Sinus and nasal problems

General Information

Many people experience problems with their nasal passages or sinuses (the air cavities within the skull which open up into the nasal passages). These problems may occur temporarily or persist long term. Most problems are due to an allergy, an infection, or as a result of a foreign substance being inhaled up the nose.

Allergic rhinitis

Allergic rhinitis is when the lining of the nose becomes inflamed, due to an allergy. Allergic rhinitis can be either seasonal (known as hayfever or intermittent allergic rhinitis), occupational (from using certain chemicals at work that trigger symptoms) or persistent (perennial). In persistent allergic rhinitis, symptoms occur continuously throughout the year rather than during a particular season, but they may be worse during the pollen season. Allergic rhinitis is also classified according to the frequency and severity of symptoms. If troublesome symptoms that affect normal daily functioning occur more than four times a week, it is classified as persistent rhinitis.

Apart from the length of time symptoms persist, most other symptoms of intermittent and persistent allergic rhinitis are similar. Nasal congestion and sneezing, runny nose, sore throat, itchy roof of the mouth, tickly cough and husky voice are common to both.

People with seasonal allergic rhinitis are more likely to experience eye involvement (sore, red and itchy eyes), while people with persistent allergic rhinitis commonly develop sinusitis (painful swelling of the sinuses) and are less likely to have sneezing episodes.

People with persistent allergic rhinitis are typically allergic to allergens which are constantly present such as house dust mite faeces, mould spores, or animal dander.

Infective rhinitis

Infective rhinitis is often associated with the common cold or sometimes the ’flu, and is usually caused by a virus. Common symptoms can include coloured nasal discharge, cough and/or sore throat, but these usually clear up within a few days.

Vasomotor rhinitis

Symptoms of vasomotor rhinitis are similar to those of allergic rhinitis (though there is usually less sneezing or itching), and it often get worse with seasonal changes; allergy testing will, however, give a negative result. Certain odours (such as perfume, cigarette smoke and paint fumes), alcohol, spicy foods, emotions and environmental factors such as temperature, barometric pressure changes and bright lights may also exacerbate or trigger the symptoms.

The nose can be either very runny or dry and congested. Vasomotor rhinitis is believed to be caused by oversensitive blood vessels, or an overabundance of blood vessels, within the nose. Topical treatment products are usually effective at reducing the symptoms of vasomotor rhinitis.

Nasal foreign bodies

Anybody with an object trapped up their nose should see a doctor if the object cannot be dislodged easily. For parents, sometimes the first sign in young children is a smelly discharge leaking from one nostril. If you suspect that something may be up there that you are unaware of, always see a doctor rather than attempting to remove it yourself. Keep toys with small parts, or other items (such as beads) out of reach of young children at all times. 

Other problems

In addition to the most common sinus and nasal problems listed above, pregnant women may also develop rhinitis (inflammation of the lining of the nose) due to hormonal changes, and persistent nasal congestion can occur due to over-use of topical decongestant medicines, e.g. nose sprays or eye drops. Certain medicines can also contribute to rhinitis, so it is important to let your medical professional know what medicines you take.

See Your Pharmacist or Medical Professional

• if the person needing treatment is a child; some medicines may not be suitable
• if it is possible an object could be trapped up the nose
• if only one side of the nose or eye is affected
• if the symptoms have persisted despite treatment
• if the nasal symptoms have come on soon after beginning a new medicine
• if you have shortness of breath, a cough or wheeze; this could be asthma, since allergic rhinitis and asthma frequently occur together
• if you have other symptoms, e.g. swollen glands, fever and/or a persistent headache, you may have an infection
• if there is any coloured or yellow discharge from the nose or eyes
• if the ears or sinuses are painful
• if there are recurrent nose bleeds or a reduced sense of smell
• if you have ongoing medical conditions or take other medicines
• if you are pregnant or breastfeeding; some medicines may not be suitable

Treatment Tips

Persistent allergic rhinitis

• try to identify what allergen(s) you are allergic to (your doctor may be able to arrange allergy testing)
• avoid unnecessary exposure to allergens if possible
• banish pets from living areas and bedrooms
• remove carpets and replace with wooden flooring
• if carpets cannot be removed, vacuum regularly
• use allergen-impermeable bed linen
• remove all soft toys from the bedroom or wash them once a week in hot water
• ensure there is adequate ventilation in bathrooms to minimise mould
• when cleaning the house, dust with a damp cloth, wear a mask to avoid breathing in allergens, and vacuum with a cleaner that has a high efficiency particulate absorbing (HEPA) filter

