Rhinitis Medicamentosa Clinical Presentation

Updated: Jan 02, 2018
  • Author: Mark S Dykewicz, MD; Chief Editor: Michael A Kaliner, MD  more...
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Symptoms are confined to the nose and consist of chronic nasal congestion as the most prominent symptom.

Symptoms do not change based on the season or whether the patient is spending time indoors or outdoors.

Because use of intranasal decongestants may not be volunteered by patients, the clinicla must directly ask about all nose spray usage to diagnose rhinitis medicamentosa. [20]

A history of more frequent or prolonged duration of use of intranasal decongestant sprays makes rhinitis medicamentosa more likely.

A common clinical history is a patient with nasal congestion from a cold or rhinitis who uses an over-the-counter intranasal decongestant for relief, and then continues to use the decongestant for weeks, months, or years. Cessation of the intranasal decongestant is followed by rebound congestion that is quite profound, leading to more use of the decongestant.

Patients with rhinitis medicamentosa often snore, have sleep apnea, or breathe mostly through their mouths. This can result in sore throat and dry mouth.


Physical Examination

The classic presentation is that the nasal mucous membranes appear "beefy-red," inflamed, and may show areas of punctate bleeding and scant mucus. There may be areas of increased tissue friability and profuse stringy mucoid discharge. Occasionally, however, the mucosa may appear pale.



Overuse of topical nasal vasoconstrictive medications (intranasal decongestants or cocaine) is the only cause of rhinitis medicamentosa.

Factors that cause nasal congestion that may lead to overusage of intranasal decongestants include the following:

  • Allergic rhinitis, nonallergic rhinitis

  • Deviated nasal septum

  • Nasal polyps, AERD (ie, nasal polyps, asthma, and aspiring intolerance)

  • Use of CPAP machine at night for sleep apnea

  • Upper respiratory infection

  • Rhinosinusitis

  • Pregnancy [21]