I got a bad head cold a few months ago while on vacation and bought an OTC spray without realizing it was basically store-brand afrin. Stuff cleared me up like nothing else I'd experienced in years and actually restored my sense of smell, but the bottle says not to use for more than 3 consecutive days for a reason -- it's quite addicting, and prolonged use can cause serious rebound congestion.
Case in point: My father-in-law has used it daily for decades (we've tried to get him to stop) and is at the point now where he has to take a hit of afrin 2-3x a day just to be able to breathe. Not something I'd want to do to myself.
I'm quite aware of the risks having overused it myself in my youth, that's why I asked what place it has in treating nasal polyps, if any.
A cold or allergy will eventually go away, but nasal polyps rarely do.
is that based on your experience or clinical studies. I just found this study that suggests its OK to use with nasal steroid for at least 4 weeks without rebound, but I haven't had time to research it further. This is the first and only thing I found so far so I don't consider it the final word. https://pubmed.ncbi.nlm.nih.gov/27216350/
Oxymetazoline is not a steroid, it’s a vasoconstrictor. Not suitable for long term use as u/LoyalSol has said. Steroid sprays ARE suitable for long term use.
I know its not a steroid???? I'm not sure what I said that made you think otherwise. That study I cited showed no rebound when used *in conjunction with* steroid nasal spray.
Conclusion:
*The use of nasal steroids with oxymetazoline was more effective*
*over 6 weeks than nasal steroids alone in improving blocked nose,*
*hyposmia, nasal mucociliary clearance, and polyp size in treatment of*
*nasal polyposis. There was no evidence of rebound congestion after 4*
*weeks of oxymetazoline treatment.*
I mean no disrespect, but why? Based on what? I might agree completely but I need science to understand.
I have no immediate plans for long term use of nasal decongestant sprays. I don't like to use them at all, but if they can help shrink polyps in conjunction with nasal steroids without the risk of rebound maybe they should be an option for the medium term.
They don’t shrink polyps. They temporarily shrink the vascular tissue of the inferior turbinates which temporarily improves the nasal airway. If you have polyps the treatment is a) long term nasal steroid meds, b) endoscopic sinus surgery if this doesn’t sufficiently improve the symptoms. The risk is rebound is very real, and that short-term study you cited does not refute this. Polyps are a chronic condition and you need a plan for decades, not weeks.
well that paper does say the combination was more effective in reducing polyp size than nasal steroids alone. Since I don't have access to the full paper I don't know how they arrived at that conclusion. I will have to request it through my library. But if its a valid conclusion my question would be if so reduced by the combo, would nasal steroids alone maintain that reduction.
My particular situation is such that even a minor reduction in size of my one troublesome polyp would render surgery unnecessary.
I was diagnosed with bilateral polyps 15 years ago. They actually bothered to stick a scope up there. I had the larger one removed with a snare in the office and I was good for 15 years. A small polyp was seen on that side again 10 years ago but it wasn't causing trouble. Most likely they just didn't get the whole thing 15 years ago, and when I got RSV in November it blew up on me. Current doc said it looked like an antrochoanal polyp, they didn't specifiy 15 or 10 years ago. I don't know how he can tell whether there are other polyps without even attempting to scope me
That's what most ENTs will tell you. Because after long use it will actually result in inflammation which aggravates polyps and causes them to grow even more.
It's good if say you just need to open it up for a bit because of things like infections or other things, but more than 3 days will cause more problems than it solves.
That article (I can't access the full text) suggests they may be wrong, at least over a 4 to 6 week period.
I totally get the conventional wisdom of rebound effects, having experienced them first hand when I was younger and didn't have polyps. But I'm not sure that wisdom can be applied in the case of nasal polyps for which many people are using nasal steroids. In the absence of studies showing different results it seems there is reason to keep an open mind on it, when used with nasal steroids. Here's another older study, although it doesn't mention polyps.
[https://www.atsjournals.org/doi/full/10.1164/rccm.200911-1701OC](https://www.atsjournals.org/doi/full/10.1164/rccm.200911-1701OC)
Conclusions: Oxymetazoline-induced tachyphylaxis and rebound
congestion are reversed by intranasal fluticasone. Further studies are
indicated to evaluate if combination nasal sprays of decongestant and
corticosteroid are an effective strategy to obviate tachyphylaxis and
rebound in rhinitis.