Vasomotor rhinitis

• avoid known triggers as much as possible
• exercise may be beneficial for assisting natural nasal decongestion

Nasal foreign bodies

• ensure small objects are out of reach of young children
• always supervise children when eating unmashed small foods, such as peas

Treatment Options

Oral antihistamines (tablets and syrups)

• when you have an allergic reaction your body releases histamine, which leads to hayfever. Antihistamines block this reaction. There are two types:
• newer less-sedating antihistamines, which do not typically cause drowsiness
• older sedating antihistamines that cause drowsiness
• antihistamines are good for treating hayfever symptoms as they occur, especially if you have a lot of different symptoms. You can also take them in advance if you know you are going to be exposed to allergens or triggers
• oral antihistamines are not effective at treating vasomotor rhinitis

Newer less-sedating antihistamines

[PHARMACY ONLY]
e.g. cetirizine (ZepAllergy, Zilarex, Zyrtec), desloratadine (Aerius, Claramax), fexofenadine (Fexal, Fexotabs, Telfast), loratadine (Claratyne, Guardian Loratadine, Lorano)

• less-sedating products are useful for symptoms that persist during the day
• cetirizine and loratadine are available as syrups for children; check correct doses for different age groups
• newer antihistamines may rarely cause drowsiness; do not drive or operate machinery if you are affected. Cetirizine is more likely to cause drowsiness than other less sedating antihistamines

Older sedating antihistamines

[PHARMACIST ONLY]
e.g. dexchlorpheniramine (Demazin 6 Hour Relief Tablets, Demazin 12 Hour Relief Repetabs, Polaramine), promethazine (Phenergan, Sandoz Fenezal)

• not available without a prescription for children under 2 years old
• these medicines can cause drowsiness, sometimes the next day; it is important you do not drive or operate machinery
• do not drink alcohol with medicines that make you drowsy
• sedating antihistamines are not suitable for everyone; check with your pharmacist
• if you have other medical conditions, such as glaucoma, epilepsy or prostate problems, or you take antidepressants, check with your pharmacist before taking these medicines

Anti-allergy nasal sprays and eye drops

[PHARMACY ONLY]
e.g. azelastine (Azep Nasal Spray), ketotifen (Zaditen), levocabastine (Livostin Eye Drops, Livostin Nasal Spray), lodoxamide (Lomide Eye Drops 0.1%), pheniramine + naphazoline (Naphcon-A,  Visine Allergy with Antihistamine)

• some products are not suitable for children; check product details or ask the pharmacist
• anti-allergy drops and sprays can relieve symptoms such as itching, sneezing and watery eyes
• azelastine works quickly
• some eye drops combine an antihistamine with a decongestant (e.g. naphazoline) which reduces redness; these are for short-term use only (not more than 5 days)
• you may need to remove contact lenses before using; check instructions
• throw drops away one month after opening; mark the opening date on the bottle
• some eye drops cause temporary stinging

Nasal corticosteroid sprays

[PHARMACY ONLY]
e.g. beclomethasone (Beconase Allergy & Hayfever 12 hour), budesonide (Budamax, Rhinocort, Rhinocort Hayfever), fluticasone (Beconase Allergy & Hayfever 24 hour), triamcinolone (Telnase)

• nasal corticosteroid sprays work by suppressing the body’s response to allergens or triggers
• these sprays are particularly effective for more severe or persistent allergic symptoms, and are the medicine of choice for predominantly nasal symptoms
• the sprays need to be used daily to prevent allergy symptoms, and can be used for longer periods such as throughout hayfever season
• these sprays may take a few days to start working and a nasal decongestant or an antihistamine may be required initially, just for a few days. The full effect of nasal corticosteroid sprays may not be seen until after several weeks of regular use
• nasal corticosteroids are considered safe, but some minor side effects include irritation, unpleasant taste, headache, coughing and nasal dryness
• nasal corticosteroids should be avoided when there is a current nasal infection

Nasal saline sprays

[GENERAL SALE]
e.g. Fess range, Narium Natural Mist spray and drops

• saline thins the nasal mucus and moisturises dry nasal passages
• allows mucus to break down faster and washes away pollen, animal dander and dust
• these sprays are not medicated, therefore unlike other topical decongestants they are safe to use in young children, pregnant women, and long term in people with persistent congestion

Nasal decongestant sprays

[PHARMACY ONLY]
e.g. oxymetazoline (Dimetapp 12 Hour Nasal Spray, Drixine, Extra-life Nasex Nasal Decongestant, Logicin Rapid Relief Nasal Spray, Vicks Sinex), xylometazoline (FLO Xylo-POS Nasal Spray, Otrivin), tramazoline (Spray-Tish, Spray-Tish Menthol)

