Nonallergic Rhinitis

A 37-year-old man presented with a 2 year history of increasing bilateral nasal obstruction. He gave a history of using an ‘Over the Counter’ nasal decongestant over the same period. Over the last 6 months, he had noticed that his nasal decongestant had become less effective and he was having to use it more frequently. An ENT evaluation revealed a picture of rhinitis with a mild deviation of the nasal septum and significant hypertrophy of both inferior turbinates (Fig. 10.1). A skin prick test was negative for the tested allergens. A working diagnosis of a rhinitis medicamentosa was made. The patient was treated successfully with a gradual reduction of the nasal decongestant use with introduction of nasal steroids and bilateral diathermy of inferior turbinates.