Understanding the Differences Between Saline, Steroid, Antihistamine, and Decongestant Nasal Sprays

What you’ll learn:

  • Why nasal sprays are an effective treatment for certain nasal conditions

  • Who can benefit from using nasal sprays, including those with allergies, nasal congestion, and sinusitis
  • What are the benefits, potential side effects, and risks associated with each type of nasal spray

Join ENT doctors Reddy, Smith, and Undavia on We Nose Noses as they explore the world of nasal sprays. They delve into the different types of sprays available, including saline, steroid, antihistamine, and decongestant, and discuss their uses, benefits, potential side effects, and risks. The hosts provide valuable insights and practical advice for anyone considering using a nasal spray to treat allergies, nasal congestion, sinusitis, and other common nasal conditions. Listen in to improve your nasal health and gain a better understanding of which type of nasal spray is right for you.

Listen to the audio version below.

Audio Transcript:

Nishant Reddy:

Out of those sprays, one of the prescription sprays that’s a little bit unique is called Xhance. It’s the only nasal spray, rather than squirting it in your nose and inhaling through your nose, you actually exhale through your mouth and it goes into your nose and it tends to work better than the other sprays because the delivery goes higher and deeper in your nose and it’s made for specialized conditions such as nasal polyps.

Nishant Reddy:

Hey guys, welcome back to the We Knows Noses podcast. I’m here with my two partners, Dr. Smith.

Greg Smith:


Nishant Reddy:

And Dr. Undavia. This is just going to be a quick topic. A lot of our patients ask us about different nasal sprays and many, many nasal sprays are available over the counter and there’s different nasal sprays for different conditions. We’ll just go over a few categories and what they’re used for. Dr. Smith, do you want to start us off with one category of nasal sprays?

Greg Smith:

Sure. We can talk about decongestant nasal sprays. Something we often see in the office are patients who come in and they say, oh, I use this spray for my nose and they may not know exactly what it is or what they’re using. They just know it makes them feel better so they keep using it.

One of those products is a decongestant nasal spray so things like Afrin or a oxymetazoline or phenylephrine or decongestant nasal sprays. We’ll talk about some of the pitfalls that can happen with these nasal sprays. Their job is to constrict blood vessels within the nasal cavity, shrinking those heating, humidifying things that we’ve talked about in our old podcasts with the turbinates. They do a great job of that shrinking the soft tissues within the nose and allowing for more airflow. You use them and within 5, 10 minutes you get a good vasoconstriction or blood vessel shrinkage and you get a lot of good breathing through the nose and make you feel better. If you have nasal obstruction, usually from allergies or viruses, a lot of times patients will use these so they feel like they can actually breath.

The decongestant sprays work great. The biggest problem is that, and most people know that you can get “addicted to nasal sprays”. This is that nasal spray that has that problem where you can get addiction to it and that’s called rhinitis medicamentosa. What happens is those blood vessels shrink every time you spray that spray, but the nose is kind of intelligent and those blood vessels start to expand and get bigger to kind of counteract that shrinkage that occurs and so when you first start spraying it, those turbinates are like this big, and then over time they get bigger and bigger and bigger but every time you spray it, you notice a difference from here to here.

What you didn’t realize is you started here and now three, four days into it, you’re now starting to get swelling that becomes kind of counteractive and so that rebound swelling that occurs can happen usually within three to four days it can start to occur, but most commonly it happens after a week or two of using it.

You’ll see a warning label that says, don’t use for more than 48 to 72 hours and that typically is rather true. Sometimes we’ll see patients with severe nasal obstruction and one of the hardest things then is getting them off of these nasal sprays. We try to keep people to use these in a short duration for acute swelling and from bad viruses or bad allergies that they may just need a little relief from congestion.

Nishant Reddy:

Yep, so we went over the decongestion sprays. Another common spray that patients use are the antihistamine sprays. Do you want to go over that, Dr. Undavia?

Samir Undavia:

Yeah. There’s a few different brands of antihistamine sprays, but they’re essentially the equivalent of taking a Claritin or a Zyrtec or an Allegra or Xyzal and then crushing it up, putting it, mixing with fluid, putting in a spray and spraying it on your nose.

They’re great sprays. They tend to work much more quickly than the last class of sprays that we’ll talk about, but not as quickly as what Dr. Smith talked about as decongestants.

They do two good things. One, they can dry up your nose so you can get less mucus, less postnasal drip, less mucus coming from the front of your nose and then they can also decongest your nose. They will not do it as quickly or as fiercely as a topical decongestant like oxymetazoline but the effect is very nice. I’ve used it myself.

