Rhinitis medicamentosa: Electron microscopic changes of human nasal mucosa

OBJECTIVE: Prolonged application of nasal vasoconstrictors causes rhinitis medicamentosa (RM). Nasal obstruction is induced by rebound swelling when the decongestive effect has disappeared. The aim of this study was to demonstrate ultrastructural changes in RM. STUDY DESIGN AND SETTING: Tissue samples of inferior turbinates from 22 patients with RM and 10 patients without rhinitis were taken during nasal surgery. Ultrathin sections were investigated by using a transmission electron microscope (TEM). RESULTS: The TEM findings revealed severe epithelial damages such as loss of ciliated cells. In the subepithelial region, the vascular endothelium showed gaps and ruptures of basal lamina. CONCLUSION: RM is a drug-induced damage of human nasal mucosa. Loss and destruction of ciliated epithelial cells are the morphologic correlation of the disturbed mucociliary clearance. In addition, vascular endothelium revealed ultrastructural changes. This could be caused by an increased vascular permeability with consecutive interstitial edema. SIGNIFICANCE: This study demonstrated new morphological aspects of rhinitis medicamentosa. (c) 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.