ABSTRACT
Rhinitis medicamentosa (RM) refers to nonallergic inflammation in the nasal mucosa which is caused by the abuse of nasal decongestant and it often occurs in patients with allergic/nonallergic rhinitis along with nasal congestion. RM is characterized by nasal congestion based on long-term use of nasal decongestant, without rhinorrhoea or sneezing. The signs of RM include nasal swelling, thickening, loss of elasticity, and loss of sensitivity to the decongestant. The histological changes of RM are loss of nasal mucosa cilia, squamous epithelium metaplasia, edema of epithelium cell, hyperplasia of goblet cell, increased expression of epidermal growth factor receptor and infiltration of inflammatory cells, etc. There is no precise diagnosis standard for RM, making it even harder for its objective diagnosis. Patients with RM should immediately stop using nasal decongestant, in stead of using nasal glucocorticoid spray for the recovery of the nasal mucosa′s function.
ABSTRACT
OBJECTIVE@#To analyze the causes of misdiagnosis in patients with familial nasal bleeding and to improve the level of diagnosis and treatment.@*METHOD@#The clinical characteristics of 7 families with nose blood were analyzed retrospectively and 2 typical cases were reported, including their treatment and misdiagnosis in consulting, out-patient and in-patient.@*RESULT@#Typical case 1 was misdiagnosed and mistreated for 42 years, misdiagnosed as blood disease so that the patient was biopsied in bone marrow, misdiagnosed as endometriosis so that the patient was performed uterus resection. Typical case 2 was misdiagnosed and mistreated for 17 years, misdiagnosed as upper digestive tract hemorrhage so that the patient was performed endoscopic sleeve ligation, misdiagnosed as inferior turbinate hemangioma so that the patient was performed nasal endoscopic surgery.@*CONCLUSION@#Neglect of family history and the typical signs are the causes of misdiagnosis. So asking about the family history and checking for the typical signs in patients with nose blood can avoid misdiagnosis.