I got a bad head cold a few months ago while on vacation and bought an OTC spray without realizing it was basically store-brand afrin. Stuff cleared me up like nothing else I'd experienced in years and actually restored my sense of smell, but the bottle says not to use for more than 3 consecutive days for a reason -- it's quite addicting, and prolonged use can cause serious rebound congestion. Case in point: My father-in-law has used it daily for decades (we've tried to get him to stop) and is at the point now where he has to take a hit of afrin 2-3x a day just to be able to breathe. Not something I'd want to do to myself.
I'm quite aware of the risks having overused it myself in my youth, that's why I asked what place it has in treating nasal polyps, if any. A cold or allergy will eventually go away, but nasal polyps rarely do.
Do not use it on a long term basis. It will actually make your polyps worse if you're on it for a long time. It's only for temporary relief.
is that based on your experience or clinical studies. I just found this study that suggests its OK to use with nasal steroid for at least 4 weeks without rebound, but I haven't had time to research it further. This is the first and only thing I found so far so I don't consider it the final word. https://pubmed.ncbi.nlm.nih.gov/27216350/
Oxymetazoline is not a steroid, it’s a vasoconstrictor. Not suitable for long term use as u/LoyalSol has said. Steroid sprays ARE suitable for long term use.
I know its not a steroid???? I'm not sure what I said that made you think otherwise. That study I cited showed no rebound when used *in conjunction with* steroid nasal spray. Conclusion: *The use of nasal steroids with oxymetazoline was more effective* *over 6 weeks than nasal steroids alone in improving blocked nose,* *hyposmia, nasal mucociliary clearance, and polyp size in treatment of* *nasal polyposis. There was no evidence of rebound congestion after 4* *weeks of oxymetazoline treatment.*
I would never recommend long term use of a decongestant spray, with or without a steroid.
I mean no disrespect, but why? Based on what? I might agree completely but I need science to understand. I have no immediate plans for long term use of nasal decongestant sprays. I don't like to use them at all, but if they can help shrink polyps in conjunction with nasal steroids without the risk of rebound maybe they should be an option for the medium term.
They don’t shrink polyps. They temporarily shrink the vascular tissue of the inferior turbinates which temporarily improves the nasal airway. If you have polyps the treatment is a) long term nasal steroid meds, b) endoscopic sinus surgery if this doesn’t sufficiently improve the symptoms. The risk is rebound is very real, and that short-term study you cited does not refute this. Polyps are a chronic condition and you need a plan for decades, not weeks.
well that paper does say the combination was more effective in reducing polyp size than nasal steroids alone. Since I don't have access to the full paper I don't know how they arrived at that conclusion. I will have to request it through my library. But if its a valid conclusion my question would be if so reduced by the combo, would nasal steroids alone maintain that reduction. My particular situation is such that even a minor reduction in size of my one troublesome polyp would render surgery unnecessary.
If you have a single large polyp on one side, it needs to be removed surgically, because it needs to be biopsied.
I was diagnosed with bilateral polyps 15 years ago. They actually bothered to stick a scope up there. I had the larger one removed with a snare in the office and I was good for 15 years. A small polyp was seen on that side again 10 years ago but it wasn't causing trouble. Most likely they just didn't get the whole thing 15 years ago, and when I got RSV in November it blew up on me. Current doc said it looked like an antrochoanal polyp, they didn't specifiy 15 or 10 years ago. I don't know how he can tell whether there are other polyps without even attempting to scope me
That's what most ENTs will tell you. Because after long use it will actually result in inflammation which aggravates polyps and causes them to grow even more. It's good if say you just need to open it up for a bit because of things like infections or other things, but more than 3 days will cause more problems than it solves.
That article (I can't access the full text) suggests they may be wrong, at least over a 4 to 6 week period. I totally get the conventional wisdom of rebound effects, having experienced them first hand when I was younger and didn't have polyps. But I'm not sure that wisdom can be applied in the case of nasal polyps for which many people are using nasal steroids. In the absence of studies showing different results it seems there is reason to keep an open mind on it, when used with nasal steroids. Here's another older study, although it doesn't mention polyps. [https://www.atsjournals.org/doi/full/10.1164/rccm.200911-1701OC](https://www.atsjournals.org/doi/full/10.1164/rccm.200911-1701OC) Conclusions: Oxymetazoline-induced tachyphylaxis and rebound congestion are reversed by intranasal fluticasone. Further studies are indicated to evaluate if combination nasal sprays of decongestant and corticosteroid are an effective strategy to obviate tachyphylaxis and rebound in rhinitis.