I wanted to ask if anyone knows if steroid inhalers can also relieve some inflammation in the sinuses/ears? I have just stepped down from Symbicort 400/12 2 puffs twice a day to 1 puff twice a day a few weeks ago. My asthma is still under control although I'm keeping an eye on it as I've started to take my blue inhaler again. Ever since I've started to come down my sinuses have been more blocked and I have pressure in my ear. I'm wondering if the two could be linked and my sinuses may be less wide because there is more inflammation? I also take a steroid nasal spray Nasonex one puff twice a day as well as Singulair and antihistamines.
I know generally speaking inhalers shouldn't really have an affect anywhere except the lungs but I also have nasty bruising which the chest consultant has related to the high dose of Symbicort (he's not worried as my blood test came back fine) so the inhaled steroids are obviously getting into other parts of my body.
Not being able to hear very well is not good, I nearly got run over by a huge parcel force red lorry yesterday as I didn't see or hear it! I must work on Sandie's traffic training again!
Sorry to hear (no pun intended) that you've been having problems - being partially deaf when your eyesight is not good must be a nightmare - lorry experience sounds a bit scary!
I thought I'd try to answer, as no-one else seems to have picked up the ball on this one - I have to say, though, that I'm not all that sure what the answer is.
In general, systemic (body-wide) drugs tend to penetrate fairly poorly into the sinuses - that is why oral antibiotics and decongestants are not particularly effective for sinusitis. So even if you were getting significant systemic absorption from being on very high doses of Symbicort, I think it is unlikely that much of it would be reaching your sinuses. For example, even when I am on both high dose oral pred and very high dose inhaled fluticasone (Flixotide), I still get nasty sinusitis attacks, both in response to infection and allergy, and these do tend to respond somewhat to a steroid nasal spray - I currently use Flixonase. It always seems quite odd to me that even when I am putting large numbers of the little red fellas into my body, I still need to inhale steroids into my lungs, squirt them up my nose, and at times smear them on my skin too! Drugs that are in the bloodstream just don't necessarily penetrate to all parts of the body terribly well, though.
I think it is unlikely that there is much local deposition of the Symbicort into the sinuses when you use the inhaler, either, so I don't think it could be affecting your sinuses by that route. I have seen pictures from studies that have been done to show where the drugs that we inhale actually end up - a fair bit ends up coating the back of the throat or being swallowed, especially if you don't use a spacer, but I can't recall that any ended up in the sinuses. Of course, the sinuses do drain into the back of the throat somewhere <ahem> <tries frantically to remember some anatomy> but again, as there is a constant *downward* flow of nasal mucus from the sinuses to the back of the throat, I think it is unlikely that inhaled steroid could make its way up into the sinuses and exert a local effect.
I do have to stress, though, that all the above is guess-work based on my knowledge of the anatomy and the way the drugs work, not on evidence or personal experience!
Is it possible that there is something else going on that has caused this problem? You say it has been several weeks now? - which I guess is a little too long to blame a sinus or middle ear infection. Have you been exposed to any new allergens that could be causing rhinosinusitis? Got new washing powder, carpets, different working environment, new pet, etc etc? Do you normally suffer with worse hayfever/rhinitis at this time of year?
It sounds like drugwise you are on most rhinitis treatments - steroid spray, antihistamines and montelukast. Steam inhalation can be helpful for thinning up the mucus and helping to clear things (you can get a gadgety thing or just bend over the sink with a towel over your head with hot water running - careful of scalds!), as can saline nebs (use a mask and neb through your nose keeping your mouth shut). Eucalpytus can also be useful as discussed in another thread, if you can tolerate it - I like Olbas Oil if sinuses are bad and chest is not too twitchy. Saline nasal sprays/washs can also be useful - I have one on prescription (recommended by the ENT Prof at RBH) - I'm afraid I can't recall the name (the darn thing's upstairs at the moment) and I can't find it in the BNF but it's something like Sterimer. You can also use a syringe and ordinary saline from your doctor or pharmacist to irrigate your sinuses.
I guess, though, that ultimately if the problem persists you will have to pop along to your GP and get it sorted - we can't have you becoming the victim of another Parcel Force van!
Hope this helps a bit - sorry I can't give you a more evidence based answer - maybe others will like to wade in and help me out? CathBear - does what I've said make some sort of vague medical sense?!
but again, as there is a constant *downward* flow of nasal mucus from the sinuses to the back of the throat, I think it is unlikely that inhaled steroid could make its way up into the sinuses and exert a local effect.""
er, think I might be the exception to that rule :oD If i breathe at the worng point I can end up breathing food up the back of my nose hehehe
Christine
Heh, Christine, I know what you mean, I do that from time to time too, not so much with food but with drinks, and usually when chest is playing up and I am having to breath harder than normal. A mouthful of orange juice or other acidic drink which ends up coming out of your nose is not the most comfortable of experiences, is it?!
Generally, though, the natural flow of mucus (wafted along by all the little cilia or microscopic hairs that line the sinuses) is downwards, so although things might travel the other way when you take an ill-advised sharp breath through the nose at the wrong moment, I think it's unlikely to be a mechanism by which Symbicort can get into the sinuses. When you take your Symbicort or other inhaler you are of course breathing in through the mouth not the nose (unless your inhaler technique is *really* shocking!) so it really should not end up in your sinuses. Rinsing the mouth out and gargling after using the inhaler will also help to ensure that there is no residual steroid hanging about in the back of the throat waiting for an opportunity to cause trouble elsewhere, as well as reducing your risk of hoarseness and oral thrush.
