Sinus Congestion

[Airdale]

Ever since I moved to the DC area to instruct, I have had non stop nasal congestion. When I go back home to New Jersey for a weekend, it clears up by the 3rd day with no medication. When I'm down here in DC, I constantly have to take nasal spray to relieve the congestion. Its so bad it makes it impossible for me to fly. I hate taking nasal spray, because its tough to get off of. I've tried going 3-4 days without in DC, but the congestion just stays the same.

Is there anything I can take over the counter to use for decongestion as an alternative to nasal sprays? I've tried the Vicks vapor stick and it doesn't work very well. I'm relating this problem to the poor air quality here in DC, because after a few days back home it clears up fine. Could this be a sign of a developing condition? Thanks

[My Flight Surgeon]

Since your symptoms get better when you go back to New Jersey, it sounds like allergies to something in the DC area. The best thing you can do is treat this with medications that treat the source of the problem. I would first try NasalCrom. It is an over-the-counter nasal spray that stabalized cells in your nasal mucosa which release histamine when you are exposed to allergens. This is more effective than Afrin and not habit forming. It will take several days to see effect. You can probably purchase a generic form of this also.

The second thing to consider is using generic Claritin. Here in Phoenix the generic form of Claritin (loratidine) at Costco is $11.56 for 300 tablets.

If these two things don't solve the problem, then you will need to see a phsyician to get some steroid nasal spray such as Flonase.

Also avoid smoking environments (probably why it is worse in DC).

You may notice this clear up after there is a hard freeze in the fall. If so, it is due to something pollenating in the area.

Good luck. This makes folks miserable.

[Airdale]

Originally Posted by My Flight Surgeon

Since your symptoms get better when you go back to New Jersey, it sounds like allergies to something in the DC area. The best thing you can do is treat this with medications that treat the source of the problem. I would first try NasalCrom. It is an over-the-counter nasal spray that stabalized cells in your nasal mucosa which release histamine when you are exposed to allergens. This is more effective than Afrin and not habit forming. It will take several days to see effect. You can probably purchase a generic form of this also.

The second thing to consider is using generic Claritin. Here in Phoenix the generic form of Claritin (loratidine) at Costco is $11.56 for 300 tablets.

If these two things don't solve the problem, then you will need to see a phsyician to get some steroid nasal spray such as Flonase.

Also avoid smoking environments (probably why it is worse in DC).

You may notice this clear up after there is a hard freeze in the fall. If so, it is due to something pollenating in the area.

Good luck. This makes folks miserable.

Thanks a lot! I just got word that I'm getting transfered up to New Jersey with my company in a couple weeks, so relief in that sense is on the way. I'll try the suggested medication, I just wasn't sure if Claritin or any allergy medication taken by mouth was allowed by the FAA if you are a required crew member (which I am as an instructor), therefore I stayed with nasal sprays.

Thanks again for the suggestions!

[My Flight Surgeon]

FYI: Claritin and Allegra are allowed. Zyrtec is not, too sedating in spite of the TV ads.

[surreal1221]

Originally Posted by My Flight Surgeon

FYI: Claritin and Allegra are allowed. Zyrtec is not, too sedating in spite of the TV ads.

Hey Doc,

I've actually been having some pretty good sinus congestion for the past 2 weeks as well. Really sucks.

Nevertheless, after taking your advice here for the original poster I went and pick up some Claritin-D. You said Claritin is alright for flight, what about Claritin-D? I'm only a student pilot, but if it's not good to go then I'll halt any further usage.

Thanks!

[My Flight Surgeon]

The "D" part is pseudephedrine. At one time, this was all we could use for sinuses and allow one to fly. Yes, it is allowed. Claritin-D is a prescription item so you will have a co-pay ($$ depends on your insurance plan). Generic Claritin at Costco here is $11.56 for 300 tablets - that is less than my co-pay and lasts nearly a year. Insurance will not give you more than 90 days of medication at a time (more co-pays), so go with the large volume generic bottles. Also check the generic prices - some large pharmacy chains charge $1.00 a pill for generic Claritin.

One thing that now is a hassle is the removal of pseudephedrine from the open shelves (used to make methamphetamine). In Phoenix you have to see the pharmacist, have an ID and sign for it.

[surreal1221]

Originally Posted by My Flight Surgeon

One thing that now is a hassle is the removal of pseudephedrine from the open shelves (used to make methamphetamine). In Phoenix you have to see the pharmacist, have an ID and sign for it.

Appreciate it Doc.

Yeah I had to do the sign on the dotted line after handing my ID over so they could check and make sure I'm not some meth producer. Gotta love it.

Although, I didn't need a prescription for it. Just went to the pharmacist and ask for it. Easy as pie.

This congestion snuck up on me over the past 2 weeks, and I was hoping it would go away. Never did, so I figured I needed some meds. I doubt I'll end up stockpiling the stuff, but great advice. Thanks again!

[desertdog71]

I take a Generic Claritin with Psuedoefedrine. I just recently found a 24 hour version of this over the counter. Unfortunately you get the shake down when you buy it because people like to make Crystal Meth out of this stuff. It works great though, I like taking the 24 hour vesion simply because when I was taking the 12 hour version I didn't always get back home within 12 hours to take the next dose and I would get miserable pretty quick.

[8LegDay]

My Flight Surgeon,

Thank you very much for the information.
I also have a related question, if you don't mind.

Recently, on a descent, I had tremendous pain in my left frontal sinus - just above left eyebrow. It felt like nails penetrating my skull and my left eye released good amount of tears.

It persisted for good 7-10 minutes and then it became much less of a pain, but continued through the overnight - for good 13 -15 hours.

I didn't feel any congestion (before nor after) - no runny nose, I don't have any allergies, previously I did 2 other flights on that day and did not have any problems. Also the pain came only on descent, not during climbs.
I imagine the "descent pain" was a pressure equalizing issue and the "continued pain" from induced trauma??

I went to a grocery store and bought Afrin spray and Sudafed PE.
I started taking Sudafed (4 daily) to dry out the congestion (although I did'n feel having any) and decided to have Afrin ready to spray on the morning flight home where I planned to call in sick.

On the descent home I felt OK, did not use Afrin and decided to continue the trip.

As I was flying the following 3 days I was taking Sudafed and had only lingering pain in the same area - again I think because of the previous "trauma". It intensified during subsequent descents, but was very much manageable.

I am off now for a couple of days and wonder if I should find an ENT doctor and try to see him? Feels like the "damage" is healing and since I didn't have the pressure equalizing pain any more should I just close this chapter in my life or are there any chronic possibilities?

Thank you.

[My Flight Surgeon]

I'm sorry to hear about your episode. I think you did the right thing by starting on Afrin and Sudafed. You are correct, the residual discomfort is from the trauma that occurred. When you descended, the pressure in the sinuses was eventually less than the ambient pressure, thus the pain.

Since this has resolved, you probably don't need to see an ENT right now. Hopefully this was a one time episode. I would carry the Afrin with you and if there is another episode you should be seen. Also note, if it is severe-requiring continuous use of medication or effected by barometric changes. This requires review by the FAA and a Special Issuance. Italics from FAA document. (More on this topic to come in a seperate thread next week.)

Good luck

[8LegDay]

Thank you Dr. Forred.

P.S. Doug, excellent idea, thank you for this forum!

[My Flight Surgeon]

You are welcome