What can a 17-week pregnant patient take for sinus congestion and ear pain?

Safe Treatments for Sinus Congestion and Ear Pain in a 17-Week Pregnant Patient

For a pregnant patient at 17 weeks gestation with sinus congestion and ear pain, saline nasal rinses and acetaminophen are the safest first-line treatments, while intranasal corticosteroids like budesonide, fluticasone, or mometasone can be safely used for persistent symptoms. 1

First-Line Safe Treatments

• Saline nasal rinses are safe and effective for nasal congestion during pregnancy and should be the initial treatment of choice 1, 2
• Acetaminophen is the preferred medication for pain relief, including ear pain, during pregnancy 1, 3
• Nasal saline washings provide symptomatic relief and are completely safe during pregnancy 4, 5

Second-Line Treatments

• Intranasal corticosteroids such as budesonide, fluticasone, and mometasone are safe to use for persistent nasal symptoms during pregnancy 1, 6
• These modern nasal corticosteroids have established safety profiles and can be used at recommended doses 2
• Studies in allergic rhinitis during pregnancy have found nasal corticosteroid sprays to be safe and effective 2

Medications to Avoid

• Oral decongestants should not be used, especially during the first trimester, as they may increase the risk of fetal gastroschisis and contribute to maternal hypertension 2, 1
• First-generation antihistamines should be avoided due to their sedative and anticholinergic properties 2, 1
• Anti-leukotrienes (such as montelukast) should be avoided unless the patient has recalcitrant asthma with prior favorable response 2
• Aspirin and other NSAIDs should be avoided during pregnancy as they pose unacceptable fetal risks 2, 1

For Ear Pain Specifically

• Acetaminophen remains the safest analgesic option for ear pain during pregnancy 1, 3
• If ear pain is due to infection and antibiotics are needed, penicillins and cephalosporins are the safest antibiotic classes during pregnancy 2, 7
• Mechanical methods like warm compresses applied externally may provide some relief without medication 6

Special Considerations

• The first trimester carries the highest risk for medication-induced teratogenicity, but at 17 weeks (second trimester), there is generally lower risk 6, 8
• If symptoms are severe or persistent, consultation with an obstetrician is recommended before starting any medication beyond the first-line treatments 2
• Pregnancy rhinitis (nasal congestion during pregnancy without infection or allergic cause) is common, affecting approximately 20% of pregnant women, and may contribute to symptoms 9, 4

Treatment Algorithm

1. Start with non-pharmacological approaches:

   • Saline nasal rinses/sprays several times daily 2, 1
   • Adequate hydration and humidification of air 5

2. If pain persists:

   • Add acetaminophen at recommended doses 1, 3

3. For persistent nasal congestion:

   • Add intranasal corticosteroid (budesonide, fluticasone, or mometasone) 2, 1

4. If symptoms suggest bacterial infection (purulent discharge, fever, facial pain):

   • Consult physician about appropriate antibiotics (penicillins or cephalosporins) 2, 7

5. Avoid all oral decongestants, first-generation antihistamines, and NSAIDs 2, 1