title: Rebound congestion and rhinitis medicamentosa: nasal decongestants in clinical practice. Critical review of the literature by a medical panel.
abstract: BACKGROUND
  Systemic and topical nasal decongestants are widely used in otorhinolaryngology and general practice for the management of acute rhinosinusitis and as an adjuvant in certain forms of chronic rhinosinusitis. These products, very effective to rapidly improve nasal congestion, are sometimes available over the counter and can be the subject of misuse, which is difficult to control. The Société Française d'ORL has recently issued guidelines concerning the use of these decongestants in the doctor's office and the operating room.
  
  
  METHODS
  The review of the literature conducted by the task force studied in detail the concepts of "rebound congestion" and "rhinitis medicamentosa" often reported in a context of misuse, particularly of topical nasal decongestants. The clinical and histopathological consequences of prolonged and repeated use of nasal decongestants have been studied on animal models and healthy subjects.
  
  
  RESULTS
  Discordant results have been obtained, as some authors reported a harmful effect of nasal decongestants on the nasal mucosa, while others did not identify any significant changes. No study has been able to distinguish between inflammatory lesions induced by chronic rhinosinusitis and lesions possibly related to the use of nasal decongestants.
  
  
  CONCLUSIONS
  The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis.
  
  
  CONCLUSIONS
  Nasal decongestants are recommended for the management of acute rhinosinusitis to reduce the consequences of often disabling nasal congestion. They are also recommended during rhinoscopic examination and for preparation of the nasal mucosa prior to endonasal surgery.
authors: Service d'ORL et de chirurgie cervico-faciale, hôpital Huriez, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France. g-mortuaire@chru-lille.fr
authors: G
authors: G
authors: Mortuaire
authors: L
authors: L
authors: de Gabory
authors: M
authors: M
authors: François
authors: G
authors: G
authors: Massé
authors: F
authors: F
authors: Bloch
authors: N
authors: N
authors: Brion
authors: R
authors: R
authors: Jankowski
authors: E
authors: E
authors: Serrano
mesh_terms: D026683:Advisory Committees; D000818:Animals; D019317:Evidence-Based Medicine; D006077:Government Agencies; D006801:Humans; D014663:Nasal Decongestants / Q000008:administration & dosage / Q000009:adverse effects*; D009297:Nasal Mucosa / Q000187:drug effects* / Q000473:pathology; D017410:Practice Guidelines as Topic; D012220:Rhinitis / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D014663:Nasal Decongestants