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 (OTC) medications.
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.
Decongestant medications
- 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.
Decongestant-combination products
- 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.
Antihistamine medications
- 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.