Nasal congestion is a blocked or stuffy nose, lasting several days or for a prolonged period. The nose is lined by a mucous membrane which can swell in response to infection or allergy.

The common cold is the most usual cause and is accompanied by nasal discharge which may be clear, yellow or green. The sinuses are air-filled spaces inside the cheekbones and forehead which drain into the nose. Sinusitis is usually triggered by infection and can cause long-lasting congestion. Most cases are acute and last up to four weeks, while chronic cases last 12-plus weeks.

“Adults with acute sinusitis usually present with nasal discharge, or blockage and congestion, facial or cheek pain and pressure, and a change in sense of smell. It can be difficult to distinguish between viral and bacterial acute sinusitis,” says GP and Olbas expert Dr Roger Henderson. “However, a bacterial cause may be more likely if symptoms have been present for more than 10 days, if there is a discoloured or offensive discharge, a fever, or localised severe pain on one side of the face. There are several triggers that make sinusitis more likely. These include a history of allergies or asthma, smoking, diabetes, dental problems, previous trauma to nose or cheeks and sporting activities including swimming, diving and high altitude climbing.”

Viral and bacterial infection both cause swelling of the tissue inside the nose and thickening of mucus, which slows normal sinus drainage. The infected sinuses become painful, which feels worse when bending forward. It also causes a feeling of fullness and pressure inside the ears. The thick mucus that develops with sinusitis may block the Eustachian tube, causing ear pain and muffled hearing.

“There are a number of simple home treatments that can ease congestion, including use of a humidifier or vaporiser, taking long showers or steam inhalation, using a saline nasal spray and drinking plenty of fluids,” says Dr Henderson.

Saline sprays and drops are especially useful for those who may have drug interactions, a contraindicated condition or for pregnant women

Naresh Rallmil, Numark service development pharmacist, has this advice: “Self-care tips can often be enough to relieve some milder symptoms. Try placing a warm, wet flannel or towel over the face to relieve congestion. At night, try sleeping on two pillows to ease breathing. Use a saline spray to prevent the nasal passage drying out.

“Nasal sprays are effective as they target the nasal cavity and their local action reduces the risk of systemic side effects. Oral decongestant tablets can be more convenient to take. However, they are not suitable for customers with certain medical conditions, such as diabetes, hypertension, glaucoma, over-active thyroid, prostate problems and heart conditions.”

Ingredients like ephedrine, xylometazoline, phenylephrine and pseudoephedrine work by constricting the small blood vessels in the nose and sinuses, which reduces swelling of the lining and improves congestion. Ipratropium spray works by drying up nasal secretions.

“Oral decongestants are long lasting as they are systemic, but need to be used with caution as they can interact with other drugs,” says Anil Chauhan, Alphega pharmacist at MX Pharmacy, Ribbleton. “Nasal sprays and drops act quickly, giving more immediate relief. Saline sprays and drops are especially useful for those who may have drug interactions, a contraindicated condition or for pregnant women.”

Decongestants containing natural and herbal ingredients providing short-term relief are mainly based on eucalyptus oil and menthol. “Whichever form of decongestant is preferred by the patient is usually the best one to use,” says Dr Henderson. “But in all cases, most should only be used between one and four times daily. Nasal sprays and drops should not be used for more than a week at a time to avoid rebound congestion.”

Congestion in babies and children

Mr Rallmil has this advice: “Congestion in babies can often be treated with saline drops, which are safe from birth, to help loosen the mucus, which can then be cleared with a nasal syringe. Clearing mucus before feeds is helpful. If congestion is worse at night, put the mattress on an incline. Humidifiers also help loosen mucus. Cold mist humidifiers are safer than heat or steam-based for children.”

Dr Henderson says placing a bowl of warm water with a few drops of decongestant oil in the child’s room at night is helpful. For children over three months, you can recommend a few drops of a decongestant oil on a tissue.

Blocked ears

Ear wax is a combination of dead cells, hair, dust and natural cerumen. As we get older, we produce more wax, and people who use hearing aids, earplugs or in-ear headphones are more prone to it. Wax build-up can cause muffled hearing, earache, tinnitus, itchiness and vertigo.

“Pharmacists can advise customers on how to keep their ears healthy and prevent problems,” says Claire Campbell, Earex brand manager. “For example, wearing in-ear headphones can prevent wax from being naturally pushed out of ears. This can block the ear passages and increase the number of bacteria in the inner ear by up to 700 times.”

Mr Rallmil expains: “There are different categories of ear drops. There are wax softeners such as arachis oil, almond oil or olive oil. Other drops help produce oxygen to help break up wax from the ear canal. If the build-up is severe or regular, customers may need ear irrigation. This is becoming a popular service for pharmacists, as some GP surgeries no longer offer it.”

Most common in children, otitis media can cause earache, fever, sickness, difficulty hearing and a feeling of pressure in the ear. Most cases resolve within three days without treatment, but it can last up to a week. You can recommend analgesics to treat fever and pain. Most infections will not need antibiotics.

Views of the P3pharmacy category panel

“We already have a private hearing clinic and we’re thinking of having a private ear irrigation/microsuction service, as we are frequently asked about this. Otex is a popular brand for ears. For eyes, Optrex, Blephaclean wipes and preservative-free eye drops such as Hylo-tear sell well. In nasal congestion, popular products are Otrivine, Sterimar and Neilmed. At the moment, customers want to keep stocked up on these products just in case they have to isolate and can’t get to the shops. So as well as siting them in the OTC area, keep products at the counter point too.”

Sarina Mughal, Day Lewis Pharmacy, Knightbridge

“These are all really important categories for us. We started an ENT consultation service here last October and it was really successful. Unfortunately, we had to suspend it because of Covid, but it should be up and running again by the end of the year. We can now treat conjunctivitis again, which is great as this is a service we can help customers with and means they don’t have to bother the GP. Actimist for eyes is really popular and also Blephaclean. Sudafed is our most popular congestion brand and Otrivine is always very popular.”

Lindsey Fairbrother, Goodlife Pharmacy, Hatton, Derbyshire

“This has become a very important category for us during the pandemic as GPs are less able to treat or have become more willing to signpost to pharmacies. We have had queries ranging from conjunctivitis to nasal polyps. Making sure that our staff are well trained about the licensing of these product, especially nasal steroids, makes a huge difference when dealing with the many requests we get from customers. Beconase is the best seller by far, even though we stock a generic option. Display is critical both for OTC and P medicine products.”

Gareth Evans, Wansford Pharmacy, Peterborough