Rhinitis Medicamentosa Workup

Updated: Jan 02, 2018
  • Author: Mark S Dykewicz, MD; Chief Editor: Michael A Kaliner, MD  more...
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Approach Considerations

Carefully collected medical history (see History and Physical Examination) usually determines the diagnosis.


Laboratory Studies

There are no definitive laboratory studies for diagnosis of rhinitis medicamentosa per se, but other tests (see Other Tests) may be useful for identifying an underlying cause for nasal congestion that led to overuse of intranasal decongestants.


Imaging Studies

Sinus imaging studies may be helpful to rule out rhinosinusitis, nasal polyps, deviated septum, or other anatomic causes for nasal obstruction.


Other Tests

Rhinitis medicamentosa usually coexists with other medical conditions that originally trigger decongestant use. It is important to identify any condition that can be potentially treated.

  • Allergy skin testing or in vitro IgE tests for specific IgE to aeroallergens generally are indicated to determine if the underlying cause of nasal congestion is allergic rhinitis or not.

  • Rhinoscopy (rigid or fiberoptic) is useful in identification of nasal septal deviation, other anatomic abnormalities, and nasal polyps.

  • Patients who are suspected to hae AERD may be considered for aspirin challenge.


Histologic Findings

The following findings have been reported in rhinitis medicamentosa, but most findings may occur in some other types of rhinitis, and therefore are not diagnostic.

  • Increased vascularity, edema of the nasal mucosa

  • Squamous cell metaplasia; change from ciliated columnar to nonciliated stratified squamous epithelium

  • Mononuclear infiltration

  • Glandular and Goblet cell hyperplasia

  • Increased secretory activity

  • Abnormal cilia structure and function

  • Increase in plasma cells, fibroblasts, and lymphocytes