Wednesday, January 30, 2013

ENT Questions & Answers II

ENT Questions & Answers II

- What are the keys aspects to be considered in addressing rhinosinusitis?
- The precepts established in the recently created EPOS consensus must be followed and observed. As this consensus indicates, now we have a system for classifying and grading the clinical evidence for each of the treatments of choice and, therefore, it is recommended to use the treatments that have the most clinical evidence supporting them. But we must also keep an eye on the new products that are in the pipeline or about to come on the market and which, although they do not yet have a broad body of evidence behind them, suggest significant benefits.


- Are you referring to the effect of plant extracts?
- Exactly. This is a product that drains the nasal passages and which it is thought could be very effective in the treatment of rhinosinusitis. It may be a revolutionary product in the management of certain cases of mild or moderate acute rhinosinusitis. With an eminently mechanical action, this product seems to be able to assure effective symptom control.
- What is the mechanism of action of these natural plant extracts?
- After intranasal administration, they act on the mucosal surface, triggering a reflex secretory response by the mucous membranes lining the nasal passages and paranasal sinuses. Shortly after administration, the patient may feel smarting or irritation in the nose. At the same time, an intense reflex secretion begins after a few minutes and which may continue for a couple of hours. This rapid secretion dehydrates the mucosa, reducing the swelling and opening the ostiomeatal complex. An intense physiological drainage of the paranasal sinuses occurs, which has effective results in terms of symptom relief.
This product effectively decongests and adequately drains the nasal sinuses. This has significant practical implications. Indeed, rhinosinusitis is basically a problem of congestion and obstruction of sinus ventilation and drainage. Subsequently, infection may appear but the initial problem is that there is this obstruction. It is common for the infection to be treated but without improving the underlying obstruction, thereby increasing the risk of reinfection.
- So, on the basis of what you are saying, is elimination of the obstruction one of the first goals that should be pursued in the treatment of rhinosinusitis?
- If we improve the obstruction, the drainage, the ciliary movement and the quality of the mucus, we will already be moving towards a cure and we will be able to avoid using other treatments. For example, we could avoid the use of antibiotics in many cases and, in others, we could at least shorten the time during which antibiotics must be administered. We need clinical studies that help us confirm this evidence.
- What is your personal experience and personal opinion of the cyclamen extract?
- Very satisfactory. I have even used it personally and I have been able to see for myself how this product works and the rapid symptom improvement it brings. The patients report significant benefits too, with the symptoms improving after just a few days. Although the initial smarting sensation is uncomfortable, the patients tolerate it very well, better than expected. We therefore think that it could offer significant advantages, as major benefits are achieved using a natural, very non-aggressive therapy. On top of that, its dosage schedule is very easy to follow, as it consists of a single daily spray in each nostril for 7 days.

H. Massegur
57th National Congress of the Spanish
Society of Otorhinolaryngology
 Granada, 1 October 2006



Monday, January 28, 2013

ENT Questions & Answers I

ENT Questions & Answers I

- Why was a consensus needed for the diagnosis and management of rhinosinusitis?
- Until now, we did not have any agreed recommendations about how to address this health problem and, in fact, we even had problems in defining what rhinosinusitis was. This no doubt creates significant practical problems. Thus, although we had a very extensive treatment armamentarium, it did not always meet patients’ needs and demands. Faced with such a situation, the experts were duty-bound to draw up a consensus document.

- This document has sought to put a logical order to the medical procedure that must be followed in the detection and management of rhinosinusitis.
- That’s right. It was something that was absolutely necessary, particularly considering the fact that many of the drugs that were being used routinely to treat these patients had not been tested properly for efficacy. Worse still, in many cases, antibiotics were being used without any control when in actual fact they weren’t necessary. We cannot accept patients with rhinosinusitis being prescribed or taking treatments that are not backed by scientific evidence.


