- Design
- Randomised, double-blind trial, single centre
- Population
- 60 adults with chronic nasal obstruction who had failed topical steroids
- Primary outcome
- Responders on Clinical Global Impression–Improvement at 4 weeks
- Effect
- 83% vs 36% (difference 47 points, 95% CI 25 to 70)
A single-centre, double-blind trial randomised 60 adults with chronic nasal obstruction, who had already failed topical steroids and did not have chronic sinusitis, to twice-daily oxymetazoline plus budesonide spray or budesonide alone for four weeks, followed by a three-week wean.
Responders, defined as at least moderate improvement, were 83% with the combination and 36% with budesonide alone, a difference of 47 points (95% CI 25 to 70). No patient on oxymetazoline developed rebound obstruction during treatment, and all weaned off without difficulty.
This challenges the rule that topical decongestants must never go beyond a few days. A steroid co-spray appears to protect against rebound, at least over a month. Longer use was not tested, so the combination is best reserved for patients who have failed steroids alone, with a planned wean.
- Consider a time-limited oxymetazoline–steroid combination for adults whose obstruction persists on steroids alone
- Plan the wean from the start, as the trial did over three weeks
- Exclude chronic rhinosinusitis before starting, as these patients were not studied
- Warn patients not to use oxymetazoline alone for prolonged periods
- Review at four weeks and stop if there is no meaningful benefit
Why it matters
It challenges the blanket rule against using topical decongestants beyond a few days.
Don't overread it
Four weeks of treatment in 60 patients; safety beyond a month is unknown.
The statistics, in plain English
A 47-point difference in responders means about one extra responder for every two patients treated. The interval (25 to 70 points) is wide but entirely favours the combination.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ent & head and neck surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free