CPAPtalk.com

Physician wrote: ....
1. There's a big difference between Neo-synephrine and Oxymetazoline. Short-acting topicals vasoactive substances have a far greater chance of addiction, and

2. Neosynephrine is more irritating than oxymetazoline, and that plus the very short duration of action -----> more rebound.

Any rebound to oxymetazoline is easily treated, and rebound is nothing compared to the consequences of intense nasal congestion.

Phys, We need to be careful about tradenames.

Bayer makes three different decongestants that are marked with the Neo-Synephrine trademark.

- Neo-Synephrine Phenylephrine HCL 0.5%

- Neo-Synephrine Phenylephrine HCL 1.0%

- Neo-Synephrine Oxymetazoline HCL 0.05%

The active ingredients in the third product are the same as in Afrin and could cause rebound congestion.

Physician was saying that phenylephrine is shorter acting and more likely to cause rebound than oxymetazoline.

Just wanted that to be clear.

And I think that manufacturers using the same brand name for different active ingredients is extremely confusing to consumers. Not everyone is a pharmacist.

have been using Flunisolide spray for several months now with good results.no congestion or sinus head aches.also have another kind -Fluticasone Propionate from VA i haven't started on yet. so glad not using Afrin. Off prednasone & no rheumatoid flare ups with auto cpap working well

CT is the gold standard for sinuses - an endoscope can't begin to show what the lining looks like inside the sinuses nor can it see how much fluid is trapped behind. I do assume it can give an idea of how swollen the turbinates are. For me, the biggest bang for the buck was having my turbinates reduced - I went from totally stuffed to a normal person. I'm still not sure a dentist can really diagnose sinus related issues via a CT - I'd rather find a good ENT but that's just my opinion. Sorry your first was not helpful. And, in the end, an ENT is the one who can offer a surgical fix if indicated and you've exhausted all other options.

jdm2857 wrote:Physician was saying that phenylephrine is shorter acting and more likely to cause rebound than oxymetazoline.

Just wanted that to be clear.

And I think that manufacturers using the same brand name for different active ingredients is extremely confusing to consumers. Not everyone is a pharmacist.

Right on ! That branding is confusing. I should have indicated phenylephrine and not "Neo-Synephrine".

Thank you for clarifying.

mgrunk wrote:CT is the gold standard for sinuses

Yes, CT is the "gold standard" but is over-used. If an AFL (air-fluid level) is seen on a standard X ray, preferably with the head titled slightly upward (termed a Water's View) then the diagnosis of sinusitis is made.

To save everyone money, if a person has the classical symptoms and signs of sinusitis, treatment with decongestants, anti-inflammatories, and antibiotics can be initiated and an imaging study(ies) done only if there fails to be improvement and/or at the conclusion of therapy.

Tests are often over-ordered.

Well, that's when I did get my CT after 6 months of failed treatment and 10+ years of suffering.

mgrunk wrote:Well, that's when I did get my CT after 6 months of failed treatment and 10+ years of suffering.

10 years of suffering is very long time. I really feel for you.

In my scenarios had 2 nasal surgery was memorable at age around 20's and later at mid 30's. Both procedures considered successful BUT recurrent is very high each time after suffering until go for surgery again. The second ENT surgeon advised "It may grow back". I think this is what is happening again.

I use a high density head light and look into the right nostril and found 3 "look alike" hump shape swollen up on the right wall of the septum 1 (immediate close to the front bottom of the septum) behind it another 1 a larger hump shape. The third hump shape is on the right nostril septum wall with event larger hump shape inner middle of the wall. I think these 3 humps are the "polyps or vane walls" that grow back over time? Is this correct?.

The ENT surgeon mentioned he burned it and after 2 weeks will dropped off...during my second revisits the ENT surgeon use a vacume like suction to suck off the dried up skinned like from the nostril and right after used a metal flat spoon alike heat it with a flame and knock it with another metal which produce a high frequency sound then placed it into my upper palate in my mount. Wondered what was it for?

Please comment....

Cheers,
Mckooi

Hi,

Just a quick update. Been using oxymetazoline hydrochloride for two weeks now on my right nostril (only the right nostril is block close to 100% of the time unless I exercise) with 3 nights (each night with 2-3 puffs) then stop for 3 days (when stop using the OH the right nostril block again). Worry that if I continue using it the rebound would be worst off. Very tempted to use more on days time as now only using it at night time. Will it be worst off and rebound to totally block if I continue 3-5 nights? Or I should use it Twice a day (each morning) and night (each night before on the cpap)? Very tempted as each time when the right nostril open up fell real good. Very tempting.....I am seeking for optimum treatment so that I can breath better (am I addicted already as this is second week...Oh, feel so much better when I can breath). Please share you opinion......

Cheers,
Mckooi

Mckooi, In precisely which position are you sleeping?