- Basically, what does the EPOS consensus consist of?
- Faced with this lack of guidelines both in Europe and in the United States, it was considered necessary to create guidelines based on scientific evidence. Work had already started a few years before within the Academy of Allergology and Clinical Immunology (EAACI) and the European Rhinology Society (ERS) on designing certain basic guidelines for proper diagnosis and treatment of rhinosinusitis. At the same time, in the United States, a series of guidelines have been developed that are very similar to those included in the EPOS consensus.
So we have now managed to put a little order in the management of rhinosinusitis, by clearly establishing when a particular treatment is indicated.

- But this consensus document goes further in that it establishes a common definition for rhinosinusitis and determines the stages of severity …
- This is also very important. At last, experts are talking about the same thing when they refer to rhinosinusitis or when they say that it is an acute or chronic condition. In actual fact, these guidelines are not intended to be unchangeable rules that must be followed to the letter. Rather, this consensus seeks to establish a common language and design a broad highway with certain basic rules and which give a certain amount of flexibility.

- The EPOS consensus talks about rhinosinusitis. Does this concept encompass all types of sinusitis?
- It is true that we used to talk about sinusitis. However, in recent years, we have been learning that when there is sinusitis, there is always rhinitis too, so we currently think that it is more correct to say rhinosinusitis rather than just sinusitis. When a person has sinusitis, the nose is always affected too.
- What should we understand by the term rhinosinusitis?
- Rhinosinusitis is the acute or chronic inflammation of the mucosa lining the nasal passages and paranasal sinuses.

- Is it possible to estimate the current prevalence of this disease in Spain?
- The prevalence depends on whether we are talking about chronic or acute rhinosinusitis. In the case of acute rhinosinusitis, we consider that it is a complication that occurs in approximately 1-2% of the people who have a common cold. If we consider that about 90 million cases of common cold a year are recorded in Spain, it is estimated that each year there may be over a million cases of acute rhinosinusitis. In the case of chronic rhinosinusitis, the prevalence is approximately 10% of the general population. As a general rule, we can say that there about 4.5 million people in Spain with rhinosinusitis, although the severity is highly variable.

- Turning to the new treatments that are appearing and which will appear in forthcoming years, such as those obtained from plant extracts, what can they contribute?
- The effect of the various plant extracts that are being studied is essentially based on activating a reflex secretion which produces a natural drainage or irrigation. In the specific case of this plant extract-based product, there are a number of observations which give us reason to feel very optimistic. New studies are currently being designed which will provide conclusive information about its benefits and possible indications. In any case, it can be definitely said that it is a product that facilitates elimination of secretions and stimulates a reflex secretion. In this respect, we know that glandular secretions have significant intrinsic antibiotic properties.


Interview with J. Mullol
Coordinator of the Rhinology Unit. Hospital ClĂ­nic. Barcelona.


At 57th National Congress of the Spanish
Society of Otorhinolaryngology

Granada,Spain 1 October 2006

Thursday, January 24, 2013

Future prospects in rhinosinusitis and postoperative care

Future prospects in rhinosinusitis and postoperative care



The classic postoperative care after sinonasal surgery has followed the recommendations made more than a decade ago by Professor Stammberger. This expert advised using merocel+beclometasone solution for 1-2 days and antibiotic ointment + corticoid (although it has since been shown that this measure does not offer any advantage and that it may even be contraindicated). In addition, during the first three days of the postoperative period, aspiration and removal of clots and secretions were recommended. As with other types of care, the importance of performing non-routine irrigations with saline and soaking with merocel + beclometasone was pointed out. It was considered that at least six weeks were required for re-epithelialisation. The monitoring visits were scheduled for after 1 week and after 4-6 weeks.



