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.