Treatment for stuffy nose/ poor clearing
What follows is what I frequently recommend to divers, pilots, etc.
This may or may not be applicable to your situation/condition.
This is similar to currently recommended approaches to control of asthma, another chronic respiratory inflammation condition.
1. First line therapy for frequent nasal congestion (and frequent difficulty clearing) Is Nasal cortisone sprays. There are several brands available, such as Flonase, Nasonex, Nasacort-AQ, and others.
Almost all of them use the same steroid molecules used in asthma control, and just like in asthma, they are first-line therapy.
2. Second line therapy for chronic congestion is a toss-up between the newer non-sedating antihistamines (specifically Allegra or Claritin) or the mast cell desensitizers/ leukotriene inhibitors ( nasalcrom spray is a mast cell desensitizer and Singulair tablets are a leukotriene inhibitor). Older antihistamines may also work well but have more risk of sedation. (see warning regarding testing new meds before the trip, below.)
All chronic therapies take days to get working full power, but generally offer the most powerful relief with the least risk.
3. For the acute congested nose, (as in I'm diving in a couple hours, what do I do?) we move on to Sudafed (pseudoephedrine) tablets and/or Oxymetazoline nose sprays, which work by acting like adrenaline in the nasal mucous membranes and elsewhere. This reduces swelling by constricting the blood vessels in the swollen tissues (and may have some other effects.)
With Sudafed, adrenaline-like effects on the whole body include increasing alertness, but may possibly raise blood pressure and may lower the threshold for anxiety or panic. There are some theoretical concerns for a modest effect on Oxygen toxicity and or seizure threshold, but there is no real data, and the physiologic rationale is weak. I would personally sweat the anxiety effects more than OXTOX effects, but this is just educated speculation, and many many divers take Sudafed with good benefit.
The most common nose spray adrenaline-analogue is oxymetazoline, marketed in the US as Afrin nasal spray and many others. In US markets, any "12-hour" nasal spray is based on oxymetazoline. These sprays are analogous to albuterol for asthma (salbutamol to the Brits in the audience) and other adrenaline-like asthma inhalers.
One specific caution with adrenaline-like nasal sprays.. when they wear off, the sinuses may become tightly blocked, and you end up with a reverse squeeze on the way up. Use only the twelve hour ones, and use them only for a couple days before graduating to a chronic suppressive treatment.
Using Afrin for a week-long dive trip can lead to rebound and early wearing off by the last part of the trip.
In asthma, these adrenaline-like medicines are referred to as "rescue" medicines, to be used when the chronic suppressive therapy fails. I feel we should look at nasal congestion the same way we look at asthma.
Similar "wearing-off" effects are seen with chronic sudafed. Day 5 of a seven day trip is the wrong time to start feeling worse and having more pain or risk a squeeze.
ANY MEDICATION that is new to you
should be tested well prior to a dive trip. Any one person can develop unusual side effects or a medication allergy, and
130 feet is not the place to find out that your new medicine makes you drowsy or hyper. It would also not be the greatest choice of times to find out your doc's advice didn't work and your ears still won't clear.
Note to the other docs.. the mention of Singulair for nasal congestion is outside current labeling, but has worked in a couple patients, and has a reasonable rationale.
Note to the non-docs.. This is my opinion as to a reasonable approach to treatment of a complex problem. It cannot be taken as a statement that this is the best treatment for you, or that it's the only thing that will work for you. Only you and your physician can determine that. Some patients with anatomic abnormalities of the Eustachian tube witll not respond at all to this.
All I wish is for happy and painless diving for you..
I hope this works for you... if not, I hope you find something else that does and share it with us.
Just back from 8 days Bonaire and worked well for me ( as usual)
John