Another reference author, Professor Hosemann, established in 2000 a series of basic postoperative care procedures: mechanical cleaning, topical steroids, inhalations and irrigations, use of ointments/gels or solutions, removal of scabs and bone fragments, removal of synechias and aspiration of all the cavities. He recommended not performing nasal suction by hand and reminded that the level of postoperative care depended on the patient’s progress. According to this expert, scabs appeared during the first ten days and, after about 30 days, a lymphatic-obstructive oedema appeared while the mesenchymal reaction is usually detected after 3 months and healing usually occurs any time beyond 90 days after surgery.
Quoting another acknowledged expert, Professor Bernal et al. pointed out in 2001 on the subject of postoperative care that dressing changes had to be performed 3-5 times during the first 15 days, 1-2 times/week during the first month, and then once a week until the healing process was complete. Inhalations, irrigations and topical medication were recommended after the operation.

Wednesday, January 23, 2013

The goals of postoperative care

The goals of postoperative care

The priority goal of postoperative care after this type of surgery is usually to restore the patency and ventilation of the nasal passages and paranasal sinuses and the mucociliary clearing mechanism, as well as speeding up the healing process.
“the enormous future prospects opening in this field with the advent of new products containing plant extracts for nasal cleansing and drainage”.
One of the keys to success in postoperative care is to work closely with the patient. Explaining a series of basic recommendations to them not only helps improve their monitoring but also actively helps ensure the operation’s success.

  • To facilitate the physiological healing process and prompt recovery of the ciliated mucosa and ciliary transport.
  • To assure adequate ventilation and drainage of the paranasal sinuses.
  • To reduce the risk of infection and oedema and control granulation tissue and stenosis.
  • To improve the patient’s comfort.
Patient recommendations
  • Participate actively in your recovery.
  • Regularly perform nasal irrigations.
  • Blow your nose carefully, without applying too much pressure or breathing in detritus towards the oropharynx.


Orbital decompression
  • Do not practice scuba-diving or sports requiring intense effort such as weight-lifting.
  • Do not blow your nose (in the postoperative period).
  • If sinusitis appears: prompt antibiotic therapy.
  • Explain the postoperative situation and the risks if it should be necessary to re-operate.




Monday, January 21, 2013

Postoperative care in endoscopic sinonasal surgery

Postoperative care in endoscopic sinonasal surgery

In endoscopic sinonasal surgery, surgical treatment of the nasal passages and sinuses is performed under internal visual control by means of a flexible optical system that is inserted in the nostrils. This type of surgery has become increasingly popular in recent years, thanks to the improvements made in the technique and its acceptance by physicians and patients alike. It is often carried out in chronic conditions, which are usually associated with mucus production, such as nasal polyps, chronic sinusitis and surgery for tumours or sinonasal disorders.


The priority goal of postoperative care after this type of surgery is usually to restore the patency and ventilation of the nasal passages and paranasal sinuses and the mucociliary clearing mechanism, as well as speeding up the healing process. To achieve this goal and in order to prevent complications and risks (such as bleeding, scab formation, synechias and granulomas, closure of the ostium and accumulation of secretions in the immediate postoperative period), it is considered vital to establish an effective guideline for postoperative care. “these protocols vary from one centre to another and the efficacy associated with them also varies”. Given the success rate at Graz Hospital, it was particularly interesting to learn at this forum the premises used as the basis for their action protocol in such cases.
physiological healing process and rapid recovery of the ciliated mucosa and ciliary transport, obtain adequate ventilation and drainage of the nasal sinuses, reduce the risk of postoperative infection, oedema and stenosis and, above all, improve the patient’s comfort.
The treatment given in the preoperative period has an influence on the postoperative care that should be offered to the patient who has undergone endoscopic sinonasal surgery. The choice of medical treatment in the postoperative period will depend, to a great extent, on the previous treatment. It is currently accepted that topical steroids are the drugs of choice for polyposis and allergic rhinitis; the oral antihistamines are also drugs of choice in allergic rhinitis. As regards the systemic steroids, they may be indicated in patients with asthma or polyposis. Finally, the antibiotics would be indicated when there is infection.
During the perioperative period, success will depend on using the appropriate instruments. It is also vital to avoid causing unnecessary injury to the mucosa.
Doctors recommended preserving the mucosa as much as possible and avoiding any type of injury at this level (he recommended the use of microdebriders), not leaving the bone exposed without mucosa during surgery (this enables complications to be avoided in the postoperative period), avoiding combining septoplasty and other operations, and avoiding the so-called packing (using hyaluronic acid).

