With OTC Meds
Do I Need to See
Some chronic problems are reasonably well controlled by using OTC medicines. If you have problems that are becoming worse, or that you spend a lot of time treating or "living with"; it is really worth your while to seek professional advice. For chronic problems, a nasal and sinus specialist is best. Click below or scroll down.
Doctors rightfully will treat sinusitis with antibiotics, but that doesn't mean that a bacterial component to the problem won't potentially quiet down "on it's own" or with a little help. In fact, we don't always know what causes chronic sinusitis. If you think you have a low grade chronic infection/inflammation and want to try and treat it yourself, you can start with frequent saline nasal rinses, occasional use of decongestants, and if available, steroid nasal sprays. Flare ups that hurt or last very long should be seen by a doctor. If such problems significantly impact your life, see a specialist and probably end up getting a CT scan to more fully diagnose the condition.
Some patients who get frequent sinus infections or flare ups of chronic infections find that if they take a mucous thinner on a regular basis, they can reduce the frequency of flare up. Guaifenesin is the main mucous thinner. It is available OTC as Mucinex, a 600 mg tablet. Take 2 of these every 12 hours. Side effects are rare, sometime they upset your stomach. It's worth a try.
People who are prone to infections are generally more prone to having a common viral cold "turn into" a bacterial infection. For such people, consider using zinc gluconate medicines to shorten the common cold, and be more vigilant with sanitary measures when around people who are sick or when around young children. The basic issue is keeping your hands from touching your eyes, nose, or mouth unless they have just been washed or sanitized with the new gels like Purell.
Sinus infections are only dangerous when they spread outside of the confines of the sinuses, such as causing bronchitis or pneumonia, eye abscess, or brain abscess. These complications are rare but not unheard of.
Sometimes the problem is that you just can't breath well through your nose. This is especially likely to bother people at night. It is often not entirely clear what the cause is. The most common diagnoses would be a nasal septal deviation, turbinate hypertrophy, and chronic sinusitis.
One problem is that the decongestant sprays are not at all good if used routinely and oral decongestant pills have side effects and interfere with sleep.
I have included steroid nasal sprays in the OTC category because they should be OTC, but in the U.S. they are currently only by prescription. You should try to obtain one of the preferred brands, and use 2 squirts in each side of your nose before bed every night. They are OTC in other countries and are available on line (sorry no specifics available). Sometimes it is all that is needed to tip the scale in your favor. Give this type of medicine about a week before drawing any conclusion about its effectiveness.
If the problem is more intermittent, you should get a decongestant spray, dump half of the bottle out, fill with saline nasal spray to dilute this in half. You can use this diluted decongestant spray sparingly and not have a great chance of developing the rebound phenomenon if you limit the amount. You can use it at full strength, but it works fine at 1/2 strength, and you can us it longer before it causes problems. I would guess that if you could limit yourself to 8 total pumps per week of 1/2 strength, you will be OK even for the long haul. Try treating just one side each night, alternating, and see if that can allow you to get more total comfort out of this medicine despite its limitations. Beware the urge to use it more frequently, people end up with worse nasal congestion if they exceed a certain amount of use. People who have been "hooked" on these medicines before should not use them at all.
If this problem is every night and day, then you need to see a specialist. Your problem may be chronic sinusitis, and may benefit from prescription medicines and diagnostic studies. There are times when minor procedures done in the office can relieve the problem. Other times minor outpatient surgical procedures are needed. Trouble breathing through the nose is the symptom that is most reliably correctable if surgery is needed. You can live with it, but you don't have to.
There are a couple of ways that your sinuses can hurt. If your sinuses are infected or obstructed, they can cause pain. Several non-inflamed anatomic abnormalities can cause sinus pain also. Chronic infections that cause pain are quite different from acute sinus infections. You can keep chronic infection for years. Unless you have an evaluation and probably a CT scan, the source of chronic sinus pain can be hard to know. Even in the absence of a certain diagnosis, there are a few things you can try.
You can intermittently use ibuprofen, oral decongestants, and occasionally use spray decongestants to relieve sinus pain. If spray decongestants alone relieve the pain, this is a fairly strong indication that the pain is of a primary sinus origin. guaifenesin 600 mg tablets OTC, take 2 every 12 hours can help sinus pain in some patients. Wait about a week to draw a conclusion.
If your problem is chronic rhinorrhea, there are several possiblities. To me, runny nose means that there are too many clear secretions and that they are seen when you blow your nose, or they drip out of the front. If they are only noted in the throat, they are called post nasal drip and are addressed seperately below.
Treating allergic rhinitis, especially with a drying medicine like Tavist, is a reasonable first step. If the OTC treatment of allergies doesn't help, then you probably need a doctors visit and it is probably best to see a specialist for this chronic symptom. A medical evalution may find that the underlying problems is something other than allergies and needs specific treatment.
If no underlying treatable problems are found, the prescriptions that are helpful are listed below. Some of these may soon be available OTC, they are OTC in other countries and are sometimes available online.
Atrovent Nasal Spray (A very safe topical drying agent)
Anticholinergic drugs such as Robinul Fortes, Trans-derm Scop Patch, and meth-scopolomine containing pills.
If post nasal drip is a chronic problem and is the primary symptom, several things come to mind.
Sometimes, one or more of the posterior "deep" sinuses becomes chronically infected with bacteria. This can also happen in the adenoid pad region. The drainage from this problem is irritating and usually creates a characteristic redness in the back of the throat that can be seen on physical examination. If patients fit this pattern, they should see a specialist.
People think of chronic infection and allergy as the primary sources for PND. If PND is chronic and not associated with other nasal symptoms, I think that it is much more common for it to be secondary to LPR (Laryngo-pharyngeal reflux)
The symptoms of LPR include one or more of the following. Surprisingly, heart burn and indigestion are not usually present. Its a hard diagnosis to make, in some cases. Once other causes have been eliminated, I believe that patients should try a one month treatment for LPR.
Common symptoms of LPR
A feeling of thick mucous in the throat
|A feeling of a lump in your throat when you swallow, especially when swallowing "dry"
|Hoarseness or a voice that fatigues easily
|Chronic cough or throat clearing
|Chronic sore throat, low in throat near voice box
|Waking up choking or with burning
|More likely if overweight or snore loudly or if you have sleep apnea
If the problem is likely to be LPR, the next "test" is to treat with high dose antacids and see if there is any relief from the symptoms.
If the doctor thinks that it is more likely to be a chronic sinus infection, then a course of specially selected antibiotics will possibly be given or a culture of the nasopharynx can be done to identify the possible bacteria. If improvement isn't found, a CT scan may be helpful.
If you want to try and treat LPR for yourself for a while, I would start by using saline nasal rinses and also high doses of antacids. Not just any antacid will work. It is well appreciated that treatment of LPR can be difficult and the results can be slow to come. You should get Prilosec OTC® and take 2 of them in the morning, and 2 of them in the evening. I would recommend taking them at this rate for at least 2 weeks and probably for 4 weeks before drawing any conclusions. This type of medicine is expensive, even the OTC form.
Treating a Cold
With OTC Meds
With OTC Meds
Problems with OTC