Paradoxical increase in nasal airway resistance after topical nasal decongestion - does it really exist? A retro- and prospective study.

OBJECTIVE: To explore the prevalence and reproducibility of paradoxically increased nasal airway resistance after decongestion of the nasal mucosa as well as to identify patient-related factors associated with it.

DESIGN: Retrospective analysis of all rhinomanometric measurements carried out at one ENT department in Sweden in the time between 1990 and 2010. In the baseline material, 207 of 4435 patients (4.7%) showed a paradoxically increased nasal airway resistance >20%. A follow-up rhinomanometry was performed in patients eligible for the study.

SETTING: Secondary care centre.

PARTICIPANTS: Patients with paradoxically increased nasal airway resistance >20% who returned a complete questionnaire and had not undergone any nasal- or sinus surgery. Thirty-six patients (33-72 years) were eligible for the study.

MAIN OUTCOME MEASURES: All patients answered a questionnaire and underwent rhinoscopy. Nasal airway resistance before and after decongestion with 0.1% xylometazoline hydrochloride was assessed by active anterior rhinomanometry.

RESULTS: Twelve of thirty-six patients (33%) showed a paradoxically increased nasal airway resistance in the follow-up rhinomanometry. No patient-related factors were identified.

CONCLUSION: The results indicate the existence and reproducibility of paradoxically increased nasal airway resistance.