• these decongestants unblock your nose and make breathing easier
• decongestants may be used for symptom relief while waiting for nasal corticosteroids to take effect
• decongestants may not be suitable for young children. Ask your pharmacist 
• do not use for longer than 5 days, otherwise their effect is lost and a blocked nose from ‘rebound’ congestion is likely

Oral decongestants

[GENERAL SALE]
e.g. phenylephrine (Nyal Cold and Flu Medicine, Nyal Decongestant Medicine, Nyal Nasal Decongestant PE, Nyal Sinus Relief Elixir, Nyal Sinus Relief PE)

[PHARMACY ONLY]
e.g. phenylephrine (Dimetapp PE Nasal Decongestant Liquid Caps, Sudafed PE Nasal Decongestant)

[PHARMACIST ONLY]
e.g. pseudoephedrine (Logicin Sinus Tablets, Sudafed Sinus and Nasal Decongestant, Sudafed Sinus 12 hour Relief)

• decongestants dry up a runny nose, but may also cause restlessness and should not be taken later than 6 pm since they can cause insomnia
• not recommended for children
• if you take other medicines or have other health conditions, check with the pharmacist if these products are suitable for you
• always check the ingredient list on the packet and make sure you are not doubling up with other products you may be taking.
• customers may be asked for identification as part of regulatory requirements and/or the Project Stop program before supply. This is to stop diversion of pseudoephedrine these tablets into illicit substances*

Combination products

• these treat a range of symptoms, and may include:
• analgesics (to relieve pain)
• decongestants and antihistamines (these can help to relieve a blocked or runny nose)

Decongestant + analgesic

[GENERAL SALE]
e.g. Panadol Cold & Flu + Decongestant, Panadol Cold & Flu Max + Decongestant Hot Lemon, Panadol Sinus Relief PE, Sudafed PE Sinus + Pain Relief (quantities below 30)

[PHARMACY ONLY]
e.g. Dimetapp PE Sinus Pain Tablets, Sudafed PE Sinus + Pain Relief (quantity of 30)

[PHARMACIST ONLY]*
e.g. Codral Original Cold & Flu Tablets (contain codeine), Lemsip Pharmacy Flu Strength - Daytime, Nucosef Syrup (contains codeine), Nurofen Cold and Flu, Panadol Sinus Relief Original Formula, Sinutab Sinus + Pain Relief Tablets, Sudafed Sinus + Anti-inflammatory Pain Relief Caplets, Sudafed Sinus + Pain Relief

• customers may be asked for identification as part of regulatory requirements and/or the Project Stop program before supply. This is to stop diversion of these tablets into illicit substances*

Decongestant + antihistamine

[PHARMACY ONLY]
e.g. Demazin Cold Relief Syrups, Dimetapp Elixir

[PHARMACIST ONLY]
e.g. Demazin 6 Hour Relief, 12 Hour Relief Repetabs

Decongestant + analgesic + antihistamine

[PHARMACY ONLY]
e.g. Demazin PE Cold & Flu Relief Day & Night Tablets (contain codeine), Dimetapp PE Sinus Day + Night Tablets, Sudafed PE Sinus + Allergy & Pain Relief Tablets, Sudafed PE Sinus Day + Night Relief 

[PHARMACIST ONLY]*
e.g. Codral 4 Flu Tablets (contain codeine), Codral Original Day & Night Cold & Flu Tablets (contain codeine), Demazin Cold and Flu Tablets, Demazin Day & Night Cold & Flu (contain codeine), Panadol Sinus Day/Night Original Formula, Sinutab Sinus, Allergy & Pain Relief Tablets, Sudafed Sinus + Allergy Pain Relief Tablets, Sudafed Sinus Day + Night Relief Tablets

• customers may be asked for identification as part of regulatory requirements and/or the Project Stop program before supply. This is to stop diversion of these tablets into illicit substances*
• use these products occasionally, when symptoms are particularly bad, but don't use them continuously (i.e. for longer than 3 to 5 days at a time)
• always check the ingredient list on the packet and make sure you are not doubling up with other products you may be taking

More Information

Availability of medicines

• GENERAL SALE available through pharmacies and possibly other retail outlets.
• PHARMACY ONLY available for sale through pharmacies only.
• PHARMACIST ONLY may only be sold by a pharmacist.

*Pseudoephedrine containing products may not be available at all pharmacies

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Last Reviewed: 08 February 2010