The biggest downside with these sprays, and there’s a few different brands. There’s Azelastine which is called Astelin. I’m going to mispronounce the name, Olopatadine which is Patanase. These sprays taste horrible. Typically, we have patients that tilt up their neck like that, spray it in, and then within a second they’re tasting it and it just tastes horrible. It stays in your mouth for a couple hours. The best thing to do for these sprays just to tolerate them better, is to make sure your head is level or a little bit forward. You can even have some of the spray come out the front and that allows you to tolerate them better.

Another side effects, which I don’t see that often is that patients complain that they’re pretty tired. I’ve had a few patients tell me that. We basically switched. If they’re using Azelastine, we try Olopatadine. If they were using Olopatadine, we try Azelastine. If both cause the tiredness, we just stay away from this class of medications.

Nishant Reddy:

Yep, and then the other big class of nasal sprays are intranasal steroids or intranasal corticosteroids. There’s multiple different brands. Some are prescription and some are available over the counter. Some of the common brands include the sprays like Flonase or Fluticasone and Flunisolide. There’s Nasacort, there’s Nasonex, there’s QNASL. There’s actually a combination steroid antihistamine spray called Dymista. Then there’s a more specialized nasal spray that’s a steroid as well called Xhance.

All of these sprays generally have a steroid in them that’s an anti-inflammatory that reduces swelling in the nose. They’re generally safe to be used long term, so you can use them for months or even years. The most common side effect we see is dryness and crusting. Sometimes you can get some nose bleeds with the spray. If you’re using these sprays for the long term, we’re talking about months to years, it may be a good idea to get your eye pressures checked once a year as well because there’s a theoretical risk of increased intraocular eye pressure with these over the long term.

Samir Undavia:

Which is called glaucoma.

Nishant Reddy:

Exactly. Out of those sprays, one of the prescription sprays that’s a little bit unique is called Xhance. It’s the only nasal spray, rather than squirting it in your nose and inhaling through your nose, you actually exhale through your mouth and it goes into your nose and it tends to work better than the other sprays because the delivery goes higher and deeper in your nose and it’s made for specialized conditions such as nasal polyps.

Those are some of the main medicated sprays. Then there is non-medicated sprays available too, right over the counter. One of the most commons are saline sprays. You want to go over some saline sprays.

Greg Smith:

Saline sprays, there’s all sorts of different concoctions of them. There’s gels and there’s some more viscous solutions that are a little bit thicker. There’s the more commonly thinner solutions. Some of them have bicarbonate in them that help buffer some of the pH in there. Some of them have other soothing agents that may help be a little aloe and other things in there that may make them a little more tolerable for patients with sensitive or dry noses. All in all, the purpose of the nasal sprays is to help with the cleansing and the clearance of the dirt, dust, pollen, and debris that settle in the nasal cavity.

Most of us talk about avoidance as the best treatment for allergens. A lot of it that’s great, but a lot of the things that people are allergic to like grass and weeds and mold and dust are kind of inevitable, they’re unavoidable.

Nasal saline sprays can help thin the mucus within the nasal cavity and help the transport mechanism that self cleans the nose, but then there’s also some of these more powered one like these Arm and Hammer, saline kind of aerosolized cans. Then there’s also the nasal rinses like the NeilMed sinus rinses or the Navage or some of the other neti-pot type devices that help flush and cleanse out the nasal cavity.

Most of those, unless you’ve had sinus surgery, are really cleansing the nasal cavity and not necessarily cleansing all of the sinuses, but they do a very thorough job at just cleaning out the turbinate and the filters in the nose, decreasing your contact exposure to those allergens irritants and can even be helpful during acute infections to thin the mucus out when it’s real thick, sticky, or even if there’s like a mild sinus infection to help thin some of that out to help your body flush and clean that stuff out of there.

Nishant Reddy:

Yep, and a common question we get asked is how do you use a nasal spray? Just really quickly, one of the easiest way to use it is you put it in your nostril and you point the tip away from your septum, so away from the midline and you kind of aim it towards the inside corner of that eye, at about a 45 degree angle to the floor. Anything else you guys want to add?

Samir Undavia:

Sometimes patients don’t like that and I actually tell them to use, if they’re spraying their left nostril, use your right hand and point it to their ear if it feels like it hurts and same thing for the right side. Use your left hand and point it to the left ear. Sometimes that can help.

Greg Smith:

Lots of tips to help tolerate some of the sprays, especially if they need to be used on more of a chronic basis or a daily basis.

Nishant Reddy:

Very good. Well, I think that’s it for today’s episode. Thank you for joining us. Please like and subscribe and we’re looking forward to the next podcast. Take care.

Whether it’s nasal sprays or other ENT concerns, the experienced professionals at NJ ENT & Facial Plastic Surgery are here to help provide relief. Contact us today to learn more about our services. We look forward to serving you. Visit us online at njent.com for more information about itchy ears and ENT procedures to treat them, or call us today to schedule an appointment. We’re here to help!

Listen on your favorite platform!

More Episodes of We Nose Noses