G. Wolf
ORL University. Graz Hospital. Austria

Friday, January 18, 2013

Side effects of corticosteroids

Side effects of corticosteroids

The Anti-inflammatory effects of corticosteroids cannot be separated from their metabolic effects, as all cells use the same glucocorticoid receptor; therefore when corticosteroids are prescribed measures should be taken to minimize their side effects. Clearly, the chance of significant side effects increases with the dose and duration of treatment and so the minimum dose necessary to control the disease should be given.
The safety of nasal and oral corticosteroids has been the subject of concern in medical literature since many patients with chronic sinus disease are prescribed these drugs due to their efficacy. Suppression of the hypothalamic-pituitary-adrenal axis, osteoporosis or changes in bone mineral density, growth retardation in children, cataracts and glaucoma have been reported to be the main adverse effects of corticosteroid treatment (6). In relation to adverse effects of corticosteroids, it is obvious that a clear distinction needs to be made between nasal (topical) and oral corticosteroids.


Nasal corticosteroid treatment represents one of the long-term treatment modalities in patients with chronic sinus disease. It is well established that absorption into the systemic circulation takes place after nasal administration of corticosteroids. However, several factors influence the systemic absorption, like the molecular characteristics of the corticosteroid, the prescribed dose, the mode of delivery and the severity of the underlying disease (4)
There is insufficient evidence from the literature to relate the use of nasal corticosteroids at licensed doses to changes in bone mineral biology, cataract and glaucoma. Adrenal suppression may occur with some nasal corticosteroids at licensed doses, but the clinical relevance remains uncertain. Overuse of nasal corticosteroids may be responsible for adrenal insufficiency and decrease in bone mineral density.  Of note, inhaled corticosteroids are the mainstay of treatment for children and adults with asthma and are more often associated with systemic side effects than the nasal route of treatment for rhinosinusitis. Intranasal administration of corticosteroids is associated with minor nose bleeding in a small proportion of recipients. This effect has been attributed to the vasoconstrictor activity of the corticosteroid molecules, and is considered to account for the very rare occurrence of nasal septal perforation (5) although it is also hypothesized that it could be related to repeated traumas on the nasal mucosa and septal cartilage by the nasal device, to the underlying nasal disorder for which corticosteroids were prescribed. However, it should be remembered that minor nosebleeds are common in the population.
Nasal biopsy studies do not show any detrimental structural effects within the nasal mucosa with long-term administration of intranasal corticosteroids (6).
Short treatment with oral corticosteroids is effective in chronic rhinosinusitis with nasal polyps. It is obvious that repeated or prolonged use of oral corticosteroids is associated with a significantly enhanced risk of the above-mentioned side effects.
In summary, intranasal corticosteroids are highly effective in cases of NP; nevertheless, they are not completely devoid of systemic effects. Thus, care has to be taken, especially in children, when long-term treatments are prescribed.

Thursday, January 17, 2013

Topical corticosteroids with Nasal polyps

Topical corticosteroids with Nasal polyps

It is of value to look separately at the effect on rhinitis symptoms associated with polyposis and the effect on the size of nasal polyps per se.
Topical corticosteroid sprays have a documented effect on bilateral Nasal Polyps and also on symptoms associated with NP such as nasal blockage, secretion and sneezing but the effect on the sense of smell is not high. There is strong evidence for effect on polyp size and nasal symptoms associated with nasal polyposis.


For individual symptoms blockage responds best to corticosteroids but improvement in sense of smell is not so obvious. Nasal drops are more effective than nasal spray and have a significant positive effect on smell. Nevertheless, corticoids are not well accepted and higher dosages are required to achieve small effects. Moreover, the question of “how corticosteroids reach the sinuses” is unanswered. The indication for topical steroids in ARS has not been accepted by EMA (European Medicines Agency).

