Correlation between Objective Nasal Mucosal Swelling and Estimated Stuffiness during Long-Term Use of Vasoconstrictors

Abstract

The correlation between nasal mucosal swelling and estimated stuffiness was evaluated in 13 healthy volunteers who entered the trial. The nasal mucosa was challenged with increasing concentrations of histamine solutions. The amount of mucosal swelling was recorded using rhinostereometry, and the stuffiness was estimated by the subjects on a visual analogue scale. Then the subjects were randomly chosen to receive either oxy- or xylometazoline nasal spray for 30 days. After 10 days on the drug, the histamine sensitivity was enhanced, and after another 20 days, it had increased further, reflecting the development of rhinitis medicamentosa. Before the subjects started the nasal spray and after 10 days on the drug, a correlation between stuffiness and swelling was seen in the individual subject only when the degree of stuffiness almost obliterated the nasal opening. At the end of the month, no correlation was present. In all histamine provocations throughout the month, a very high correlation was noted between mean mucosal swelling and mean stuffiness. It is concluded that the symptom scores for nasal obstruction are useful for determining nasal mucosal swelling in groups. However, in the individual subjects one can estimate the mucosal swelling only when the amount of swelling almost obliterates the nasal opening. This cannot be done when the mucosa is hyperreactive.