Dear doctor,
I am a 40 years old woman, I am a researcher in physics, I have one
child and I am in good health, except for a nasal problem.
Since I was a child, I have been using nafazoline nose spray to improve my
nasal respiration. I am very anxious, and if my nostrils are not wide open,
I cannot sleep.
I did not have problems until a few years ago, when I started having
side effects; for example, I started having runny nose after stress and
dryness in the morning. I decided to solve the problem.
Two months ago, I consulted a specialist and I stopped using the spray, I
took an oral corticosteroid for 1 months (slowly decreasing the dose) and a
deflazacort nasal spray for an additional month. One of my nostrils seemed to
be healed, while with the other I continued having stuffiness problems,
especially at night.
Nevertheless, I went on for these two months quite well during the day, but
during the night I waked up once or twice because of the stuffy nose and
I had to walk around to relieve the symptoms, then I could return to bed.
This made me going nuts!
After 1 month, the specialist noticed some progress in the status of the
nose, saying that probably I was too demanding with my nose and that the mucose
was not too bad.
At the end of the two months period, before the final check with the
doctor, I had a severe attack of runny nose, I could not sleep at all
for a couple of nights, my anxiety grew exponentially and I had to go
back to nafazoline.
Now it is a week I am having one spray of nafazoline at night, none in
the morning, but I have additional nose problems during
the day: runny nose, dryness,etc. Did I become allergic to nafazoline?
I am scared I will not be able to perform a normal respiration any
more!
The specialist says a turbinectomy could help me. However, I think I could not
whithstand the post-operatory phase, with tampons in my nose. As I said, my
anxiety makes me feel very badly; during my last crisis I had suicide feelings
(no kidding!) and I am now undergoing a theraphy for depression.
Could you help me with some suggestions? What happens if I go on with
nasal spray?
Is there any Internet association of patients with this kind of symptoms?
I would really speak with people having my same problems or people that
already had nasal surgery, to compare my feelings and experiences.
Of course I also follow the directions of my specialist, but I would
feel more confortable if I could have other opinions.
Also, I would like to stress that nasal problems are strictly related to
anxiety, I think that this aspect of the matter is sometimes underestimated by
the doctors.
Please, suggest me how to overcome this problem, that is becoming the
center of my life!
Thanks
Reply: -----------------------
I am not familiar with nafazoline nasal spray but assume it is a topical vasoconstrictor spray such as oxymetazoline or neo-synephrine. These sprays improve the airflow through the nose by shrinking vascular channels in the lining of the nose located in the nasal turbinates. Repeated use of topical vasoconstrictor nasal sprays daily over a week or more can result in a condition known as rhinitis medicamentosa. Remember that blood delivers oxygen to the tissues. Repeated vasoconstriction of the blood vessels therefore can lead to oxygen deprivation in the nasal tissues which then can lead to edema. Edema of the nasal tissues then results in nasal blockage triggering the urge to repeat the nasal spray and an endless cycle results with the duration of effect of the nasal spray progressively shortening.
Most patients can break the cycle with a little assistance from topical and occasionally systemic steroids. Once the cycle is broken it is important to address any contributing nasal conditions that may have been present initially causing the use of the topical vasoconstrictor sprays in the first place. For example, some patients have an underlying anatomic deformity such as a septal deviation which might warrant surgical correction. Other patients may have an underlying allergic or non-allergic (vasomotor) rhinitis which over the years has lead to some degree of irreversible enlargement of the nasal turbinates. These patients may benefit from a surgical procedure known as a partial turbinectomy. I perform a partial turbinectomy with a laser under local anesthesia and do not use any post-operative packing (ie tampons). Post-operatively one expects dryness and nasal crusting which is treated with pulsed nasal saline irrigations and nasal emollients such as Ponaris or Pretz solutions. Other patients with less severe cases may simply require long term maintenance use of topical nasal steroids such as Vancenase AQ, Nasacort, Rhinocort, Flonase, etc which can be safely used daily indefinitely (ie years).
One final note, your post suggests that a "runny nose" (rhinorrhea) is one of your predominant symptoms. There is a relatively new type of nasal medication called Atrovent nasal spray which is specifically designed to treat this symptom and in fact is probably the most effective medication with the least side effect potential in the treatment of watery rhinorrhea such as that which occurs in some cases of allergy or vasomotor rhinitis. In any event, it is extremely important to understand that regular use of topical vasoconstrictor nasal sprays such as Afrin or Neo-Synephrine can result in serious problems including nasal septal perforation and atrophic rhinitis. The occasional use of such sprays is acceptable provided they are not used for more than 3 consecutive days.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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