Rhinitis medicamentosa is caused by prolonged use of which class of nasal drops, and what is the underlying pathophysiological mechanism of rebound congestion?

• A Topical corticosteroid sprays; mechanism = HPA axis suppression causing mucosal thinning
• B Antihistamine nasal sprays; mechanism = muscarinic receptor sensitization
• C Nasal saline irrigations; mechanism = sodium chloride hyperosmolarity causing goblet cell hypertrophy
• D Topical decongestants (alpha-adrenergic agonists like oxymetazoline/xylometazoline); mechanism = down-regulation of alpha-adrenergic receptors leading to rebound vasodilatation and congestion on drug withdrawal ✓

Explanation

Rhinitis medicamentosa results from prolonged use (>3–5 days) of topical sympathomimetic (alpha-1/alpha-2 agonist) decongestants (xylometazoline, oxymetazoline). Chronic receptor stimulation downregulates alpha-adrenergic receptors; on drug cessation, the lack of receptor response causes exaggerated rebound vasodilatation and mucosal congestion. Treatment is withdrawal of the offending agent (cold turkey or gradual taper) combined with topical nasal corticosteroids (mometasone/fluticasone) to suppress the rebound inflammation.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.