[Ultrastructural changes in human nasal mucosa in rhinitis medicamentosa].
BACKGROUND
Long-term abuse of decongestive nasal drops causes rhinitis medicamentosa due to cytotoxic and ciliary-toxic effects. Nasal obstruction is caused by rebound swelling when the decongestive effect has disappeared. The patient starts using nasal drops more frequently as a result of tachyphylaxis.


METHODS
Tissue samples from human inferior turbinates from 22 patients who had overused decongestive nose drops were taken during nasal surgery and preserved in phosphate-buffered paraformaldehyde or glutaraldehyde. Ultrathin sections were cut. The samples were dehydrated and embedded in Araldit. The findings were photo-documented using a light- and transmission electron microscope. Biopsies from ten patients without chronic inflammation of the nasal mucosa were used as controls.


RESULTS
The electron microscopic investigations revealed epithelium showing severe damage corresponding to regions with hyperplastic and metaplastic changes. Loss of ciliated cells was observed. Under a thick basal membrane, ultrastructural changes to the endothelial lining, such as openings and rupture of the basal lamina, were detected. Prominent endothelial cells were conspicuous.


CONCLUSIONS
Rhinitis medicamentosa is a drug-induced injury to human nasal mucosa associated with the prolonged abuse of topical nasal decongestants. Loss and destruction of ciliated epithelial cells are the morphological correlation to the disturbance of mucociliary clearance. Endothelial cells of capillaries, in particular, revealed ultrastructural changes indicative of increased permeability with consecutive interstitial edema.
Universitätsklinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg. stephan.knipping@medizin.uni-halle.de
S
S
Knipping
H J
HJ
Holzhausen
A
A
Riederer
M
M
Bloching
D000281:Administration, Intranasal; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D002199:Capillary Permeability / Q000187:drug effects; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004730:Endothelium, Vascular / Q000187:drug effects / Q000473:pathology; D004847:Epithelial Cells / Q000187:drug effects / Q000473:pathology; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D008134:Long-Term Care; D008854:Microscopy, Electron; D009079:Mucociliary Clearance / Q000187:drug effects; D014663:Nasal Decongestants / Q000008:administration & dosage / Q000009:adverse effects*; D009297:Nasal Mucosa / Q000098:blood supply / Q000187:drug effects* / Q000473:pathology*; D015508:Nasal Obstruction / Q000188:drug therapy*; D010109:Oxymetazoline / Q000008:administration & dosage / Q000009:adverse effects*; D012220:Rhinitis / Q000139:chemically induced* / Q000473:pathology*; D013618:Tachyphylaxis; D014420:Turbinates / Q000187:drug effects / Q000473:pathology
D000316:Adrenergic alpha-Agonists; D007093:Imidazoles; D014663:Nasal Decongestants; D010109:Oxymetazoline; C009695:xylometazoline