Use of mometasone furoate aqueous nasal spray in the treatment of rhinitis medicamentosa: an experimental study.

OBJECTIVE: We aimed to investigate, histopathologic changes in the nasal mucosa of guinea pig's after prolonged administration of oxymetazoline and the development of rhinitis medicamentosa, and the efficacy of mometasone furoate aqueous nasal spray and saline in reversing the ultrastructural changes attributable to rhinitis medicamentosa. METHODS: In the study, 24 male guinea pigs (500 to 600 gr) were used. Oxymetazolin (0.05%) was sprayed into the nasal cavities of the guinea pigs 3 times daily for 8 weeks. At the end of this period, 6 guinea pigs were killed and examined to make sure that the animals had developed rhinitis medicamentosa. The remaining guinea pigs were randomly divided into 3 groups. In the first group, one spray-puff of 0.05% mometasone furoate aqueous nasal spray (50 microg) was applied twice daily for 14 days. In the second group, saline solution (0.9% NaCl) was applied twice daily for 14 days. No treatment was performed in the third group. At the end of the treatment period, nasal mucosal changes were evaluated by light microscopy and electron microscopy. RESULTS: After oxymetazolin application for 8 weeks, the main histologic changes were edema, congestion, proliferation of subepithelial glands, and squamous cell metaplasia. After topical mometasone furoate aqueous spray application for 2 weeks, the edema fluid was found to diminish markedly. In the saline and no treatment groups, edema and congestion continued. In these groups of guinea pigs, fibrosis has been seen in the nasal mucosa. CONCLUSION: We found that mometasone furoate nasal spray was effective against experimentally induced rhinitis medicamentosa in guinea pigs. Mometasone furoate nasal spray may have value in the treatment of patients with rhinitis medicamentosa.

Possible role of plasminogen activator in the occurrence of profuse watery rhinorrhea after topical application of epinephrine to the nasal mucosa.

Epinephrine and lidocaine have been used for the diagnosis and treatment of nasal diseases. However, watery rhinorrhea and frequent sneezing occur in many patients after topical application of these drugs to the nasal mucosa. This study was aimed at characterizing these side effects, and developing a means to prevent such side effects. A questionnaire was given to each patient who complained of side effects after treatment with epinephrine and lidocaine, and the answers were analyzed with respect to the occurrence and features of the symptoms after the treatment. Eosinophil and mast cell numbers were determined in nasal smears from the patients with side effects. These side effects were different from rhinitis medicamentosa and allergic rhinitis, and were due to epinephrine, not to lidocaine or to the preservatives in the epinephrine. Tranexamic acd, an inhibitor of plasmin, was effective in blocking the side effects.

Rhinitis during pregnancy and rhinitis medicamentosa.

Vasomotor rhinitis is a nonspecific disorder that is caused neither by infection nor allergy but rather by an imbalance of the autonomic nervous system with a preponderant action of parasympathetic fibers on nasal blood vessels. Rhinitis during pregnancy appears to result from the increased production of estrogen; increased estrogen levels caused by treatment, puberty, or liver disease may also cause rhinitis. Nasal saline mist, antihistamines, and topical corticosteroids are recommended; intranasal corticosteroid injections are also useful but must be administered under expert care. Rhinitis medicamentosa results from overuse of topical vasoconstrictors, which produce a rebound phenomenon. Rebound can also result from numerous medications, including antihypertensive preparations that reduce catecholamine levels, antidepressants, antipsychotics, and tranquilizers. Management of rhinitis medicamentosa consists in limiting the use of vasoconstrictors to no more than 3 days and giving the patient saline nasal sprays, daytime oral vasoconstrictors, and nocturnal antihistamines. Corticosteroids, preferably topical nasal steroids rather than even a short-term course of systemic administration, should also be used.

[Drug side effects on the nasal mucosa and sense of smell]. / Arzneimittelneben-wirkungen auf die Nasenschleimhaut und den Geruchssinn.

Several drugs may induce pathologic changes of the nasal mucosa, especially at a long-term treatment. The clinical appearance of an allergic or vasomotoric rhinopathy, a chronical hyperplastic or an atrophic rhinitis, hemorrhagic changes of the mucosa with the incidence of epistaxis or smelling disorders may be caused by several drugs. The ENT-specialist, therefore, should always take in consideration the various drugs, which the patient received but mostly have been prescribed by another doctor.

[Effects and side effects of hormonal contraceptives in the region of the nose, throat, and ear]. / Wirkung und Nebenwirkung hormonaler Antikonzeptiva im Bereich von Nase, Hals und Ohr.

The pathomechanism of diseases in the field of oto-rhino-laryngology caused by an hormonal contraceptive therapy are presented on base of a critical literature survey. Complications of oral contraception are proved only for the oral tissue (hyperplastic gingivitis) the larynx and the eustachian tube. Otological (otosclerosis, acute deafness, slowly progressive deafness) and rhinological diseases (Rhinopathia vasomotorica) in women under oral contraception cannot be attributed exclusively to this therapy.

Rhinitis medicamentosa.

Rhinitis medicamentosa, the syndrome of rebound nasal congestion secondary to prolonged topical intranasal use of vasoconstrictors, is reviewed. In this condition, the nasal airway is very obstructed; atrophic rhinitis is the most serious complication. Management consists of withdrawing the offending nasal spray and alleviating the nasal obstruction by means of any of several treatment modalities.