As I said though, I'm only guessing really, so if anyone has any other ideas feel free to butt in!
Em
EmH,
Thanks, that makes sense.
I've always had trouble with my sinuses for longer than I've had trouble with asthma! Was always on and off sudafed before I became sensitive to it. Its usually my silly sinuses that get infected drip into my lungs and cause a chest infection.
My hayfever is always bad at this time of year and is very much improved on previous years because of getting my medication right, so I never thought it might actually be my hayfever kicking in. In previous years my nose has just run constantly but at the moment the mucus is very thick and I've been having attacks of sinusitis.
Do you think it is worth trying a different steroid nasal spray? Or do you think its better asking for an add on saline solution? (in a syringe or spray as I don't have a neb) My doctors see me as the expert patient and will only give me what I ask for . So its usually worth going armed with information and letting them make the final decision. I know its really hard to say but I just wondered if you had an idea of which one might work better.
Beth
Hi Beth,
I'm glad it makes sense!
I am the same - I get sinusitis both due to infection and allergies - it usually goes cold --> sinusitis --> chest infection --> hospital! Thankfully I don't get colds all that often but when I do that seems to be the sequence! I hate that horrid stuffy pressure headache and tender face that you get with good-going sinusitis. I've never found that decongestants or antibiotics have made much difference (at least until it gets to the chest infection stage) so I tend just to stick to the things I've already mentioned and wait till it clears by itself.
It might be worth trying a different nasal steroid spray - I'm not aware of any evidence that one is particularly better than another but everyone's different so it's possible that you might benefit from a different one. I'm on Flixonase which I like. It's probably also worth checking to see if you are on the max dose, or whether it can be increased.
If you are getting very thick sticky nasal mucus, though, that is often difficult to clear and provides a focus for infection. That is where nasal irrigation with saline can be really helpful. As I say, you can get a spray (wish I could remember what the darn thing is called! - brain failure!) or you can use a syringe. I know that the other Emily has been shown how to do it with a syringe and she's more of an expert than me so I'll ask her to hop on here and talk you through it.
Hope this helps
Em H
Found it! Was down here after all.
Sterimar sea water nasal spray. Still can't find it in BNF, but I definately got it on prescription whilst at RBH, it has their pharmacy label on it. Maybe it is in Mimms.
I only use it when I get a flare associated with the sort of thick sticky mucus that implies infection and is difficult to clear without some help. I do find it helpful for that.
Em
Haven't read whole thread but Im sure i used to sell sterimar nasal spray in tesco (used to work in pharmacy) and the prob all the other pharmacies Just ask behind counter- but we used to have to order it in.
*hops in*
As emh has said sterimar is great and as marmite has said you can get it over the counter. It's £5.95 in boots for a can. However, it is quite an expensive option as you get through it quite quickly. My bf used it following a nose op and sings its praises.
The cheaper and i believe more effective option is 'nasal irrigation'. I make up a solution of tap water and salt. Approx 1 flat teaspoon of salt in a pint of water. You can alter the salt amount according to your response to 'treatment'.
1. Begin by blowing your nose
2. Draw up 5-10mls of the solution in a syringe and squirt in one nostril.
3. Repeat again and then repeat all over again on the other nostril.
4. If you are using a steroid nasal spray, use it now. The saline rinses all the allergens out of your nasal passages allowing the steroid spray to work more effectively.
Hope that makes sense! The solution will end up going down your throat and you know then you've rinsed right through. You get used to it pretty quickly.
Good luck
Em xx
sinuses, nasal gunk etc
Hi guys
I found your thread and wasvery interested to read about this nasal irrigation, and also just to hear that other people have this problem.
I get really nasty 'earaches/headaches' that stem from inflammation of the mastoid bone and the end of the bone under the ear, then my neck muscles tense up because of the pain and before I know it I've got a horrid tension neck/headache for the next 3-4 days.
Does anyone else get this?
Also occasionally it goes from stage one (inflamed mastoid) straight into a whopper of a headache that feels like someone's periodically hitting my head with a hammer, and I end up doubled up. Is it just me, or does anyone know what i mean?
thanks
ligilooli
Thanks Em, I will give it a go sounds a lot cheaper than buying a can. Can I buy a syringe over the counter? The only one I have is for Sandie's medication! lol!
Beth
ligilooli,
Yep, I get the horrible headaches too! Although mine is either bad head posture, sinuses or eye strain/eye problems. I tend to put a hot wheat bag at the base of my head top of my neck and lie down for twenty minutes. It really seems to relieve the tension.
Beth
I'm cheeky and I nick my from the hospital. I'm sure your pharmacist or GP could give you one if you explain!?!
xx
Again pharmacies all have them for kids meds used to be grand cost of 50p to get one on it's own but that was long time ago!
Thanks everyone for their replies. You guys are always so fantastic!
I've been and bought some Sterimar to try it out as my boyfriend wasn't too keen on me mixing my own solution! I've had a few goes and it has really helped so far and my sinuses are beginning to clear. I'm then going to go and talk to my doctor nicely to put it on prescription for me.
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