They contain substances that negatively affect the tone of the blood capillaries and, as a result, lead to the development of a drug-induced rhinitis. According to practical observations, dependence on topical anticongestants develops within 7-15 days. During this period, vascular dystonia occurs, therefore, a sharp refusal from drugs leads to swelling of the nasopharyngeal mucosa and difficulty breathing. In this regard, the patient is forced to use vasoconstrictors over and over again. The article will consider the causes and mechanisms of the development of addiction, as well as effective methods of treating drug-induced rhinitis.
What drops are addictive?
Addiction to nasal drops occurs when using only those drugs that contain adrenergic receptor stimulants. The absorption of these components into the nasopharyngeal mucosa leads to irritation of the so-called α1- and α2-receptors, which are localized in the arterioles. Subsequent narrowing of the blood capillaries and a decrease in their permeability can eliminate swelling in the nasal passages and facilitate breathing.
The process of getting used to nasal products is almost imperceptible. When an allergic or infectious rhinitis occurs, each person seeks to quickly eliminate the unpleasant symptoms of the disease - congestion, abundant nasal discharge, nasal voice, etc. Topical anticongestants, which restore nasal breathing within 2-3 minutes, do the best with this task.
Some of the more well-known addictive and rhinitis medications include:
- "Nazivin";
- Sanorin;
- Galazolin;
- "Naphtizin";
- "Tizine";
- "Rinonorm"
- Rinostop;
- "Snoop";
- Knoxprey;
- "Rinorus".
Most drugs from the decongestant group cannot be used during pregnancy, as they have a systemic effect on the body and can provoke premature birth.
Few know that an overdose of vasoconstrictor drugs leads to very disastrous consequences. If you use the drugs for more than 7 days in a row, in the future this will cause the development of drug or atrophic rhinitis. Moreover, sympathomimetics (substances that stimulate the synthesis of norepinephrine) stop only the manifestations of the common cold, but not the causes of its occurrence.
The mechanism of development of addiction
Addiction to drops in the nose occurs due to a violation of the tone of the vessels, which permeate the nasopharyngeal mucosa. Most topical anticongestants contain substances that are antagonists of α1- and α2-adrenergic receptors:
- naphazoline;
- xylometazoline;
- tetrizoline;
- indanazolamine.
Stimulation of receptors localized in small arterioles leads to their narrowing and, accordingly, less blood circulation in the mucous membranes. Due to this, swelling in the tissues decreases, as a result of which the diameter of the choanas (internal nasal openings) increases. In other words, the use of vasoconstrictor aerosols and sprays helps to increase nasal patency and facilitate breathing through the nose.
Inhibition of the secretory function of the goblet cells secreting nasal mucus leads to the development of atrophic rhinitis.
It is important to remember that anti-congestants negatively affect the tone of the blood capillaries. Exceeding the dosage and period of use of drugs is fraught with the emergence of a "rebound" syndrome. After drug withdrawal, the arterioles in the nasopharynx expand, which increases their permeability. Subsequently, this leads to tissue edema, difficulty breathing and impaired secretory function of the glands in the nasopharynx.
Symptoms of addiction to decongestants
If the patient literally cannot live without topical decongestants, this indicates the development of addiction to nasal drops. Overuse of drugs leads to the fact that the blood vessels in the nasopharynx can no longer independently regulate their tone. To eliminate the feeling of congestion and abundant nasal discharge, a person is forced to use vasoconstrictors every day, 2-3 times a day.
Itching and burning in the nasopharynx
Anticongestants disrupt the activity of the goblet cells, which are found in the mucous membrane. Insufficient production of nasal secretions leads to dehydration of tissues and, as a result, the formation of small cracks on their surface. Violation of the integrity of the tissues entails the appearance of itching or severe burning.
It should be understood that dehydration of the nasopharynx sooner or later leads to a decrease in local immunity. This means that any pathogens that have penetrated the respiratory system can provoke inflammation in them. That is why people suffering from "drip" addiction often suffer from sinusitis, flu, rhinopharyngitis, posterior rhinitis, etc.
Loss of smell (anosmia)
Anosmia is a disorder of smell, in which a person ceases to feel and distinguish smells. Most often, people who are addicted to decongestants suffer from partial anosmia, i.e. hyposmia. It develops due to the destruction of the olfactory bulbs by stimulants of adrenergic receptors.
It is very difficult to restore the activity of olfactory receptors. The destruction of most of the nerve pathways connecting the olfactory bulbs with the corresponding zones in the cerebral cortex leads to irreversible processes. According to practical observations, even minimally invasive surgeries and physiotherapeutic procedures do not allow to restore the sense of smell in full.
Chronic nasal congestion
Due to failures in the autonomic regulation of blood vessels, an abundant blood supply to the mucous membrane occurs. The increased supply of oxygen and nutrients to tissues leads to overactive goblet cells. They begin to produce more and more nasal secretions, which do not have time to evacuate from the nasal cavity.