Tuesday, January 15, 2013

Nasodren Scientific support (II)

Nasodren Scientific support


In March, another unique and impressive study was accepted for publication in The Laryngoscope, (organ of the American Laryngological, Rhinological and Otological Society): “An exploratory Trial of Cyclamen Europaeum Extract for Acute Rhinosinusitis” by J. Ponikau et al.
The key messages learnt from this study are:
In patients with Acute Rhinosinusitis, Cyclamen extract (Nasodren:

  • Improves objective outcomes compared to placebo
  • Produces a clinically relevant symptoms improvement
  • Is the only product marketed for Rhinosinusitis that has been tested in this way (CT); other products, such as corticosteroids, antibiotics or decongestants, measure only symptomatic improvement.

The results of these studies have led, as mentioned above, to the inclusion of Cyclamen europaeum, in the EPOS 2012, the European Guidelines on Rhinosinusitis. Therefore, we can claim to possess a unique product for the treatment of this prevalent condition.





 


References:
Pfaar O, Mullol J, Anders C, Hormann K, Klimek L. Cyclamen europaeum nasal spray, a novel phytotherapeutic product for the management of acute Rhinosinusitis: a randomized double-blind, placebo-controlled trial. Rhinology. 2012 Mar;50(1):37-44. PMID: 22469604
Ponikau J, Hamilos D, Barreto A, Cecil J, Jones S, Manthei S.  An exploratory trial of Cyclamen europaeum extract for acute Rhinosinusitis. Accepted for publication  Laryngoscope, March, 2012. PMID: 22675486


Monday, January 14, 2013

Nasodren Strong scientific support

Strong scientific support


Over the years, many studies to prove the efficacy and safety of Nasodren have been conducted, involving around 2,000 patients. Most of these articles have been published and many of them in journals indexed in PubMed.  
Last April, Rhinology (official Journal of the International Rhinologic Society) published the article “Cyclamen europaeum nasal spray, a novel phytotherapeutic product for the management of acute rhinosinusitis: a randomized double-blind, placebo controlled trial” by Oliver Pfaar et al. From this study we obtain the following key messages:

  • Nasodren is effective and safe for the treatment of patients with Acute Rhinosinusitis assessed subjectively and objectively.
  • The specific symptom of facial pain/pressure significantly improved after 5 - 7 days treatment with CE. This is important since facial pain/pressure is undoubtedly one of the most severe symptoms affecting the patient’s quality of life in Acute Rhinosinusitis.
  • Endoscopic evaluation showed that mucus oedema/nasal obstruction improved significantly with CE. Improvement (defined as a sum of endoscopy scores of 0) was significantly higher with CE than placebo at the end of the study.
  • Both patients and investigators reported signi­ficantly greater treatment satisfaction with CE than placebo


Friday, January 11, 2013

EPOS 2012

EPOS 2012: An important step for Nasodren


During the 24th Congress of the European Rhinologic Society, in conjunction with the 31st International Symposium on Infection and Allergy of the Nose, which took place in Toulouse last June, the European Position Paper on Rhinosinusitis and Nasal Polyps 2012 was presented. Four of the leaders of this project, gave a talk on the key aspects of the document, which is intended to be a state-of-the art review for the specialist and general practitioner alike.



To agree the final version, leaders in the field of ENT were invited to critically appraise the literature and write a report on a subject assigned to them. All contributions were distributed before
a meeting in November, when the group came together in Amsterdam. 4 days of the meeting were dedicated to discussing every report in detail. In addition, general discussions on important dilemmas and controversies took place. Finally, the management schemes were revised significantly, in light of new data that was available.

