Can Long-Term Use of Steroid Nasal Sprays Cause Nasal Turbinate Hypertrophy?

Q: Can Long-Term Use of Steroid Nasal Sprays Cause Nasal Turbinate Hypertrophy?

Hello, regarding allergic rhinitis： The primary triggers are genetic predisposition and environmental allergens. <br>If one parent has allergic rhinitis, the likelihood of their children developing it is four times higher. <br>Treatment typically begins with oral medications and

Can steroid nasal sprays be used long-term? Can they cause turbinate hypertrophy or hyperplasia?

Hello Doctor: I had severe chronic sinusitis (allergic) during my childhood, which improved on its own around middle school.
In recent years, I have experienced mild nasal congestion and post-nasal drip, but since it wasn't severe, I didn't seek treatment and only visited an ENT once.
The doctor at that time mentioned that I had turbinate hypertrophy and advised against using nasal sprays, as it could lead to further enlargement.
In October of this year, due to a prolonged cough from a cold, I visited a large hospital's pulmonary department and was diagnosed with asthma.
The doctor prescribed Aymunshi (which I believe is a steroid nasal spray), bronchodilators, and recommended long-term use for three months.
However, after recovering from my cold, I have been hesitant to use Aymunshi, fearing that it would worsen my turbinate hypertrophy.
Recently, I caught another cold and have been suffering from persistent nasal discharge.
After researching online, I found that there are many types of nasal sprays, and it is suggested that individuals with allergic rhinitis should use steroid nasal sprays long-term for better efficacy.
Is this statement correct? I am concerned that long-term use of steroid nasal sprays might also lead to turbinate hyperplasia or further enlargement.
I kindly seek your clarification.
Thank you!

momoylan, 30~39 year old female. Ask Date: 2017/12/25

Dr. Ji Zhaoyun reply Otolaryngology

Hello, regarding allergic rhinitis: The primary triggers are genetic predisposition and environmental allergens.
If one parent has allergic rhinitis, the likelihood of their children developing it is four times higher.
Treatment typically begins with oral medications and nasal sprays, and surgery may be considered if necessary.
The main medications include oral antihistamines and intranasal corticosteroid sprays used in combination.
Depending on the situation, local antihistamines/vasoconstrictors or oral leukotriene receptor antagonists may also be utilized.
If symptoms do not improve with medication and there is significant structural obstruction, such as a deviated septum, enlarged inferior turbinates, or nasal valve narrowing, appropriate surgical intervention can be performed to alleviate these issues.

Regarding nasal sprays, there are long-acting corticosteroid nasal sprays and short-acting vasoconstrictor nasal sprays.
Long-acting corticosteroid nasal sprays can be used long-term; however, short-acting vasoconstrictor nasal sprays should only be used for 3-5 days followed by a 2-week break to avoid the risk of rhinitis medicamentosa.

To avoid allergens, it is advisable to reduce irritants by wearing masks, regularly cleaning bedding, avoiding extreme fluctuations in temperature/humidity, and minimizing exposure to air pollution.

Wishing you health and safety.

Sincerely,
Dr.
Chi Chao-Yun,
Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2017/12/25

More Info

The concern regarding the long-term use of steroid nasal sprays, such as Flixonase (fluticasone propionate), and their potential effects on nasal turbinate hypertrophy is a valid one, especially for individuals with a history of chronic rhinosinusitis or allergic rhinitis.
Steroid nasal sprays are commonly prescribed for the management of allergic rhinitis and other nasal inflammatory conditions. They work by reducing inflammation in the nasal passages, which can alleviate symptoms such as nasal congestion, sneezing, and runny nose. The anti-inflammatory properties of these medications make them effective for long-term management of chronic nasal conditions.

However, there is a concern that prolonged use of steroid nasal sprays could lead to nasal turbinate hypertrophy, which is the enlargement of the nasal turbinates—structures within the nasal cavity that help to humidify and filter the air we breathe. The fear is that while these sprays can reduce inflammation, they may also cause a rebound effect or lead to changes in the nasal mucosa that could contribute to turbinate enlargement over time.

Research indicates that the long-term use of intranasal corticosteroids is generally safe and effective for managing allergic rhinitis without significant adverse effects on nasal structures. In fact, studies have shown that these medications can help to reduce nasal obstruction and improve airflow, which may actually prevent the worsening of turbinate hypertrophy. The key is to use these medications as directed by a healthcare professional and to monitor for any side effects.

It is important to note that while steroid nasal sprays can be beneficial, they should be used judiciously. Overuse or incorrect usage can lead to potential side effects, including nasal irritation, bleeding, or, in rare cases, systemic effects if used inappropriately. Therefore, it is crucial to follow the prescribed dosage and frequency of use.

In your case, since you have a history of asthma and have been prescribed a steroid nasal spray, it is advisable to use it as directed by your physician. If you have concerns about nasal turbinate hypertrophy, it would be beneficial to discuss these with your healthcare provider. They may recommend regular follow-ups to monitor your nasal condition and adjust your treatment plan as necessary.

In summary, while there is a theoretical concern regarding the long-term use of steroid nasal sprays and nasal turbinate hypertrophy, the evidence suggests that when used appropriately, these medications can effectively manage symptoms of allergic rhinitis without significantly increasing the risk of turbinate enlargement. Regular communication with your healthcare provider is essential to ensure that your treatment remains effective and safe.

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