Central  South  Dakota  Medical News
The Clinical View
by Phillip Hoffsten,M.D.
3 June 2004

RUNNY NOSE AND EAR PROBLEMS

        A gentleman came to the emergency room complaining that when he flew into Pierre to visit family he had a terrible earache as the plane was descending into the airport.  The pain was very severe and lasted approximately an hour.  He was getting ready to fly back home and wanted to be sure that this didn’t happen again.  He had always had difficulty with a stopped up nose and felt that it was due to “sinus problems”.  On examination of his ears, it was seen that the drums were deeply cupped and somewhat irritated in appearance.  He did not have a fever.  A test called a tympanogram was done which showed that the tube (eustachian tube) from his ears to his nose was completely stopped up.

        It was explained to him that he had “eustachian tube dysfunction” which meant that the tube between his ear and his nose didn’t allow equalization of the pressure on his ear drum.  As the airplane descended and the atmospheric pressure increased as he came closer to the ground, there was more pressure pushing in on his ear which caused the severe pain.

        He was instructed that the appropriate care at this point was the use of a nasal spray called oxymetazoline (Afrin) which would shrink the swelling around the openings to his eustachian tube and allow the eustachian tube to again function normally.  He was instructed to use this about an hour before the flight was to occur.  Instructions were to blow his nose as well as he could, then spray the nasal cavity with the Afrin spray.  Following this, he should wait about 5-10 minutes, blow his nose a second time and put in a second application of the spray.  With this method, eustachian tube dysfunction can be effectively dealt with in most people.

        Fortunately, several days later, I did hear a phone call back from him indicating that he had flown back home without difficulty.

        For children who have recurrent ear infections and ear aches, the use of the Pediatric Afrin used only once a day at bedtime is very useful to prevent the recurrent ear infections.  Children get the same problem as this gentleman had but tend to get infected in addition.  The eustachian tube dysfunction is avoided with the Afrin nasal spray and the repeated infections can often be stopped.

        The problem with Afrin nasal spray is the tendency to habituation.  The spray works remarkably well and some individuals will use it 2-3 times a day which leads to a dependency.  Without the spray, the dependent person becomes very congested and the problem is propagated and made worse.  An important step in using this product is to use it no more than once  a day for children with chronic problems.  This is preferably best given at bedtime.

        The second common ear, nose and throat problem has to do with chronic sinus congestion.  In these individuals, the mucous membranes lining the sinus cavities and the nasal cavities swell.  Like any swollen tissue, these linings then weep secretions causing the runny nose and material dripping down the throat causing a cough.  The common causes are allergies, contaminated atmospheres, or in some individuals, no specific cause for the problem is determined.

        The treatment for this is more or less the same regardless of the cause.  I think the most effective method of dealing with the problem is the use of Afrin nasal spray, again use only at bedtime by the double spray method mentioned above.  Afrin will shrink the swollen membranes, stop the weeping fluids that comes from them and thereby decrease the cough.  At the same time the nasal passages are open so they can drain normally and the corruption and infection that often develops overnight is avoided.  If secretions are repeatedly purulent, yellow, green discharge, the use of a decongestant and an antibiotic together may be helpful.  Though without adequate drainage of the congested areas and decrease in the amount of secretions, antibiotics will have little long term effect.

        A third problem for which patients commonly seek help is the nasal congestion and secretions that occur when a person sits down for a meal.  Often times, the secretions can be so large in amount that it causes choking and the embarrassment of a runny nose at the table.  Normally when a person sits down to a meal, there is a natural increase of secretions into the mouth.  These secretions are called salvia and are a normal and natural expectation.  Unfortunately, in some individuals, the same nervous stimulation that causes increased secretions in the mouth causes increased secretions in the nose also.  This can lead to an embarrassing runny nose and nasal congestion at the table.  Now there is a spray that a person can use to dry up those secretions before the meal and avoid this embarrassing and uncomfortable situation.  This is called Atrovent (Ipratropium).  This is very effective in stopping the so called vasomotor rhinitis that occurs at the table or at other times.

        There are several remedies often prescribed that in my experience are less effective than the above.  The first of these is the use of antihistamines such as Benadryl, Zyrtec, Claritin,etc.  These products tend to dry up secretions if the person’s basic problem represents an allergies.  Most of the runny noses and eustachian tube dysfunction that occur are not related necessary to allergies and the use of antihistamine products is not effective.

        The second treatment often prescribed is the use of “decongestants”.  Most commonly these are the pseudoephedrine based products that raise blood pressure sometimes to dangerous levels in the elderly.  Again, in my experience these are less effective than the use of Afrin nasal spray and cause side effects of very cold hands and very cold feet in addition to high blood pressure.

        The last product which I am not impressed with is the use of cough syrups to help with the nasal congestion problems when secretions are dripping down the person’s throat.  The cough suppressants will raise the threshold at which a person coughs but it doesn’t turn off the basic problem of the secretions that are making the cough happen to begin with.  To do that, one needs to stop the congestion in the nose and that uses products such as Afrin nasal spray.

        Of the above products, antibiotics and the Ipratropium spray require prescriptions but Afrin nasal spray is available over the counter and very useful when used judiciously no more than once a day.  The healthcare professionals at your local clinics can help prescribe other products when appropriate.