In view of said data, Cyclamen europaeum (Nasodren active substance) has been included in EPOS 2012 with highest level of evidence Ib and maximum level of recommendation A. This means that the efficacy and safety of Nasodren is endorsed by the most important paper in the ENT world and, consequently, should not be questioned.

Thursday, January 10, 2013

Take precautions while buying constant sinus congestion medicine online

Take precautions while buying constant sinus congestion medicine online

Probably no aspect of our lives is untouched by internet. For instance, even medicines, especially herbal and non-prescription formula can be bought online. If you are one of internet devotees and suffering from constant sinus congestion, browse through the companies’ websites and then dig the websites of institutes offering reliable and scientific information like the U.S. Food and Drug Administration (FDA) to make a right choice.  


For example, FDA has highlighted false information published on the following websites selling medicines to treat sinus congestion and infections:

Beneficial Solutions, LLC
In 2011, FDA sent a warning letter to Beneficial Solutions, LLC that operates www.nutrasilver.com. While reviewing the website, the agency observed that NutraSilver is being marketed as a drug. The website claimed that NutraSilver® treats sinus congestion and infection. However, the drug is misbranded according to the Federal Food, Drug, and Cosmetic Act (the Act). Get the full document.

Harmony Cone
In 2010, FDA wrote a warning letter to Harmony Cone, as the company is selling its Harmony Cone ear candles without the necessary approval, a violation of the Act. The Center for Devices and Radiological Health’s (CDRH) Office of Compliance (OC) reviewed www.harmonycone.com. During review, the OC found out that the candles are promoted to treat sinus infections and congestion, headaches, vertigo, cold, swollen glands and flu. The candles are adulterated and misbranded in the absence of marketing approvals and clearance required as per the U.S. laws. Read the full letter.

Aerosol Science Laboratories, Inc.
In 2008, FDA reviewed website of Aerosol Science Laboratories, Inc., www.aslrx.com. The agency observed that the website features misleading and false information about its compounded aerosolized drugs used in Sinus Science Aerosol Medication Delivery System. The website claimed that the aerosolized therapy helps in improving symptoms of allergic rhinitis and chronic sinusitis. This misbranding is a violation of the Act, as the company did not take necessary approval for marketing the system. Read the full warning letter.

InterNatural
In 2006, the Department of Health and Human Services, Minneapolis District Office Central Region reviewed http://www.internatural-alterriativehealth.com, the website of InterNatural. The department found out that the company is promoting “Rainforest Remedies’ Cold Season” as a drug, which is a violation of the Act. The department observed that Rainforest Remedies’ Cold Season is promoted as a treatment for symptoms of sinus congestion, sore throats, minor infections, colds and flu. Read the complete document.
So, next time, ensure that a quick constant sinus congestion remedy from online may not further your troubles. Choose safe and proven therapies.

Wednesday, January 9, 2013

How to treat sinusitis

How to treat sinusitis

You may use herbs and / or prescription or non-prescription drugs to treat sinusitis. However, you should consult your doctor before starting the treatment. The physician should therefore decide how to treat sinusitis because there are chances of beneficial and harmful interactions between herbs and drugs. Here are some examples of such interactions:


Acetaminophen, Allium sativum, vitamin C and quercetin
The herb / supplement containing vitamin C interacts with acetaminophen, an analgesics administered to treat allergic rhinitis and sinusitis. The interaction has both good and bad effects. The vitamin may prevent the hepatotoxic effects of the analgesics. The vitamin may, however, enhance the analgesics’ biological half-life, increasing adverse effects of acetaminophen. Although risk is low, liver enzyme monitoring is required.
The herb/supplement containing quercetin reacts with the analgesics. During co-administration, quercetin may initiate hepatoprotective process to protect the liver against the adverse effects of paracetamol. Co-administration is recommended when the analgesics are used for long-period.
If the herb/supplement featuring Allium sativum and the analgesics are administered simultaneously, the pharmacokinetic interaction is generally harmless. It may mitigate acetaminophen’s hepatotoxic metabolite.
Acetylsalicylic acid, vitamin C and zinc
When the herb/supplement containing vitamin C and acetylsalicylic acid, an analgesics, are co-administered, type of interactions is not certain. Aspirin reduces metabolic availability of the vitamin, increases ascorbic acid’s excretion in urine and affects the absorption of the vitamin, increasing requirements of the vitamin. The vitamin may mitigate aspirin-related toxicity and damage to the gastric mucosa.
Outcome of co-administration of the herb/supplement containing zinc and acetylsalicylic acid is not clearly known. Aspirin may prevent neuronal death due to zinc and change urinary zinc and serum. Therefore, close monitoring required during co-administration.
Antibiotics, Albizia lebbeck, Armoracia rustica and Scutellaria baicalensis

