Why do we suffer from nasal and sinus discomfort?
The body’s nasal and sinus membranes have similar responses to viruses,
allergic insults, and common bacterial infections. Membranes become swollen
and congested. This congestion causes pain and pressure; mucus production increases
during inflammation, resulting in a drippy, runny nose. These secretions may
thicken over time, may slow in their drainage, and may predispose to future
bacterial infection of the sinuses.
Congestion of the nasal membranes may even block the eustachian tube leading
to the ear, resulting in a feeling of blockage in the ear or fluid behind the
eardrum. Additionally, nasal airway congestion causes the individual to breathe
through the mouth.
Each year, more than 37 million Americans suffer from sinusitis, which typically
includes nasal congestion, thick yellow-green nasal discharge, facial pain
and pressure. Many do not understand the nature of their illness or what produces
their symptoms. Consequently, before visiting a physician, they seek relief
for their nasal and sinus discomfort by taking non-prescription or over-the-counter
What is the role of OTC medication?
There are many different OTC medications available to relieve the common complaints
of sinus pain and pressure, allergy problems, and nasal congestion. Most
of these medications are combination products that associate either a pain
reliever such as acetaminophen with a decongestant or an antihistamine. Knowledge
of these products and of the probable cause of symptoms will help the consumer
to decide which product is best suited to relieve the common symptoms associated
with nasal or sinus inflammation.
OTC nasal medications are designed to reduce symptoms produced by the inflammation
of nasal membranes and sinuses. The goals of OTC medications are to: (1) reopen
to nasal passages; (2) reduce nasal congestion; (3) relieve pain and pressure
symptoms; and (4) reduce potential for complications. The medications come
in several forms.
Nasal saline sprays: non-medicated nasal sprays
Nasal saline is an invaluable addition to the list of over-the-counter medications.
It is ideal for all types of nasal problems. The added moisture produced by
the saline reduces thick secretions and assists in the removal of infectious
agents. There is no risk of becoming “addicted” to nasal saline.
It should be applied as a mist to the nose up to six times per day. Nasal saline
can also be made at home: use one cup of boiled water and ¼ tsp. of
non-iodized salt with or without ¼ tsp. of baking soda.
Nasal decongestant sprays: medicated nasal sprays
Afrin nasal spray, Neo-Synephrine, Otrivin, Dristan nasal spray, and other
brands decongest the swollen nasal membranes. They clear nasal passages almost
immediately and are useful in treating the initial stages of a common cold
or viral infection. Nasal decongestant sprays are safe to use, especially appropriate
for preventing eustachian tube problems when flying, and to halt progression
of sinus infections following colds. However, they should only be utilized
for 3-5 days because prolonged use leads to rebound congestion or “getting
hooked on nasal sprays.” The patient with nasal swelling caused by seasonal
allergy problems should use a cromolyn sodium nasal spray. The spray must be
used frequently (four times a day) during allergy season to prevent the release
of histamine from the tissues, which starts the allergic reaction. It works
best before symptoms become established by stabilizing the nasal membranes
and has few side effects.
Pressure and congestion are common symptoms of nasal passage swelling. Decongestant
medications are OTC products that relieve nasal swelling, pressure, and congestion
but do not treat the cause of the inflammation. They reduce blood flow to the
nasal membranes leading to improved airflow, less breathing through the mouth,
decreased pressure in the sinuses and head, and subsequently less discomfort.
Decongestants do not relieve drippy noses. Their side effects may include light
headedness or giddiness and increased blood pressure and heart rate. (Patients
with high blood pressure or heart problems should consult a physician before
use.) In addition, other medications may interact with oral decongestants causing
side effects. The most common decongestants are pseudoephedrine (Sudafed) and
phenylpropanolamine. Both of these are available as single products or in combination
with a pain reliever or an antihistamine. They are labeled as “non-drowsy” due
to a side effect of stimulation of the nervous system.
Some medications are combined to reduce the number of pills. Tylenol–Sinus
or Advil Cold and Sinus exemplify products that join a pain reliever (acetaminophen
or ibuprophen) with a decongestant (pseudoephedrine). These products relieve
both sinus and cold/flu symptoms yet retain all the attributes of the individual
drug including side effects.
Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines
such as diphenhydramine (Benadryl), or clemastine (Tavist) may be used for
relieving allergic symptoms of itching, sneezing, and nasal congestion. They
relieve the drainage associated with the allergic inflammation but not obstruction
or congestion. Antihistamines have a potential for sedation causing grogginess
and dryness after use. Newer nonsedating antihistamines are available.
Antihistamine-decongestant combination products
Antihistamines and decongestant products are often combined to relieve multiple
symptoms of congestion and drainage and reduce the side effects of both products.
Antihistamines produce sedation; decongestants are added to make them “non-drowsy.” The
combined allergy product then relieves congestion and a runny nose.
If you have further questions about Over-the-counter Medicine, please feel
free to contact our office.
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