5 PathogenesisCaused by over activity of para-sympathetic nervous system leading to:nasal congestion (due to nasal vasodilatation)nasal block (due to nasal vasodilatation)watery rhinorrhoea (due to ed nasal secretion)
13 General Measures Sleep with head end elevated by 300 Sleep + work in a cool environment (not cold) Keep body warm Regular exercise program to improve vasomotor tone Avoidance of trigger factors
14 Medical Treatment Ipratropium bromide spray (0.03%) Intra-turbinal injection of Botulinum toxinSteroid sprayTopical Cromolyn sodium (prophylaxis only)Anti-histaminesNasal decongestant
29 Surgical TreatmentMeasures which reduce size of nasal turbinates to relieve nasal obstructionSectioning parasympathetic secreto-motor fibers of nose (vidian neurectomy) to relieve excessive rhinorrhoea
40 IntroductionRebound nasal congestion due to use of intranasal decongestants for > 7 daysWith prolonged use, tachyphylaxis occurs, resulting in need for more frequent doses & shorter duration of action of these drugsNasal medications containing benzalkonium chloride cause more rebound congestion
41 Offending drugs 1. Oxymetazoline 2. Xylometazoline These drugs contract smooth muscle of venous erectile tissue, present in nasal turbinates, causing mucosal shrinkage & decreasing airway resistance
44 Clinical Features1. Chronic nasal block requiring increased dose & frequency of topical decongestants2. Watery rhinorrhoea usually absent, seen only in co-existing allergic or vasomotor rhinitis3. Nasal mucosa appears hyperemic, granular & boggy in early stages4. Later, it appears pale & anemic
45 Treatment Immediate withdrawal of topical decongestant Substitute with systemic nasal decongestantsNasal corticosteroid spraysOral corticosteroids (for severe cases only)Rhinostat systemPatient Education: Avoid topical decongestantuse for > 7 days
46 TreatmentFor patients unable to stop topical decongestant immediately, stop nose drops in more patent nasal cavity & use it in other cavity for < 7 daysSystemic decongestants used to relieve nasal block as pt is weaned off topical decongestantsPhenylephrine & pseudoephedrine are usedCorticosteroid spray used to local inflammation
47 Rhinostat SystemConsists of 2 bottles. First contains pt’s nasal decongestant spray, second has saline solution. Two solutions precisely combined for dosage 15% / day. Dosage titration allows gradual withdrawal from decongestants while maintaining nasal inspiratory flow.Takes 3-6 weeks days for complete withdrawal.
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