Is guaifenesin a nasal decongestant

Sinus infection

Sinus infection(Sinusitis): Acute or chronic inflammation of the lining of the sinuses.

While an acute sinus infection usually occurs as a result of a cold, the chronic form usually develops from an acute sinus infection that has not healed or a persistent allergic runny nose. Anatomical changes within the nose have a beneficial effect.

Leading complaints

  • Impaired nasal breathing
  • Constant flow of secretions in the throat.

Acute form:

  • Purulent (yellowish-green) nasal discharge
  • Impaired general condition, possibly also fever
  • Headache (increased pain when stooping) in and around the affected sinus.

Chronic form:

  • Thin secretion
  • Fluctuating headaches (sometimes more, sometimes less)
  • Loss of efficiency
  • Chronic fatigue.

Overview of the paranasal sinuses of a 28-year-old student with constant headaches and runny nose. The x-ray clearly shows the accumulated secretion with mirror formation (horizontal fluid level, see arrow) in the right maxillary sinus. Ultimately, only an endoscopic procedure with fenestration of the maxillary sinus helps here.
Prof. Dr. med. Gerhard Grevers, Starnberg

When to the doctor

The next day if

  • the above-mentioned leading complaints occur.

Today if

  • the skin around the nose, eyes or forehead becomes red and swollen.

Immediately if

  • severe headache, sensitivity to light, pressure on the eye or impaired vision, irritability and / or severe tiredness occur.

The illness

Disease emergence

In the case of a sinus infection, the constrictions (ostia) between the nasal cavity and sinuses are blocked, which means that the mucus no longer flows out of the sinuses. A build-up of secretion occurs in which bacteria multiply easily and trigger purulent nasal discharge and other complaints.

One, several, or all of the sinuses may become inflamed. The system of the paranasal sinuses has a natural constriction near the ethmoid cells (see illustration): When the mucous membrane in the ethmoid cells becomes inflamed and swollen, it blocks the drainage of mucus from the frontal and maxillary sinuses. Although the inflammation is initially only located in the ethmoid cells, it also spreads to the other paranasal sinuses.

Frontal section of the left half of the face. To cure chronic sinusitis, doctors sometimes widen the ducts, e.g. B. from the maxillary sinus (orange) in a small operation.
Georg Thieme Verlag, Stuttgart

The maxillary sinus, ethmoid cells, frontal sinus, and sphenoid sinus are most commonly affected in adults, in descending order. In children it is usually only the ethmoid cells that cause problems because the rest of the sinus system is still developing.

causes

A acute sinus infection usually occurs as a result of a cold, when the viral inflammation of the nasal mucous membrane spreads to the paranasal sinuses and causes the mucous membranes to swell there. An allergic runny nose, bent nasal septum, pharyngeal polyps or enlarged nasal concha can also block the openings in the paranasal sinuses and cause sinusitis.

Rarer causes are dental diseases (dentogenic sinusitis, suspicion especially in unilateral events), pressure fluctuations when flying or diving (barosinusitis) or the penetration of pathogens while swimming (bathing sinusitis).

course

If a sinus infection has persisted for more than eight weeks or if acute symptoms occur four times a year or even more frequently, there is one chronic sinus infection in front. It often goes undetected for a long time because the symptoms are less pronounced than in the acute form. The maxillary sinuses and ethmoid cells are most commonly affected.

Complications

In rare cases there are serious complications, such as: B. when the inflammation spreads to the eye socket (orbital phlegmons), the meninges (meningitis) or the brain (encephalitis). Warning symptoms for meningeal or brain involvement are severe headache, sensitivity to light, irritability and severe fatigue.

Diagnostic assurance

While an acute sinus infection is usually associated with a cold, further investigations are necessary if the chronic form is suspected. The doctor looks at the inside of the nose, including the entrances between the main and paranasal sinuses, during a nasoscopy or endoscopy. An X-ray and / or a CT scan of the paranasal sinuses confirm the diagnosis or rule out other causes of the symptoms (e.g. a tumor). In some cases, an allergy test is also carried out.

treatment

Pharmacotherapy for acute sinusitis

The first goal of the treatment is to improve the ventilation of the sinuses and to get the mucus to drain away. Decongestant nasal drops or sprays or, if the effect is insufficient, a so-called high insert can help. For this purpose, a cotton wool soaked in decongestant nasal drops is pushed up into the middle nasal passage for ten minutes. Such nasal drops and sprays should not be used for more than ten days.

The doctor often recommends expectorant drugs (e.g. acetylcysteine ​​as in ACC 600®) or an essential oil such as in Gelomyrtol®, which stimulate the drainage of the secretion. However, studies have not found any decongestant effects from the active ingredients acetylcysteine ​​and ambroxol (e.g. Mucosolvan®, AmbroHexal®). Myrtol has now been shown to be effective in treating acute sinus infections in a number of clinical studies. The combined administration of verbena, gentian, elderberry, sorrel and primrose extracts (such as in Sinupret®) alleviate symptoms. Mustard oil glucosides - plant-based active ingredients that occur naturally in cabbage, broccoli or nasturtiums - help effectively. However, these should not be taken in high doses as they can cause a goiter.

