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Nasal congestion from decongestant overuse — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareNasal congestion from decongestant overuseUSMLE Step 3

A 36-year-old man has persistent nasal congestion despite using oxymetazoline spray every few hours for 3 weeks. He has no fever, purulent discharge, facial pain, or anosmia. Nasal mucosa is erythematous and swollen. Which of the following is the most appropriate at this time?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Stop topical decongestant and use intranasal corticosteroid temporarily

Rhinitis medicamentosa is caused by topical decongestant overuse and is treated by stopping the offending spray with supportive intranasal steroid therapy.

Reference: Allergic rhinitis practice parameters: https://www.aaaai.org/