A number of medicines have been found useful for treating nasal dysfunction, and depending upon your specific dysfunction, a selection of medicines will be prescribed. It is important that you take the medicines exactly as prescribed; many of the medicines achieve their effect over a long term and if you use them in a sporadic fashion they will not be effective.
The simple drugs used to decongest the nose are called decongestants and the one most commonly prescribed is Sudafed. This medicine is taken as a pill. Normally 30 mg are taken every two to four hours. The medicine should cause some decrease in nasal congestion and discharge. Sudafed causes little if any drowsiness or other systemic symptoms. It may be taken on a prn basis; that means you may take it as needed, and do not need to take it on a regular basis. To the best of our knowledge this medicine has no long-term deleterious effects, and may be taken for years.
For many situations a simple decongestant is not effective, and the combination of an antihistamine and a decongestant is more potent. There are many antihistamine-decongestant combinations available on the market today. Most are available over the counter. There is variation in an individual´s response to these drugs. It is common for one medicine to work well for one individual and not for another. Each of us has our favorites, and if you identify a preparation which works most effectively for you, bring this to your doctor´s attention as a preferred medicine. Some of the antihistamine-decongestants have a short term effect. Actifed is prescribed three to four times a day. The majority of the antihistamine-decongestants have a long-term, slow-release effect and are prescribed at a maximum of once or twice a day. The antihistamines tend to cause drowsiness, and this side effect is often disconcerting. If one takes the antihistamines on a regular basis, one normally adapts to the drowsy effect and will no longer be bothered by it. The antihistamines do have a long-term effect can be taken on a regular schedule. Many individuals find that they do well by taking one in the morning and one in the evening. Others find that the drowsy effect interferes with their normal daily function and prefer only taking a pill at bedtime. This is particularly helpful in decongesting the nose during sleep. Another side effect of the antihistamine-decongestants is drying of the nasal mucosa and the throat. While this is a desirable effect in the drippy, runny nose, it is for others an unpleasant side effect. New preparations allegedly have antihistamine effects without the annoying drying effects. Some patients find antihistamine-decongestants to be effective medicines.
While many prescribe antihistamines and many use them, I personally rarely prescribe antihistamines. Nasal steroids are more effective. Antihistamines thicken secretions and impair ciliary motility and may be counterproductive in the management of nasal disease.
Antibiotics are prescribed when it is felt there is infection in the paranasal sinuses, and only occasionally for infection in the nasal cavity. Acute sinusitis is most commonly treated with Amoxicillin, Augmentin or a Z-pak.
Chronic infections are best treated with low dose Amoxicillin. Chronic sinus infections are difficult to treat and are resistant to antibiotic therapy. It is important that the antibiotics be taken for an extended period of time, and this varies from six to twelve weeks. The drugs are best taken one-half hour before eating or two hours after eating. In some individuals this causes gastric discomfort, and for these individuals it is best to take the medicine with some food in the stomach, ideally thirty to sixty minutes after eating, or with a cracker or a snack at bedtime. Antibiotics must be taken on a regular basis. If they are not taken as prescribed they potentially can do more harm than good.
There are a number of potential side effects to antibiotics, and if problems occur you should call your pharmacist or physician.
Antibiotic resistance is a terrible problem in the United States. All of the bacteria which cause sinus and ear infections have now been exposed to our antibiotics for so long that many have developed resistance. Hence, the pharmaceutical industry has had to develop newer and stronger antibiotics. While one is tempted to prescribe these for one´s own infections, you have to realize that every time you take a new antibiotic you now expose the bacteria to the new antibiotic and slowly but surely induce resistance to the new antibiotic. Newer antibiotics are 5–15 times more expensive, and so the cost of medical care slowly rises. My own philosophy is to begin with the simple time-proven antibiotics. If resistance develops there is plenty of time to add more potent antibiotics. It is wrong to begin each new infection with the world´s most potent, most expensive, and probably most dangerous antibiotic.
Prednisone is a steroid and can be extremely effective in treating smell disorders, specifically those caused by inflammatory disease. While it is not safe to take steroids for a prolonged period as they may reduce the body´s resistance to infection and cancer, it is relatively safe to take prednisone for a week or two. We prescribe it as a diagnostic test. If the smell disorder improves on prednisone, then we know the problem lies in the nose and is theoretically treatable. If there is no change while taking high dose prednisone, it is more likely that the smell disorder is not a nasal inflammatory disease and may not be treatable.
New medicines available for the treatment of allergic rhinitis are the nasal steroids. These include such medicines as Rhinocort, Flonase or Nasacort. As with the antihistamine-decongestant preparations, there are personal preferences for one or the other. The nasal steroids are one of the medicines that definitely have a long term cumulative effect and should be taken on a regular basis. They will be prescribed for you to take one or two sniffs in each nostril once or twice a day; that is, once in the morning and once in the evening. You should remember when you use this medicine that you are trying to get it into your nose and not to inhale or sniff to deeply or else you will sniff it all the way back into your throat and lungs. The medicine is easy to take. Hold the tip to your nose, depress the sprayer and a small amount of medicine will be squirted into your nose. Simultaneously, take a gentle sniff, thereby inhaling the medicine into the nasal cavity. The application is repeated on the opposite side of the nose. Some individuals report a burning when using nasal steroids. This is caused by the propellant in the steroid and has nothing to do with the medicine. Often this can be relieved by sniffing a squirt of normal saline just prior to using the nasal steroid. You can buy some saline from your druggist or you can mix your own by mixing a glass of water and a half teaspoon of salt. Place this in your nose with a small dropper or place it in a squeeze bottle and stiff it into your nose
A variety of medicines are available for cleaning the nose. Fingers, cotton swabs, and other mechanical instruments should not be used. The simplest and most commonly used is normal saline. This can be purchased as Nasal Saline Ocean Spray or Ayr, or by mixing one glass of water with a level teaspoon of iodine-free salt. This is administered to the nose either with a dropper or as a spray, and should be sniffed in and then blown back out. This helps clean the nose and in many individuals makes the nose feel more comfortable. For some individuals a different nasal douche will be prescribed. This is called Nasal Lubricant. It contains a variety of drugs including oil of eucalyptus and is effective for cleaning the nose and coating the mucosal lining. Particularly in individuals with a dry crusty nose, this medicine may be extremely useful. It is important that the nasal lubricant not be inhaled into the lungs, for this could cause pulmonary damage.
If allergic nasal disease is diagnosed and if medicines are either ineffective in controlling the symptoms, or if they cannot be tolerated because of the side effects, or if one wishes to decrease the use of medications, allergy desensitization injections may be useful. These injections consist of dilute solutions of the materials causing the allergy. The materials are injected in gradually increasing amounts to cause the build-up of protective (rather than allergy-causing) antibodies. Generally, 75 percent of people benefit from this therapy. It requires one to three years, initially on a weekly basis but eventually only one injection a month is required. This treatment is provided under the direction of a trained allergist.