Treatment Regimen for Acute Viral Rhinitis in Patients with a History of Rhinitis Medicamentosa

Aims: The aim of this research is to study the efficacy of intranasal administration of 0.9% saline solution in patients with acute viral rhinitis and a history of Rhinitis medicamentosa.

Materials and Methods: The study included 96 patients with a confirmed diagnosis of acute viral rhinitis and a history of Rhinitis medicamentosa. All patients were equally randomized to two groups. In both groups, patients were treated according to the European Position Paper on Rhinosinusitis and Nasal Polyps with nasal decongestants (oxymetazoline), but in Group 2, the treatment regimen was supplemented with topical use of 0.9% saline solution. Local TNF-α and IL-1β levels were determined in all patients on Days 1, 5, and 10. In addition, on the next day after oxymetazoline withdrawal, a Nasal airway resistance was measured in all patients using active posterior rhinomanometry.

Results: The duration of rhinorrhea and nasal congestion and, respectively, the duration of oxymetazoline administration significantly differed between the groups (p<0.001) and was 7.9±1.1 days for Group 1 and 4.7±0.9 days for Group 2. In general, the dynamics of changes in local TNF-α and IL-1β levels in both groups was similar. Throughout the study, there was a progressive decrease in both inflammatory mediators, with faster changes occurring in Group 2. A strong positive correlation (rs=0.89; p<0.001) between TNF-α and IL-1β levels was established. According to the results of active posterior rhinomanometry on the day following oxymetazoline withdrawal, Nasal airway resistance was significantly higher in Group 1 (p<0.001), which indicates the presence of difficulty breathing in patients of this group. In addition, patient examination showed that manifestations of Rhinitis medicamentosa occurred in 3 (6.25%) patients of Group 1 and in 17 (35.42%) patients of Group 2. Differences between the groups were significant (p<0.01).

Conclusion: The use of topical nasal decongestants, in particular oxymetazoline, in patients with acute viral rhinitis and a history of Rhinitis medicamentosa for more than 7 days has a potential risk of development of a recurrence of Rhinitis medicamentosa. Supplementing the treatment regimen for acute viral rhinitis with the topical use of 0.9% saline solution reduces the duration of treatment and the use of topical decongestants, and therefore prevents the recurrence of Rhinitis medicamentosa.