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What is the cause and treatment for rhinitis medicamentosa?

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ENT Specialist
Practicing since : 1991
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deviated nasal septum, report of CT Scan says:
* minimal polynomial mucosal thickening of both maxillary sinus bases with patent both om complexes.
* clear other pns
* no air fluid levels formations or calcification.
* deviated nasal septum
* normal scanned parts of both orbits.

issue is harder with current sinusitis allergy i'm going through ... I believe that the issue is affecting my eyes (causing me to feel some pressure on them on the sides,un relaxed sensation, can't focus, i feel all that in the muscles around the eyes ) , when I go to sleep, i feel like my nose is blocked and can't breath normally..take long time to sleep... after sleeping all pain around the eyes is gone but it returns after some time...headaches occur through the day,mostly in the morning during work.
I'm not relaxed toward the surgical option, my doctor stated that it is upto me and how uncomfortable i feel about my situation, and that I can keep going on meds only.
I'm not sure about the situation and how much do I need the surgery.
CT scan pictures are available if necessary.
Posted Tue, 5 Aug 2014 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 56 minutes later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for your query.

1. Upload the CT images for an accurate assessment.

2. Your symptoms are also consistent with Rhinitis Medicamentosa due to Otrivin.

3. Radio frequency ablation of turbines and Balloon Sinuplasty may be options in your case along with medical therapy.

I hope that I have answered your questions and if you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for rhinitis medicamentosa? 4 hours later
Thanks for replying Dr. ;

I've got something like 80+ scan pics. so I tried to attach what I thought most useful...please let me know if you need more.

regarding the 2nd point, you said due to otrivin, can you elaborate? is otrivine bad for my case? and what alternatives do you suggest?
 
 
Answered by Dr. Sumit Bhatti 18 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. The images lack contrast. Kindly upload a new, clear set of images. All if possible.

2. Rhinitis Medicamentosa results from frequent use of Otrivin nasal drops/sprays. The rebound congestion makes the nose stuffy unless the nasal decongestant drops are used again, with increasing frequency. Treatment includes anti-allergic, mucolytics, steroid nasal sprays , steam inhalation and discontinuation of the decongestant drops.

I hope that I have answered your questions and if you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for rhinitis medicamentosa? 22 hours later
reports sent
 
 
Answered by Dr. Sumit Bhatti 59 minutes later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. The CT images are not clear.

2. You have to upload a new, clear set of images. All the images, if possible.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for rhinitis medicamentosa? 22 minutes later
here is a link of the pics:
https://www.dropbox.com/sh/q5aju9ivp34lvn4/AAA0Zj-Jo0IpQf3OfxZetgLTa

the whole CD Compressed:
https://www.dropbox.com/s/u10bs9f8taoy7ed/CT%20SCAN%20%282%29.rar
How to open the images:
the program is in a folder called FAST View (autorun), run it , click ok ... the program will scan all images readable (better to extract it to an empty flash drive)....in the drop menu on the lift under patient you have to select my name (Sulaiman XXXXXXX 27Y)...click on open patient and all the scans will show, you can scroll between them (there are 2 sets) total of 87 pics please let me know if you can help the DR. receive and check my scan report
 
 
Answered by Dr. Sumit Bhatti 23 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. These are the additional findings on your CT Scan images:
a. Concha Bullosa or pnematized anterior portion of the middle turbinate, more on the Left side than the Right.
b. Small polyp in the Right Sphenoid Sinus. I would recommend an MRI for this if your eye symptoms are worse in the right eye.
c. Hyper pneumatized sinuses with thinned out walls may suggest intermittent sinus blockage.
d. Paradoxical Inferior nasal turbinate on the Left side.
e. Bony posterior deviation of the septum on the Left side.
f. Hypertrophied Inferior nasal turbinate on the Right side.

2. These may be the reasons for the blockage of your nose and your eye symptoms.

3. If you follow the treatment plan outlined this and in the previous answers, you should improve.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: What is the cause and treatment for rhinitis medicamentosa? 3 hours later
Thank you for your reply Dr.

1- Can you please explain part b&c from the 1st point?

2- would any of these listed issues cause a problem to my eye/eyesight/eye pressure?

3- If I go with the surgery option, would it solve all those issues? in other words...is surgery a fast solution to such issues or would those issues come back in the future?
 
 
Answered by Dr. Sumit Bhatti 7 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. These findings are signs that the paranasal sinuses may be responsible for your symptoms. The CT Scan shows the structural situation at that point in time when it was taken. It does not show functioning of the paranasal sinuses. The situation keeps changing everyday. The Sphenoid Polyp mentioned in (b) needs further evaluation. The finding at (c) has no straightforward intervention.

2. Your first treatment option is always sustained medication for 6 to 8 weeks. This will alo include weaning off the Otrivin.

3. There is no role for major endoscopic sinus surgery (FESS) in your case. The options are limited to radiofrequency ablation of the hypertrophied inferior turbinates, balloon sinuplasty, excision of the Concha Bullosa / Mini-FESS.

4. The success of treatment is the resolution of your symptoms (nasal blockage, pressure on the eyes, headaches). There is no way to predict the exact outcome or how long the relief will last. At the most, you may expect 80-85% improvement.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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