When antibiotics are administered with the herb/supplement featuring Albizia lebbeck, antibacterial properties of Albizia may increase medicine effect. Co-administration is recommended but regular monitoring is necessary.
If antibiotics and the herb/supplement containing Armoracia rustica are administered together, antibiotic mechanism of horseradish may enhance effects of the medicine. When antibiotics are administered with the herb/supplement containing Scutellaria baicalensis, additive effect is likely.

Corticosteroids and vitamin A
Co-administration of prednisone and triamcinolone, corticosteroids administered to treat allergic rhinitis and sinusitis, requires monitoring. Excessive use of corticosteroids may damage tissues and impair process of wound healing and immune function. The vitamin, however, prevents the adverse effects of the corticosteroids.
There are several other medicines and herbal formulae for sinusitis, which may have both positive and negative effects. Thus, let your physician decide how to treat sinusitis.

Tuesday, January 8, 2013

Oxymetazoline nasal spray relieves sinus pressure

Oxymetazoline nasal spray relieves sinus pressure

The spray, a nasal decongestant that narrows the nasal passage blood vessels, relieves sinus pressure and congestion, and nasal discomfort due to hay fever, allergies and colds. However, the patients under 6 years of age should not use the spray without prescription. Supervision is required in case the patients belong to the 6-12 age group.


How to use it
  • The spray should not be administered more than twice in 24 hours.
  • Read the prescription and / or instructions on the label of the spray. If the instructions are not clear to you, do consult the physician or the pharmacist.
  • The amount of spray used should neither be more than the quantity prescribed by the physician nor less. If you do not follow the physician’s recommendations for the spray quantity and duration, sinus pressure and other symptoms may exacerbate.
  • Stop using the spray after three days. If symptoms do fade, consult the physician.
  • Liquid / solution of oxymetazoline is sprayed into the patient’s nose.
  • Do not gulp the spray. Just use it for the nose.
  • Wash the spray dispenser tip nicely after every use. The same dispenser should not be used by more than one patient to avoid spread of the infection.
  • If you are allergic to oxymetazoline, inform your physician.
  • Since some medicines may interact with the spray, tell your physician about the medicines you are taking for any other ailment. The expectant and breast feeding ladies should not use the spray without consulting the physician.

Side effects
The spray has some side effects too. For instance, the spray may cause
  • burning,
  • dizziness,
  • dryness within the nose,
  • headache,
  • increase in nasal discharge,
  • nausea,
  • nervousness,
  • sleep problems,
  • sneezing and
  • stinging.
Sometimes the spray may increase or decrease the heartbeat. In such situations, see the physician at the earliest.
Spray brands
The spray is sold under different brand names, including Afrin® Nasal Spray, Dristan® Nasal Spray, Nostrilla® Nasal Spray and Zicam® Nasal Spray.
What is oxymetazoline?
The synthetic adrenergic agonist acts directly and stimulates alpha one and two adrenergic receptors. The vasoconstrictor is also used for the eye drops that treat redness due to contact lens, colds or swimming. The systemic circulation absorbs the agonist. Since the agonist stimulates the receptors present in the sympathetic nervous system (SNS), the nasal passages’ arterioles constrict and dry the mucous membrane.