Does nose spray addiction exist? A qualitative analysis of addiction components in rhinitis medicamentosa.

Background and Aims: Nasal congestion is a prevalent symptom often alleviated with over-the-counter nasal sprays containing decongestants. Rhinitis medicamentosa (RM), caused by the overuse of decongestants leading to recurrent mucosal swelling, poses a significant challenge for specialists in managing patients. Despite advancements in understanding, research primarily consists of case series with limited data on its impact on quality of life. This qualitative study aimed to explore the effect of nasal spray overuse on quality of life and identify addiction components among individuals with RM. Methods: Twenty participants with RM were interviewed by an otorhinolaryngologist and addiction counsellor. The study employed a qualitative approach utilising directed content analysis and revealed eleven categories, classified into addiction components and distinctive features of nasal spray addiction. Results: The analysis revealed the presence of all Griffiths' addiction components in the identified themes. Additionally, sleep disorders, the feeling of suffocation, side effects, illness identity and psychological effects on nasal congestion significantly impair individuals' quality of life. Conclusion: This qualitative study identified key components of addiction in nasal spray overuse and suggested that RM might be conceptualised in the DSM-5 category of "Other (or Unknown) Substance-Related Disorders", considering the lack of psychoactive effects. Nevertheless, in view of the current findings, it also seems to be plausible to examine the phenomenon in the behavioural addiction framework. The study underscores the need for further research and intervention strategies to address the significant impact of RM on individuals' quality of life.