoconstrictors, and if used for a long time, the long-term vasoconstriction can lead to hypoxia, reactive vasodilation, increased glandular secretion, and ciliary dysfunction or even detachment of the nasal mucosal epithelium. Submucosal capillary permeability increases, plasma oozing edema, and lymphocyte infiltration may occur over time. The above pathological changes can be gradually restored after stopping the drug. Microscopically, the cilia of the nasal mucosa are detached and disorganized. The subepithelial capillaries are hyperplastic, vasodilated, and infiltrated with a large number of inflammatory cells.
Clinical manifestations
With the long-term use of decongestants, the efficacy of the drugs becomes less and less effective, the nasal passage time becomes shorter and shorter, and the symptoms of nasal congestion become more and more severe. Patients often increase the number of drops on their own, thus occurring a vicious circle, called the phenomenon of multiple use and decongestion. It is generally believed that the symptoms will be obvious when the medication is used continuously for more than one week. The symptoms are bilateral persistent nasal congestion, decreased sense of smell, increased nasal secretion and change from clear to pus. It is often accompanied by headache and dizziness. The examination reveals congestion, swelling and hypertrophy of nasal mucosa with mulberry-like changes. It is parenchymal to touch. The contractile responsiveness to ephedrine is significantly reduced. The nasal passages are narrowed and there is a large amount of secretion. The use of naphthazoline (nasal drip) in infants and young children may cause pallor, drop in blood pressure, bradycardia, unconsciousness and even respiratory distress, and other toxic phenomena.
Diagnosis and differential diagnosis
Clinical manifestations are similar to those of hypertrophic rhinitis. It is important to carefully inquire about the history of systemic and local drug use and the time of use.
1.Treatment
(1) Gradually stop the use of vasoconstrictors after the diagnosis is confirmed, and nasal washings such as deep seawater nasal washings and saline can be used for treatment.
(2) Topical corticosteroid nasal sprays: such as budesonide, etc.
(3) Other treatments including oral hormones, antihistamines and mast cell stabilizers.
(4) Surgery is not preferred, but if the above drug treatment is ineffective, or patients with deviated nasal septum and nasal polyps, surgery can be considered. Surgery includes submucosal partial excision of inferior turbinate or submucosal local radiofrequency ablation of inferior turbinate, which is operated under the mucosa and can better protect the function of nasal mucosa and has little effect on turbinate function.
2.Prevention
(1) Nasal symptoms such as nasal congestion should be seen in a regular hospital to avoid mistaking sinusitis, nasal polyps, or even nasal and sinus tumors for rhinitis and unreasonable treatment, resulting in delayed regret.
(2) Use as little as possible or do not use nasal vasoconstrictors. If you must use them, it is best not to use them for more than a week.
(3) Some nasal drops of Chinese medicine also contain such decongestant ingredients, must be used with caution.
(4) nasal drops must be careful, in fact, many foreign drugs can be purchased in China, do not believe in foreign drugs. And some of the drugs amassed without even English instructions, do not know the composition of the drug, no doctor to guide the purchase of drugs, many cases of these nasal drops contain decongestants, can not be used for a long time.
(5) Young children and newborns should use decongestant-type drugs with caution. Take large amounts of vitamin C during the medication period.