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'Big Bang Theory' and 'Wedding Ringer' actress Kaley Cuoco Sweeting recently had sinus surgery—which sadly prompted nose-job rumors. But Cuoco Sweeting revealed the real reason she went under the knife: an "addiction" to Afrin nasal spray that ruined her sinuses.

January 15, 2015

Big Bang Theory and Wedding Ringer actress Kaley Cuoco Sweeting recently posted Instagram photos of herself post-sinus surgery, prompting rumors that she'd had a nose job for cosmetic purposes. But earlier this week on The Ellen Show, Cuoco Sweeting revealed the real reason she went under the knife: an "addiction" to Afrin nasal spray that she says ruined her sinuses.

Is this legit? Faoud Ishmael, MD, assistant professor of medicine at Penn State Milton S. Hershey Medical Center and Health System, says it certainly can be. "Over-the-counter decongestant sprays can cause rebound effects," explains the allergy and immunology doctor, "which make you feel like you need to keep using them over and over."

The actress's reason for needing surgery also makes sense, says Dr. Ishmael, since these types of medicines can cause tissue damage if used too often or for too long.

If you're an allergy sufferer or have ever used a nasal spray to clear congestion, this news may have you wondering about your own sinus health. Here's how to avoid Cuoco Sweeting's mistakes, and to unstuff yourself safely.

How OTC nasal spray works

Decongestant sprays like Afrin—as well as some from Zicam, Mucinex, and Vicks—contain an active ingredient called oxymetazoline, which works by constricting blood vessels in swollen nasal tissue. The tissue shrinks temporarily, opening up airways and allowing the user to breathe easy.

But after a few hours, that nasal tissue swells back up. "And if you use the spray consistently for more than a few days at a time, the blood vessels in your nose get used to having the medicine around," says Dr. Ishmael. "When it wears off, they dilate, even more than if you hadn't started using it in the first place."

From there, it becomes a vicious cycle: The more you spray, the worse your rebound inflammation gets—but the worse your inflammation, the more you feel the need to spray.

"You can absolutely get addicted," says Dr. Ishmael. "I see it fairly commonly in my practice: Patients start using it and they can't get off it."

Cuoco Sweeting told Ellen Degeneres she was dependent on the spray for years. “At awards shows I would have to pick out the right clutch so I could fit my Afrin in it, and I’d be under the table snorting it," she said. "I couldn't get enough."

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The dangers of long-term use

These products are labeled with a warning not to use them for more than three days at a time, and to not exceed two doses in any 24-hour period. But because they're offered over the counter, it's difficult for doctors or pharmacists to regulate how much a patient is using them.

Overuse of decongestant sprays can cause blood vessels to narrow so much that blood supply to parts of the nose become cut off, causing tissue to die, Dr. Ishmael says. This can leave you vulnerable to infections, sinus pain, and persistent inflammation and congestion.

"I've seen patients with actual holes in their septum, right in the middle of the nose," he says. "I can shine a light in one nostril and see the light come right out the other side, because there's literally tissue missing."

Surgery to fix these problems might involve repairing holes in the septum, or shaving off areas of dead or damaged tissue that have blocked breathing passages, says Dr. Ishmael, who was not involved in Cuoco Sweeting's diagnosis or treatment.

If a person is using a nasal spray several times a day, permanent damage could occur in a matter of weeks or months, he says. And while it's less common, long-term and frequent use can also raise blood pressure throughout the body, since it affects the constriction of blood vessels.

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How to safely treat your symptoms

Afrin and other nasal decongestants are safe to use when you need a quick fix, says Dr. Ishmael, but he recommends using them occasionally at most, and only as directed.

"People like it because it starts to work almost immediately, so we tell our patients it's okay to use if you have a cold and you're really miserable," he says. "But you should be aware of the potential side effects if you use it longer than two or three days."

If you're going on three days and you still can't breathe easily, stop using OTC sprays and see your doctor: He or she can prescribe a steroid spray or antihistamine pills which don't seem to cause rebound effects and are safer for long-term use. (One steroid spray, Nasacort, is currently sold over the counter, and another, Flonase, will be available early this year.)

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