Shana Zucker BA
Blair Barton MD
Edward McCoul MD
Tulane University School of Medicine
Educational Objective: At the conclusion of this presentation, the participants should be able to describe the gaps in the literature with regard to rhinitis medicamentosa, including 1) the incomplete understanding of its pathophysiology; 2) the inconsistency in current treatment practice; 3) the significant variability in study design, outcomes measured and methods of assessment, in the current literature,; 4) the current most common treatment of rhinitis medicamentosa; and 5) the necessity for prospective randomized clinical trials using standardized questionnaires, outcomes, and methods of outcome measurements to determine the optimal treatment of rhinitis medicamentosa. Objectives: Rhinitis medicamentosa (RM), resulting from overuse of topical nasal decongestants, is a common practice, but clear treatment protocol has not yet been established. The outcome measures of treatment, including but not limited to patient reports of symptom relief and ability to discontinue topical vasoconstrictors without relapse, were reviewed. Study Design: PubMed, Embase, Cochrane, and Web of Science databases were examined for patients diagnosed with RM resulting from chronic use of topical nasal decongestants. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were utilized to identify English language studies reporting treatment of human patients with the primary complaint of RM, or related complaints of rhinitis after chronic use of a topical decongestant. Two independent reviewers assessed the quality of the articles by using the Methodological Index for Nonrandomized Studies (MINORS) criteria. Results: 350 articles were identified, nine of which met final inclusion criteria for qualitative analysis. Outcomes defined in each publication were highly varied, and several utilized different, unstandardized measures of such outcomes. Due to the heterogeneity of methodology and outcomes assessed, data could not be extracted for valid comparison. Based on analysis of the data, there was no consensus on the best treatment; still, most treat with nasal steroids. Conclusions: There is not adequate evidence to develop a standardized treatment protocol for RM. The development of a uniform questionnaire, standard outcomes to be measured, and a method of assessing such outcomes are recommended to yield consensus. Prospective, randomized controlled studies are warranted to determine the optimal treatment regimen following diagnosis of RM.