Service d'ORL et de chirurgie cervico-faciale, hôpital Huriez, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Jun;130(3):137-44. doi: 10.1016/j.anorl.2012.09.005. Epub 2013 Feb 1.
Systemic and topical nasal decongestants are widely used in otorhinolaryngology and general practice for the management of acute rhinosinusitis and as an adjuvant in certain forms of chronic rhinosinusitis. These products, very effective to rapidly improve nasal congestion, are sometimes available over the counter and can be the subject of misuse, which is difficult to control. The Société Française d'ORL has recently issued guidelines concerning the use of these decongestants in the doctor's office and the operating room.
The review of the literature conducted by the task force studied in detail the concepts of "rebound congestion" and "rhinitis medicamentosa" often reported in a context of misuse, particularly of topical nasal decongestants. The clinical and histopathological consequences of prolonged and repeated use of nasal decongestants have been studied on animal models and healthy subjects.
Discordant results have been obtained, as some authors reported a harmful effect of nasal decongestants on the nasal mucosa, while others did not identify any significant changes. No study has been able to distinguish between inflammatory lesions induced by chronic rhinosinusitis and lesions possibly related to the use of nasal decongestants.
The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis.
Nasal decongestants are recommended for the management of acute rhinosinusitis to reduce the consequences of often disabling nasal congestion. They are also recommended during rhinoscopic examination and for preparation of the nasal mucosa prior to endonasal surgery.
全身性和局部用鼻减充血剂在耳鼻喉科和普通科中广泛用于治疗急性鼻窦炎，并作为某些慢性鼻窦炎的辅助治疗。这些产品可非常有效地迅速改善鼻塞，但有时可在柜台购买，可能会被滥用，难以控制。法国耳鼻喉科学会最近发布了有关在医生办公室和手术室使用这些减充血剂的指南。
工作组对文献进行了详细回顾，重点研究了“反弹性鼻塞”和“药物性鼻炎”的概念，这些概念通常在滥用的情况下被报道，尤其是在局部用鼻减充血剂的情况下。在动物模型和健康受试者中研究了长期和重复使用鼻减充血剂对鼻腔的临床和组织病理学后果。
结果不一致，一些作者报告了鼻减充血剂对鼻黏膜的有害影响，而另一些作者则没有发现任何明显的变化。没有研究能够区分慢性鼻窦炎引起的炎症病变和可能与使用鼻减充血剂有关的病变。
工作组通过停止鼻减充血剂治疗后鼻塞的恢复来解释观察到的反弹性鼻塞，并且在没有来自慢性鼻窦炎患者的科学证据的情况下，拒绝了药物性鼻炎的概念。
鼻减充血剂推荐用于治疗急性鼻窦炎，以减轻经常导致致残的鼻塞的后果。它们也推荐在鼻内镜检查期间和鼻内手术前准备鼻腔黏膜时使用。
