Diagnostic trial of oxymetazoline use with or without Breathe Right ® strips
You are being given this information because your doctor is asking you to try some over the counter products called Afrin and/or Breath Right strips. These should be available for purchase at any pharmacy. These products can be helpful for diagnosing conditions causing nasal blockage/obstruction such as inferior turbinate hypertrophy and nasal valve collapse and finding out what procedures will be helpful for managing your symptoms.
What is Afrin?
Afrin (oxymetazoline) is an over the counter decongestant nose spray. It is a very effective medicine at temporarily and rapidly reducing the size of the inferior turbinates. It is to be used 15 minutes before the times you are most bothered by nasal blockage (e.g before sleep, before exercise) and lasts for 4-6 hours. This is not a permanent solution but will help diagnose that your turbinates are the cause of your symptoms.
Using Afrin too regularly can cause you to become dependent on the medication. We do not recommend continuous use of Afrin for more than three days.
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Adapted from Bromley AAFP 2000
What are inferior turbinates and what makes them swell?
Inferior turbinates are finger shaped structuresinside the nose (See Picture) that expand and shrink in response to various things including environmental allergens, signals from the brain resulting from emotional states (e.g crying), head position, changes in humidity.
What is the nasal valve?
The nasal valve consists of pieces of cartilage along the exterior opening of the nose and the interior portion of the nose. If you place both fingers on either side of your nose, you can feel the nasal valve area right below the hard bony part of the nasal walls. Nasal valve collapse occurs when the nasal cartilage is too flexible (sometimes from surgery or trauma) causing the nasal walls to fall into the airway when breathing in. This type of nasal blockage can sometimes be corrected by pulling the skin of the cheek or pushing up the tip of the nose.
What do Breath-rite strips do and how can they help if you have nasal valve collapse?
Breath-rite strips are adhesive bandages that attach to the exterior part of your nose. They create extra exterior support along the skin of the cheek to help improve nasal obstruction or overcome blockage due to a deviated septum.
How to do the trial:
- Try using Afrin 15-minutes before activities which usually cause nasal blockage for 3 days
- Try using Breath-rite strips during activities which usually cause nasal blockage for 3 days
- Try both for 3 days
What other medications can help if I find these helpful?
Topical nasal steroids (ie. fluticasone, Nasacort, Nasonex) and topical nasal anti-histamines (Asteline, Astepro, Patanase) may help with decreasing the size of the nasal turbinates if swelling is caused by allergies or inflammation. However these medications do not work as quickly as Afrin and usually require regular use.
What procedures/surgeries can be helpful if I find these helpful?
If you find Afrin to be helpful- the nasal turbinates may be the primary source of your nasal obstruction. There are in-office procedures to reduce the nasal turbinates (e.g inferior turbinate coblation procedure) as well as well as outpatient surgical procedures that can give you durable effect similar to Afrin without use of medications.
If you find Breath-rite strips helpful-
You may benefit from a procedure to provide correct the internal anatomy of the nose such as a septoplasty or in more severe cases procedures to the exterior portion of the nose called a rhinoplasty, may be needed.