For severe forms with bacterial infection, fever and significant impairment of the general condition, the doctor will prescribe an antibiotic: amoxicillin (e.g. Amoxypen®) is the agent of choice here. Pain relievers such as paracetamol, ibuprofen or diclofenac should only be taken for facial or headache.

Pharmacotherapy for chronic sinusitis

Since decongestant nasal drops and sprays should only be taken for a short time, they are not suitable for use in chronic sinus infections. Here, treatment is first carried out with expectorant drugs and nasal sprays containing cortisone (e.g. Nasonex® or Pulmicort®). If these measures do not cure even after several weeks, the doctor expands ("windows") the ducts of the paranasal sinuses in an endoscopic operation and thus improves ventilation and drainage. The alternative to this is combination therapy with antibiotics and steroids. The drug of choice here is an aminopenicillin combined with a beta-lactamase inhibitor. If this treatment option is not available or if the treatment does not work, a fluoroquinolone can be administered as a reserve.

Further measures

If there is a bent nasal septum or polyps in the paranasal sinuses make it difficult for secretions to drain, they should also be removed.

In the case of allergic sinus infections, the additional intake of antihistamines can be beneficial.

Your pharmacy recommends

What you can do yourself

Tilt test.

You can find out whether your sinuses are affected by a cold with a simple test: tilt your head forward and down. If you feel pressure or pain in the front of your head, it is likely that you have a sinus infection. If you have antritis, you will feel pain in the frontal and maxillary region, if you have an inflammation of the ethmoid cells in the forehead and around the eye and the root of the nose, and if you have an inflammation of the frontal sinus, you will feel pain in the forehead and possibly around the eye. Sphenoid sinusitis is characterized by severe pain in the center of the head.

Inhalations.

A tried and tested home remedy are steam inhalations with dried chamomile flowers or with chamomile concentrate (e.g. Kamillosan®) or with sea salt (1 tablespoon sea salt in 1 liter of hot water). Ointments that contain eucalyptus oil (e.g. Pinimenthol Cold Ointment®) are also suitable for inhalation.

Drink.

Drink plenty, e.g. B. Herbal teas with chamomile, peppermint or thyme.

Pads.

Cold quark pads placed on the forehead and / or cheeks relieve pressure discomfort in the acute phase; later, warm pads are more useful, e.g. B. a washcloth soaked in warm lemon water (the juice of one lemon in 1/4 liter of hot water).

Appropriate medication

Nasal drops & expectorants.

In addition to nasal drops and sprays to decongest the mucous membrane, expectorant active ingredients such as Myrtol (e.g. Gelomyrtol®) or herbal combination products (e.g. gentian root, cowslips, sorrel herb, elderflower and verbena in Sinupret®) facilitate the healing process. In order for the mucus to drain off better, some doctors recommend that you first take the nasal drops to reduce swelling and then take an expectorant 10-20 minutes later.

Complementary medicine

Enzyme therapy.

The enzyme bromelain (e.g. bromelain POS®), which is obtained from the stem of the pineapple plant, is said to have an anti-inflammatory, decongestant and expectorant effect and is now also recommended by some conventional doctors for sinus infections. A proof of effectiveness is still pending.

Phytomedicine.

Cineol (e.g. Soledum® capsules), a natural active ingredient made from limonene, also has an expectorant and bactericidal effect. Antiviral effects have also been found in in vitro studies.

Homeopathy.

Acute remedies frequently prescribed in homeopathy are - depending on the amount and nature of the secretion and local symptoms - e.g. B. Cinnabaris® for thick mucus and pressure pain in the area of ​​the root of the nose, Gelsemium or Luffa® for yellow nasal secretions and dry nasal mucosa. An individually tailored homeopathic constitution therapy is recommended for recurring sinus infections or in the case of a chronic course.

Acupuncture.

In the acute phase, acupuncture can help alleviate pressure discomfort and make nasal breathing easier, but its real domain is the chronic form. If an endoscopic operation is considered, however, acupuncture is not an alternative in most cases.

Prevention

Strengthen the general immune system, e.g. B. through regular sauna visits, lots of exercise in the fresh air, alternating showers and a diet rich in vitamins and keep your head warm in winter. If you are a smoker, consider quitting, as smoking is a major contributor to sinus infections.

If you have a cold you should blow your nose with little pressure (preferably only one nostril at a time), high pressure often only brings bacterial mucus into the sinuses. Not polite in company, but it is definitely advisable to pull up your nasal mucus instead of blowing it out.

Authors

Prof. Dr. med. Gerhard Grevers; Dr. Ute Koch; Thilo Machotta; Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "The disease", "Treatment" and "Your pharmacy recommends": Dr. med. Sonja Kempinski | last changed on at 08:58


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.