Blockage of the internal nasal openings with mucus creates an obstacle to the passage of air through the nasal passages into the laryngopharynx. Difficulty breathing leads to a lack of oxygen in the body and the development of side symptoms:
- nausea;
- headache;
- decreased appetite;
- insomnia;
- increased heartbeat;
- lethargy;
- lacrimation.
Phenylephrine-based drugs have the mildest vasoconstrictor effect, since they do not cause a significant decrease in blood flow in the nasopharynx.
It is important to remember that increased blood supply to the mucous membranes leads to their hypertrophy (pathological proliferation). If you do not get rid of addiction in time, it will be possible to eliminate its consequences only through surgical intervention.
How to get rid of decongestants?
It is possible to get rid of "drip" dependence on its own only at the initial stages of its development. For this, it is recommended to replace the vasoconstrictor with drops based on seawater - Morenazal, Physiomer, No-Salt, etc. If the nasal congestion persists within two weeks, it is recommended to seek help from an ENT.
Depending on the degree of disturbance of vascular tone and hypertrophy of the mucous membranes, treatment is carried out by conservative or surgical methods. Conservative therapy involves the use of medications and physiotherapeutic procedures, and operative - resection (removal) of hypertrophied and atrophied areas of the mucous membrane.
Topical corticosteroids
Nasal corticosteroids are hormonal anti-inflammatory drugs. They are used to treat allergic and non-infectious inflammation in the nasal cavity and paranasal sinuses. Synthetic steroid hormones quickly restore the integrity of damaged tissues and eliminate inflammation, thereby improving airway patency.
To ease the manifestations of the "rebound" syndrome and quickly restore nasal breathing, it is recommended to use:
- "Nazonex";
- "Polydexa";
- "Beconase";
- Nazarel;
- Avamis.
Hormonal topical drops should not be included in the treatment regimen for bacterial or fungal rhinitis.
Topical corticosteroids can affect the microflora in the nasal cavity. Therefore, they are used only as directed by a specialist in the dosages recommended by him. Abuse of hormonal drugs is fraught with a decrease in immunity, which can lead to the reproduction of opportunistic fungi. The formation of mycotic (fungal) flora in the nasopharynx leads to the development of fungal rhinopharyngitis, sinusitis, rhinitis, etc.
Irrigation of the nose with saline
Salt water irrigation (washing) of the nasal cavity is one of the most effective methods of dealing with nasal congestion. Isotonic and hypertonic solutions are among the anticongestants that do not affect the vascular tone in the nasopharynx. To eliminate nasal obstruction (obstruction), it is recommended to rinse the nasal cavity at least three times a day with the following drugs:
- "Marimer";
- Dolphin;
- "Quicks";
- "Aqualor".
Hypertonic solutions containing more than 0.9% sodium chloride should not be used if atrophic rhinitis occurs.
Enhanced production of nasal mucus is a direct indication for the use of hypertensive drugs. They "draw" from the tissues an excess amount of intercellular moisture, thereby reducing puffiness. But if the prolonged use of decongestants has led to atrophy (thinning) of the mucous membrane, hypertonic solutions are replaced with isotonic seawater. It restores the function of the goblet cells, but does not lead to dehydration of the nasopharyngeal mucosa.
Vasotomy
Surgical intervention is resorted to only in case of ineffectiveness of drug and physiotherapeutic treatment. If necessary, atrophied and hypertrophied areas of the mucous membrane are removed using minimally invasive methods, which include:
- ultrasonic disintegration - a procedure to reduce the thickness of the mucous membrane, during which soft tissues are destroyed under the influence of ultrasonic waves;
- radiocoagulation - superficial cauterization of the ciliated epithelium in the nasal cavity, which contributes to an increase in the inner diameter of the nasal canals;
- laser vaporization - laser "vaporization" of hypertrophied areas of the nasopharyngeal mucosa.
In some cases, during the operation, surgeons perform septoplasty, due to which the nasal septum is aligned. To reduce the likelihood of developing an infection in the tissues operated on, patients are advised to rinse the nasal cavity with isotonic drugs.
Conclusion
Irrational use of topical (local) vasoconstrictors often causes chronic nasal congestion and medication rhinitis. Adverse reactions occur due to a violation of vascular tone, which is provoked by stimulants of adrenergic receptors - naphazoline, xylometazoline and indanazolamine.
Adrenaline receptor antagonists are found in most nasal vasoconstrictor drugs. It is they who make the vessels in the nasopharynx narrow. Drug abuse leads to the development of local vascular dystonia. Therefore, the rejection of vasoconstrictor drops entails the expansion of the arterioles in the nasopharynx, as a result of which it swells. This is exactly what is one of the key reasons for the occurrence of a medicinal rhinitis and difficulty in nasal breathing.