When sleeping on sides or tummy, it is common for the nostril on the "low side" to become congested due to blood settling. If you roll to the other side, it will gradually become uncongested but then the other nostril may gradually become congested due to the blood.

roster wrote:Mckooi, In precisely which position are you sleeping?

When sleeping on sides or tummy, it is common for the nostril on the "low side" to become congested due to blood settling. If you roll to the other side, it will gradually become uncongested but then the other nostril may gradually become congested due to the blood.

Yes, I notice that. I use to sleep at supine position (back) now trying to sleep from left side from time to time. As my right nose is mostly congested most of the time....slowing let the right nostril open up....sometimes it does. But I can feel that once the cpap is on blowing into my right nostril and the pressure force is strong as my auto-pap setting at min=17 max=18.5. That is very high.

Now just after a hot shower and spray 3 puffs of OH the whole right nostril is wide open and fell real good before bed. I think the right nostril wall has 2-3 polyps as I use the small light check from time to time to see it. My last ENT burnt it and that was very long time ago and he told me that it may grow back. Alas, maybe it is time to go for 3rd surgery again.

Cheers,
Mckooi

deerslayer wrote:have been using Flunisolide spray for several months now with good results.no congestion or sinus head aches.also have another kind -Fluticasone Propionate from VA i haven't started on yet. so glad not using Afrin. Off prednasone & no rheumatoid flare ups with auto cpap working well

Hi Deerslayer,

How is the Flunisoline spray doing lately? Any reason why you off prednosone and etc?

Cheers,
Mackooi

Hi,

The Oxymetazoline Hydrochloride over use may cause rebound effect as stated on this link listed below.

Q1) Has anyone has experience this rebound effect? Please share your experience. Thanks you.

http://en.wikipedia.org/wiki/Oxymetazoline

The over use of this (OH) may cause may lead to the Rhinitis Medicamentosa (RM) condiion to occur, which may caused from the listed below. Patients with RM often snore, have sleep apnea, and mouth-breath resulting in sore throat and dry mouth complains. With mode details listed below:

Associated factors that cause nasal stuffiness include the following:

Allergic rhinitis, nonallergic rhinopathy, Deviated nasal septum, Basal polyps, ASA triad (ie, nasal polyps, asthma, and aspiring intolerance), Use of CPAP machine at night for sleep apnea, Upper respiratory infection, Rhinosinusiti, Pregnancy, Other conditions with high levels of estrogen, such as puberty in boys and girls, menarche.

http://emedicine.medscape.com/article/995056-overview

Q2) With this chained effect what are the solutions that may reduce this rebound from OH and substitutions?

Cheers,
Mckooi

Hi,

Has anyone use this azithromycin or clarithromycin for decongestion on the nasal? I have continue using the Oxymetazoline hydrochloride sparingly and 3-4 nights before bed on my right nostril only since this is the only one that is congested with 2-3 puffs.

This link will explain more about the "..Chronic Stuffy Nose, Nasal Polyps and Fungus".....and please share your experience.

http://www.drmirkin.com/morehealth/G220.htm

Cheers,
Mckooi

mckooi wrote:Hi,

The Oxymetazoline Hydrochloride over use may cause rebound effect as stated on this link listed below.

Q1) Has anyone has experience this rebound effect? Please share your experience. Thanks you.

http://en.wikipedia.org/wiki/Oxymetazoline

The over use of this (OH) may cause may lead to the Rhinitis Medicamentosa (RM) condiion to occur, which may caused from the listed below. Patients with RM often snore, have sleep apnea, and mouth-breath resulting in sore throat and dry mouth complains. With mode details listed below:

Associated factors that cause nasal stuffiness include the following:

Allergic rhinitis, nonallergic rhinopathy, Deviated nasal septum, Basal polyps, ASA triad (ie, nasal polyps, asthma, and aspiring intolerance), Use of CPAP machine at night for sleep apnea, Upper respiratory infection, Rhinosinusiti, Pregnancy, Other conditions with high levels of estrogen, such as puberty in boys and girls, menarche.

http://emedicine.medscape.com/article/995056-overview

Q2) With this chained effect what are the solutions that may reduce this rebound from OH and substitutions?

Cheers,
Mckooi

I've been useing Afrin at bedtime for many years. I've tried other decongestants and corticosteroid sprays and nothing works as well as Afrin. I also use the NeilMed nasal irrigator. It helps but does not fix the congestion, especially druing the night.

One ENT had me do a test. Use Afrin in one nostril and nothing in the other. Yes, one clear nostril is all I need for the CPAP to work. But after two weeks, the nostril with no Afrin was still congested. I repeated this test for the other nostril. For me there may be a slight rebound effect but it is a moot issue. There is still underlying nasal congestion, and the Afrin only works for 12 hours. And, anything that improves breathing is likely compusive. I haven't tried surgery yet. But, If the nose doesn't work, the CPAP machine is worthless. So, I live with it.